Residential Rental Agreement And Security Deposit Receipt Page 4
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9ORIGINATING AND TERMINATING REPORT
Apt #/Address______________________________________________
Number of keys: Furnished:_______________ Returned:____________
We, the undersigned, certify that the below is the exact condition of the premises identified above
On move in ________________________________ _________ _________________________ ____________
TENANT
DATE
LANDLORD/AGENT
DATE
On move out _______________________________ ________ ___________________________ ___________
TENANT
DATE
LANDLORD/AGENT
DATE
KEY:
Clean =C
Faded = F
Burned = B
Stained = S
Hole = H
Soiled = So
ITEM
IN
DATE CORRECTED
OUT
DOORS
CARPETING
VINYL
DRAPES
BLINDS
WALLS
Upstairs
Downstairs
CEILING
Upstairs
Downstairs
LIGHT BULBS&
FIXTURES
WINDOWS
SCREENS
KITCHEN 1 (up)
Range-oven
Range top and exterior
Range pans and racks
Refig Interior
Refig Exterior
Sink and worktop
Cabinets inside
Cabinets outside
KITCHEN 2 (down)
Range-oven
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