LANDLORD
R ECEIPT
T O
T ENANT
F OR
S ECURITY
D EPOSIT
FROM
L ANDLORD(S):
_ _____________________________________________________________________
TO
T ENANT(S):
_ ____________________________________________________________________________
DATE:
_ _______________________________________________________________________________________
PROPERTY
A DDRESS:
_ ____________________________________________________________________
_ ____________________________________________________________________
AMOUNT
O F
S ECURITY
D EPOSIT:
$ _____________________________________________________
Landlord
a grees
t o
p lace
s ecurity
d eposit
i n
a
s egregated
a ccount
i n
a n
I llinois
Financial
I nstitution.
T he
s ecurity
d eposit
w ill
b e
h eld
i n
t he
f ollowing
I llinois
Location/Branch:
NAME
&
A DDRESS
O F
F INANCIAL
I NSTITUTION:
LANDLORD
A CCEPTING
S ECURITY
D EPOSIT:
PRINT
N AME
SIGNATURE
LANDLORD
A DDRESS:
_ ___________________________________________________________________
_ ___________________________________________________________________
LANDLORD
P HONE:
_ ___________________________________________________________________
LANDLORD
E MAIL:
_ ___________________________________________________________________