And Lease Termination

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					                                                              UNIVERSITY RESIDENCE HALLS & APARTMENTS
                                                                         RESIDENTIAL OPERATIONS OFFICE
                                                                                    106 SPAULDING QUAD

                         2009-2010 Agreement/Lease TERMINATION form
         Return this form to the Residential Operations Office – 106 Spaulding Quadrangle

NAME: _______________________________________________________________________________________
                       LAST NAME                                          FIRST NAME                                                   MI

PN#: __ __ __ __ - __ __ __ __                                            GENDER:                Male     Female
                                                                              (Circle one)

CELL/LOCAL PHONE: (                       ) ___________________________   EMAIL ADDRESS:________________________________

I am a:                 New/Incoming Apartment Resident
                                                         Current Apartment Resident

                                                                                                        Current Address:__________________
I have been assigned to:
 Creekside Village, Apt #_____________
                                                             Apt Size:_____________                Start Date __ __/__ __/__ __
 Flint Village, Apt #_________________
                                                             Apt Size:_____________                Start Date __ __/__ __/__ __
 Flickinger Court, Apt #______________
                                                             Apt Size:_____________                Start Date __ __/__ __/__ __
 Hadley Village, Apt #_______________
                                                             Apt Size:_____________                Start Date __ __/__ __/__ __
 South Lake Village, Apt #____________
                                                             Apt Size:_____________                Start Date __ __/__ __/__ __

Reason for Termination:___________________________________________________________________
The student completing this form has read and understands the following:
1. I am requesting a termination of my 2009-2010 Agreement/Lease. I understand that this choice does not terminate my current
    2008-2009 Agreement/Lease with the University Residence Halls & Apartments (if applicable).
2. I understand that this termination request does not guarantee a refund of my pre-occupancy security deposit. This form must
    be received by the Residential Operations Office on or before 45 days prior to the start of my 2009-2010 Agreement/Lease. If I
    choose to submit this termination request after the 45-day deadline, I understand that, in addition to the $450.00 termination
    fee, I may incur charges until my apartment space is leased to a new resident. Hadley Village and Flickinger Court Lease
    terminations are reviewed on an individual basis; refund amounts are based on this review. If you are eligible for a refund,
    it will be processed 6-8 weeks from the receipt of this form. Current apartment residents, if eligible, will receive the refund,
    minus any damages found in your current apartment after you vacate, 6-8 weeks after your current Agreement/Lease end date.
    Please forward my refund (if applicable) to:

                               (Street)                                                 (City)                 (State)        (Zip)

3. By signing this form, I agree that I have read the above-detailed information and that I understand the Agreement/Lease
    termination process. I also agree that I have read the Terms & Conditions of my Agreement/Lease and understand my
    responsibilities as an Agreement/Lease holder.

    Student Signature:_________________________________________________                                    Date:_____________
For Office Use Only:
    Staff Signature:___________________________________________________                                  Date:_____________
    Application Type:___________________                 Apt #:___________________               Size____________        Gender:_______

    Bookings Deleted: #1____________________                    #2____________________                     #3____________________

    RMS Notes:__________________________________________________________________________________________

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