Security Deposit Remittance & Refund Form (Page 2 of 2) in pdf

Security Deposit Remittance & Refund Form Page 2

La Mirage Homeowners Association, Inc

SECURITY DEPOSIT REMITTANCE & REFUND

NOTE: OWNER MUST PAY SECURITY DEPOSIT FOR PROSPECTIVE TENANT; SECURITY DEPOSITS ARE NOT

TRANSFERABLE

OWNER NAME: _______________________________ PROPERTY ADDRESS: _______________________________________

PHONE NUMBER: (______)

___

E-MAIL ADDRESS: _______________________@__________._______

TENANT NAME: _______________________________ TENANT E-MAIL: _______________________@__________._______

LEASE BEGIN______/_______/20________ LEASE END: ______/______/20_____ Monthly Rent Amount: $________._____

PART 1: SECURITY DEPOSIT REMITTANCE SLIP

Date Remitted: ________/________/20________ Check#____________ *Total Deposit Amount: $________.______

□ Mail □ Office Drop Off

Delivered Via:

Received by: _________________________ (Mgmt Print)

SIGNATURE OF OWNER: _____________________________ PRINT NAME: __________________________________

PART 2: SECURITY DEPOSIT REFUND SLIP

DATE OF REQUEST: ______/_______/20_____ MOVE OUT DAY: _____/_____/20_____ AMOUNT OF REFUND: $__________._____

□

Please Check Off:

Verification of Initial Deposit Payment (Cashed Check Copy)

REFUND MADE PAYABLE TO: _____________________________________________________________________________

MAILING ADDRESS (

): _________________________________________________________________

IF DIFFERENT FROM ABOVE

SIGNATURE OF OWNER: _____________________________ PRINT NAME: __________________________________

FOR OFFICE USE ONLY

□

FINAL REFUND STATUS:

APPROVED

DENIED

REASON FOR DENIAL____________________________________________________________________________________

IF DENIED: NEXT STEP FOR APPEAL: ________________________________________________________________________

TOTAL AMOUNT REFUNDED: $_________._______ CHECK#_____________ REF: __________________________________

REFUNDED BY: _________________________________

DATE: ______/_______/20_______

Security Deposit Remittance & Refund Form Page 2