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To Pay Double Value

SIR: I hereby give you notice to quit, and yield up, on the day of next, possession of the messuage, lands, tenements, and hereditaments, which you now hold of me, situate at - in the parish of -, and county of --, in failure whereof I shall require and insist upon double the value of the said premises, according to the statute in such case made and provided.

Dated, etc. [as in Notice to Quit, by Landlord].

CITY OF —, SS.