On or before __________________________, I promise to pay you $ ___________ for rent and other charges now owing on the dwelling which I rent from you located at _______________________________________________________________(Location)

I expect to receive sufficient funds to pay you from the following sources:

Name Address Telephone Number Amount Expected

_______________ ______________________ _______________ $______________

_______________ ______________________ _______________ $______________

_______________ ______________________ _______________ $______________

Should you wish to, you have my authorization to verify these sources.

If I fail to honor this pledge, I understand that I will be evicted and that this pledge will be used against me as evidence of my bad faith in paying what I owe.

____ (initial) I acknowledge receipt of a Notice to Pay Rent or Quit as required by law to begin eviction proceedings. I understand that the Notice may show a balance owed which is different from that given above because a Notice to Pay Rent or Quit can demand only delinquent rent. I also understand that the period mentioned in this Notice is being extended to the date given above, at which time I promise to pay you what I owe. If fail to pay on or before that date, you have the right to continue the legal eviction procedure against me without having to serve me another Notice to Pay Rent or Quit.

Signed: _____________________________ Dated: ______________________________