Statement of Security Deposit Tenant(s)________________________________________________________________ Address ___________________________City ________________State ____Zip______ Lease Term From: __/__/____ To: __/__/____ Deposit Received: __/__/____
Deposit Received.……………………………………….…………..$_____________ Interest Earned (xx%)……………………………………………….$_____________ Total Deposit + Earnings……………………………………………$_____________ Cleaning Charges _______________________________________________ $____________ _______________________________________________ $____________ Repair Costs _______________________________________________ $____________ _______________________________________________ $____________ _______________________________________________ $____________ Unpaid Rents _______________________________________________ $____________ Unpaid Utilities _______________________________________________ $____________ _______________________________________________ $____________ Replaced/repaired furnishings _______________________________________________ $____________ Legal Costs _______________________________________________ $____________ Other Charges/Costs _______________________________________________ $____________ _______________________________________________ $____________
Total deductions from security deposit……………….…..………$____________ Balance due to Tenant……………………...….……..……………$____________ Balance due to Landlord……………………….…….……………$____________ Refund Address for Tenant ________________________ ________________________ ________________________ Refund Address for Landlord ________________________ ________________________ ________________________
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