EVICTION NOTICE TO PAY OR QUIT
(DEMAND FOR RENT)
Date: March 19 2025
Tenant: MISS SARAH WILKINS (“Tenant”) and further directed to all residents, occupants,
subtenants, and any others in possession of the Premises.
Property Address: 512 BISSELL, ST LAURENS, Iowa, 50554 (“Premises”)
Lease Start Date: August 1 2024 (“Lease”)
In accordance with your lease and the laws located in this State, after receipt, you are hereby given the
following notice:
The Tenant has 3 days' notice to pay the past due amount mentioned below for the rental period from
January 1 2025 to March 31 2025:
Rent Due: $2,100.00
Late Fees: $250.00
Other Fees: $45.00
Total Amount Due: $2,395.00
Payment Instructions: CASH PAYMENT MUST BE MADE AT A TIME BOTH CONVENIENT TO
THE LANDLORD AND TENANT IN A WEEK FROM NOW.
If the above payment is not made within the required timeframe, the Tenant will be required to quit and
deliver possession of the Premises.
Landlord Signature: Date: March 19 2025
Print Name: JOHN T KEYSER
Address: 496, MARSHALL AVE, ST PAUL, Minnesota, 55103
Telephone: (651) 567-8246
E-Mail: johnkeyser2125@gmail.com
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AFFIDAVIT OF SERVICE
County of ___________________
State of ___________________
Date: ___________________
1. SERVER. I, ___________________ (“Server”), declare under penalty of perjury that a notice for
eviction was delivered and served in the following manner:
2. RECIPIENT. The notice for eviction was delivered to:
Defendant/Respondent: ___________________ (“Recipient”)
Address/Location: ______________________________________
Date: ___________________ Time: ____:____ ☐ AM ☐ PM
3. DELIVERY. The Recipient received the eviction notice by: (check one)
☐ - Mail. The Server sent the eviction notice in the mail by: (check one)
☐ - Standard Mail
☐ - Certified Mail (with return receipt)
☐ - FedEx
☐ - UPS
☐ - Other
☐ - Direct Service. The Server handed the eviction notice to a person identified as the
Recipient.
☐ - Someone at the Residence. The Server handed the eviction notice to someone who
identified as living at the residence and stated their name is: ___________________.
☐ - Someone at the Workplace. The Server handed the eviction notice to someone who
identified to be the Recipient’s co-worker and stated their name is: ___________________.
☐ - Leaving at the Residence. The Server left the eviction notice in the following area:
______________________________________.
☐ - Recipient Rejected Delivery. The Server delivered the eviction notice to the Recipient in-
person and did not accept delivery.
☐ - Other. ______________________________________.
4. VERIFICATION. I declare under penalty of perjury under the laws located in this State that the
foregoing is true and correct.
Server Signature: ________________________ Date: ______________
Print Name: ________________________
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