Form CA-230, Three-Day Notice to Pay Rent or Quit Instructions
This form contains 65 fields organized into 21 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Acceptable Payment Methods | ||
| Personal Check | Checkbox |
Check this box if personal checks are an acceptable method of payment.
|
| Cashier's Check | Checkbox |
Check this box if cashier's checks are an acceptable method of payment.
|
| Money Order | Checkbox |
Check this box if money orders are an acceptable method of payment.
|
| Credit Card | Checkbox |
Check this box if credit card payments are an acceptable method of payment.
|
| EFT | Checkbox |
Check this box if Electronic Funds Transfer (EFT) is an acceptable method of payment.
|
| Cash | Checkbox |
Check this box if cash is an acceptable method of payment.
|
| Agent for Landlord | ||
| Agent Management Company Name | Text |
Provide the name of the management company acting as the agent for the landlord, if applicable.
|
| Landlord Name | Text |
Enter the full name of the landlord.
|
| Individual Signing for Landlord | Text |
Provide the name of the individual who is signing on behalf of the landlord.
|
| page1_field24_page1_field24 | CheckBox | |
| Date | ||
| Landlord Signature Date | Date |
Please provide the date of the landlord's signature.
|
| Fifth Rental Period Charge | ||
| Fifth Rental Period Amount | Number |
Enter the monetary amount for the fifth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Fifth Rental Period Start Date | Date |
Provide the start date of the fifth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Fifth Rental Period End Date | Date |
Provide the end date of the fifth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| First Rental Period | ||
| Execution Day | Number |
Enter the day of the month when this document was executed.
|
| Execution Year | Number |
Enter the year when this document was executed.
|
| Execution City | Text |
Enter the city where this document was executed.
|
| First Rental Period Charge | ||
| Rental Period End Date | Date |
Provide the end date for the first rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Rental Amount | Number |
Enter the rental amount for the first rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Rental Period Start Date | Date |
Provide the start date for the first rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Fourth Rental Period Charge | ||
| Fourth Rental Period Amount | Number |
Please provide the monetary amount for the fourth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Fourth Rental Period Start Date | Date |
Please provide the start date of the fourth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Fourth Rental Period End Date | Date |
Please provide the end date of the fourth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Notice Service Date | ||
| Notice Service Date | Date |
Enter the date on which this notice was served.
|
| Payment Delivery Address | ||
| Delivery Address | Text |
Please enter the full address where payments should be delivered.
|
| Payment Delivery Days | ||
| Monday | Checkbox |
Check this box if payments can be delivered in person on Monday.
|
| Tuesday | Checkbox |
Check this box if payments can be delivered in person on Tuesday.
|
| Wednesday | Checkbox |
Check this box if payments can be delivered in person on Wednesday.
|
| Thursday | Checkbox |
Check this box if payments can be delivered in person on Thursday.
|
| Friday | Checkbox |
Check this box if payments can be delivered in person on Friday.
|
| Saturday | Checkbox |
Check this box if payments can be delivered in person on Saturday.
|
| Sunday | Checkbox |
Check this box if payments can be delivered in person on Sunday.
|
| Other Delivery Days | Text |
Provide any additional specific days or conditions for in-person payment delivery not covered by the standard options. Fill only if 'Other' is 'Yes'.
Depends on:
Other
|
| Other | Checkbox |
Check this box if payments can be delivered in person on days not listed, and specify the days in the provided space.
|
| Payment Delivery Hours | ||
| Delivery Start Time | Time |
Please enter the start time when payments can be delivered in person.
|
| Delivery End Time | Time |
Please enter the end time when payments can be delivered in person.
|
| Payment Information | ||
| Payable To | Text |
Please provide the full name of the person or entity to whom the payment should be made.
|
| Total Payment Amount | Number |
Please enter the total sum of money required for payment.
|
| BY LEAVING AND MAILING | Checkbox |
Check this box if the notice was left with a person of suitable age and discretion at the resident's residence or business, and a copy was also mailed by first class mail.
|
| BY POSTING AND MAILING | Checkbox |
Check this box if the notice was posted in a conspicuous place on the property, and a copy was also mailed by first class mail, after no suitable person was found for service.
|
| Payment Recipient | ||
| Recipient Name | Text |
Provide the full name of the person or entity to whom the payment should be delivered.
|
| Recipient | ||
| Recipient Full Name(s) | Text |
Please provide the full name(s) of all residents, tenants, subtenants, and all others in possession of the rental unit.
|
| Unit Number | Number |
Please enter the unit number for the rental property, if applicable.
|
| Recipient Telephone Number | ||
| Recipient Telephone Number | Text |
Enter the telephone number for the recipient or the address where payments should be delivered.
|
| Rental Unit Location | ||
| Street Name (Line 1) | Text |
Enter the primary street name of the rental unit.
|
| Unit Number | Text |
Enter the unit, apartment, or suite number of the rental unit, if applicable.
|
| City | Text |
Enter the city where the rental unit is located.
|
| Zip Code | Text |
Enter the zip code of the rental unit.
|
| Street Number | Number |
Enter the street number of the rental unit.
|
| Street Name (Line 2) | Number |
Enter the secondary street name or additional address details for the rental unit, if applicable.
|
| State | Text |
Enter the two-letter abbreviation for the state where the rental unit is located. Fill only if 'BY DELIVERING PERSONALLY' is 'Yes'.
Depends on:
BY DELIVERING PERSONALLY
|
| BY DELIVERING PERSONALLY | Checkbox |
Check this box if the notice was personally delivered to the resident(s).
|
| Second Rental Period | ||
| Proof of Service Execution Day | Text |
Enter the specific day of the month when this Proof of Service was executed.
|
| Proof of Service Execution City | Text |
Enter the city where this Proof of Service was executed.
|
| Declarant Printed Name | Text |
Enter the full printed name of the person who is making the declaration.
|
| Second Rental Period Charge | ||
| Second Rental Period Start Date | Date |
Provide the start date of the second rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Second Rental Period End Date | Date |
Provide the end date of the second rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Second Rental Period Amount | Number |
Enter the monetary charge for the second rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Sixth Rental Period Charge | ||
| Sixth Rental Period Amount | Number |
Please provide the monetary amount charged for the sixth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Sixth Rental Period Start Date | Date |
Please provide the start date of the sixth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Sixth Rental Period End Date | Date |
Please provide the end date of the sixth rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Third Rental Period | ||
| Declarant Signature | Text |
Provide the signature of the person making the declaration for this proof of service.
|
| Third Rental Period Charge | ||
| Third Rental Period Charge Amount | Number |
Enter the monetary amount charged for the third rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Third Rental Period Start Date | Date |
Enter the start date for the third rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|
| Third Rental Period End Date | Date |
Enter the end date for the third rental period. Fill only if 'Total Rent Amount' is specified
Depends on:
Total Payment Amount
|