Rental Unit Check-Out Form
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1
2Check-out Form
Agent’s Delivery of Check-out Form
Address of Rental Unit ____________________________________________________________________
Owner/Agent Providing Form ____________________________________________ Date ___________
Tenant(s) moving out
Complete and return this form to landlord/manager, keeping a copy for your records. If you would like to schedule a
walk-through, contact ___________________ (name) at ______________(phone) before __________ (date).
Tenant Name(s) _______________________________________________________________________________
Forwarding address for return of security deposit: _____________________________________________________
Please return the security deposit to:
Tenant Signature(s)
______________________________
Date ____________
Amount _________
______________________________
Date ____________
Amount _________
______________________________
Date ____________
Amount _________
Original Deposit Amount $_________
Rent Credit Due
$_________
Explanation for any rent credit deemed not due:_________________________________________________
Provided?
Condition?
Kitchen
Y es/No
Provided?
Dining Room
Range/Stove
________ ________________________
Y es/No
Condition?
Hood fan
________ ________________________
Walls/Ceiling
________ ________________________
Microwave
________ ________________________
Woodwork/T rim
________ ________________________
Oven
________ ________________________
Door(s)
________ ________________________
Dishwasher
________ ________________________
Window(s)
________ ________________________
Sink/Faucets
________ ________________________
Window Coverings ________ ________________________
Disposal
________ ________________________
Light Fixture(s)
________ ________________________
Refrigerator
________ ________________________
Outlets/Switches
________ ________________________
Exterior
Flooring/Carpet
________ ________________________
Refrigerator
________ ________________________
Cabinets/built-ins
________ ________________________
Components (ice
trays, shelves, etc.)
Closet(s)
________ ________________________
Countertops
________ ________________________
Other
________ ________________________
Pantry
________ ________________________
Provided?
Living Room
Walls/Ceiling
________ ________________________
Y es/No
Condition?
Woodwork/T rim
________ ________________________
Walls/Ceiling
________ ________________________
Door(s)
________ ________________________
Woodwork/T rim
________ ________________________
Window(s)
________ ________________________
Door(s)
________ ________________________
Window Coverings ________ ________________________
Window(s)
________ ________________________
Light Fixture(s)
________ ________________________
Window Coverings ________ ________________________
Outlets/Switches
________ ________________________
Light Fixture(s)
________ ________________________
Flooring/Carpet
________ ________________________
Outlets/Switches
________ ________________________
Cabinets/Built-ins
________ ________________________
Flooring/Carpet
________ ________________________
Closet(s)
________ ________________________
Cabinets/built-ins
________ ________________________
Other
________ ________________________
Closet(s)
________ ________________________
Other
________ ________________________
Other
________ ________________________
Hall, Closet(s)
Entry, Stairs
Describe
Condition?
Describe
Condition?
__________________________ ________________________
__________________________ ________________________
__________________________ ________________________
__________________________ ________________________
__________________________ ________________________
__________________________ ________________________
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