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3-DAY NOTICE OF TERMINATION AND NOTICE TO QUIT

CLEAR AND PRESENT DANGER 562A.27A

TO: ______________________________________________________________________________________

You and each of you are hereby notified that, pursuant to Iowa Code 562A.27A which provides for this single

notice combined form, your Rental Agreement is terminated effective three (3) days from the date of this

Notice, and it is demanded that you vacate and surrender within that three (3) days the possession of the

premises described as follows:

__________________________________________________________________________________________

This Combined Notice of Termination and Notice to Quit is being given to you for the reason that you or

persons on the premises with your consent have created circumstances, or maintained a threat, constituting a

clear and present danger to the health or safety of other tenants, the landlord, the landlord’s employees or

agents, or other persons on or within one thousand feet of the landlord’s property, and includes any of the

following activities. (Check all that apply and state the incident or incidents giving rise to this Notice of

Termination and Notice to Quit.)

( ) Physical assault or the threat of physical assault. ________________________________________________

__________________________________________________________________________________________

( ) Illegal use of a firearm or other weapon, the threat to use a firearm or other weapon illegally, or possession

of an illegal firearm. _________________________________________________________________________

__________________________________________________________________________________________

( ) Possession of a controlled substance not obtained directly from or pursuant to a valid prescription or order

by a licensed medical practitioner while acting in the course of a practitioner’s professional practice, by you or a

person on the premises with your consent and knowledge. ___________________________________________

__________________________________________________________________________________________

( ) Other (specify)

__________________________________________________________________________

__________________________________________________________________________________________

You will, therefore, take action and govern yourself accordingly.

THIS WRITTEN NOTICE WILL REMAIN IN FORCE UNLESS EXPRESSLY WITHDRAWN IN

WRITING. YOU MAY NOT RELY ON ANY VERBAL COMMUNICATION CONCERNING IT.

Dated this ___________ day of ______________________, 20 ________.

___________________________________ (Landlord)

By ________________________________ Address: _______________________________________________

3-Day Notice Of Termination And Notice To Quit Form - Clear And Present Danger 562a.27a