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following date and time, for the following purpose:[identify date, time and purpose] If you have good cause for refusing Landlord’s entry at the above date and time, you must contact landlord immediately in order to arrange for an acceptable alternative. If you have any questions please call at Issued this the , 20 day of Signed: Landlord, or authorized agent Notice of Intent to Enter – page 1 . . PROOF OF DELIVERY A copy of this Notice was delivered to Tenant: by hand by register.

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