Landlords Security Deposit Offset Statement

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Landlord’s Security Deposit Offset Statement
To:
From:
(Tenant)
(Landlord)
(Address)
(Address)
This statement concerns the following premises:
Description:
(house, 4-plex, apartment building, trailer, trailer space, etc.)
Location:
(street address, apartment number, city and state)
This statement is made pursuant to AS 34.03.070(b). It accurately sets forth the amount of rent due and is an itemization of damages to
the premises.
Date of tenant’s departure from premises:
Amount of tenant deposit: $
Offset for rent due landlord
$
Offset for damages to premises
$
Itemize the offsets below: (attach continuation sheets as necessary)
TOTAL OFFSETS (if any)
$
AMOUNT DUE TENANT, IF ANY (check enclosed)
$
Signature:
(Date)
Print Title:
Instructions: Provide or serve a copy of this statement to tenant at checkout or thereafter, or mail to tenant’s last known address within 14
days of tenant’s departure. Immediately make a notation of service or mailing on the retained original and copies of this
statement. Complete all that apply.
Tenant acknowledges receipt of this statement on
.
(Date)
(Tenant Signature)
This statement was personally served on
by the
(Name of Tenant)
undersigned on
.
(Date)
This statement has been mailed to tenant at tenant’s last known address which is set forth above. It was mailed on
.
Signature:
(Date)
Print Name:
PUB-30 (7/12)
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