To

Shri/ Shrimati
Residing at

Please take notice that the Chief Executive Officer/ Board demands from _____________________________________ the sum of ______________________ due from on account of ____________________________________________________
___________________________________________________________________________________________ (here describe the property, occupation, circumstance or thing in respect of which the sum is payable under) leviable under ____________ ______________________________________________________________________________________ for the period ______________________________ of _______________________ commencing on the _________________________ day of 200__, and ending on the _________________________ day of 200__, and that if, within thirty days from the service of this notice, the said sum is not paid to the Chief Executive Officer/ Board at _________________________________________
_______________________________________________________ or sufficient cause for non-payment is not shown to the satisfaction of the Chief Executive Officer/ Board, a warrant of distress or attachment will be issued for the recovery of the same with costs.

Dated this _____________________ day of ___________________ 200__ .