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/ / Behavior by you or members of your family which adversely affects the health or safety of
the other tenants or the landlord pursuant to RSA 540:2 II (d), or your failure to accept suitable
temporary relocation due to lead-based paint hazard abatement, as set forth in RSA 130-A:8-a, I, as
/ / For other good cause pursuant to RSA 540:2 II (e), RSA 540:2 III, RSA 540:2 IV, or RSA
540:2 V as follows:
Dated: , 20
(City, State, Zip Code)
I hereby certify that on the day of , 20 , at am/pm I
gave in hand to/left at the abode of , above named, a
true copy of the above original notice.