Security Deposit Acknowledgment Form printable pdf download

Security Deposit Acknowledgment Form

TENANT NAME:

GRANT: ___________________________

APARTMENT ADDRESS:

LANDLORD NAME & ADDRESS: ______________________________________________________________________

____________________________________________________________________________________________________

I acknowledge my request for a Security Deposit to be paid on my behalf to my landlord in the amount of

$___________________. ________ (tenant initials)

I understand a new security deposit will not be granted in a new unit unless 100% payment for previous security deposit debt has

been received. I will be responsible for any debt to lost Security Deposit and Damage Claims due to tenant damages in the unit

or back rent owed. _______ (tenant initials)

The landlord agrees upon termination of lease or habitation at the above address to notify

_________________________________ (LAA), and must request a move-out inspection prior to cleaning or making repairs to

the unit.

The landlord agrees to return the security deposit IN FULL unless monies from said deposit are required for tenant

back rent and/or to repair damages to the above premises cause by the tenant. Within 30 days, the landlord agrees to notify the

LAA of the disposition of the security moneys and to provide an itemized explanation for any portion of the security deposit not

returned to the LAA. ________ (landlord initials)

Tenant/Guardian

Date

____________________________________________________________________________________________________

Landlord

Date

LAA Representative

Date

LAA use only:

Please check one of the following after tenant moves from unit:

Security Deposit balance was returned by Landlord: $________

Damage claim was approved for $________

Security Deposit was forgiven due to: ______________________________________________________________

Damage Claim/Debt Letter Sent to Tenant on:

08/15/2011

Security Deposit Acknowledgment Form