Security Deposit And Last Month'S Rent Receipt

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Form 4: Security Deposit
and Last Month's Rent Receipt
Attach to your Lease
I hereby acknowledge receipt of $___________ to be applied as follows:
First month's rent for __________ (month)
$ _____________
Last month's rent for deposit
$ _____________
Security deposit
$ _____________
Purchase or installation cost for new lock or key $ _____________
A tenant is entitled to interest on the security deposit and the last month's rent (paid in
advance) as required by law. Interest is payable to a tenant at the end of each year of a tenancy.
Upon termination of tenancy, interest shall be prorated. The tenant should provide the landlord
with a forwarding address at the termination of tenancy indicating where such interest may be
given or sent.
Landlord or ______________________________________ Date: ________
Landlord's Agent
Signature
Address ______________________________________________________
City __________________________________ State __________ Zip ____
Phone________________________________________________________
As required by law, the security deposit is presently or will be held in a separate, interest-bearing
account at:
Name of bank _________________________________________________
Address ______________________________________________________
City ____________________________ State ________ Zip_____________
Account number _______________________________________________
Form 4 • 499

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