Date: _________________, 20___
To: ____________________ From: ____________________
Property Address: ___________________________________
Rental Period: ______________________________________
1. Security Deposit Received: $____________________
2. Interest on Deposit (if required by lease or law): $____________________
3. Total Credit (sum of lines 1 and 2): $____________________
4. Itemized Repairs and Related Losses:
_________________________________________________________
_________________________________________________________
_________________________________________________________
Total Repair Cost: $__________________
5. Necessary Cleaning:
_________________________________________________________
_________________________________________________________
_________________________________________________________
Total Cleaning Cost: $__________________
6. Defaults in Rent Not Covered by Any Court Judgment (list dates and rates):
_________________________________________________________
_________________________________________________________
_________________________________________________________
Total Rent Defaults: $__________________
7. Amount of Court Judgment for Rent, Costs, Attorney Fees:
$____________________
8. Other Deductions (please specify):
_________________________________________________________
_________________________________________________________
_________________________________________________________
$_________________
9. Amount Owed (line 3 minus the sum of lines 4, 5, 6, 7 and 8)
___ a. Total Amount Tenant Owes Landlord: $_________________
___ b. Total Amount Landlord Owes Tenant: $_________________
Comments:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
