Form 5 Complaint For Landlord To Evict Tenants For Failure To Pay Rent Page 3

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4. Defendant failed to pay the rent due
,
20
.
(insert date of payment Tenant has failed to make)
5. Plaintiff served Defendant with a notice on
,20
,to pay the
(insert date of notice)
rent or deliver possession but Defendant refuses to do either. A copy of the notice is attached as Exhibit "B."
WHEREFORE, Plaintiff demands judgment for possession of the property against Defendant.
COUNT II Damages
6. This is an action for damages that do not exceed $15,000.
7. Plaintiff restates those allegations contained in paragraphs 1 through 5 above.
8. Defendant owes Plaintiff $
that is due with interest
(insert past due rent amount)
since
, 20
.
(insert date of last rental payment tenant failed to make)
WHEREFORE, Plaintiff demands judgment for damages against Defendant.
Landlord’s Name
Address
Telephone Number
This form was completed with the assistance of:
Name:
Address:
Telephone Number:

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