AFFIDAVIT OF DAMAGES by hedumpsitacross

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									                            AFFIDAVIT OF DAMAGES

Landlord/Property Owner Name: ___________________________________

Re: __________________________________________________________
     (Tenant Name)

At: __________________________________________________________
     (Unit Address)

The above named tenant wishes to relocate to another unit. Please complete
the information listed below. THIS FORM MUST BE SIGNED BY BOTH
TENANT AND LANDLORD.

LEASE ENDING DATE:         __________________________________________

1. List ALL occupants of unit: _____________________________________

_____________________________________________________________

2. The Tenant paid a deposit of $_______________ upon move in.

3. Check all that apply.

    [   ] Tenant is responsible for needed repairs and costs (estimated) as
          indicated below (You must complete, if applicable):

     Tenant-Related Damages                          Costs (estimated)
  ___________________________________                ___________________
  ___________________________________                ___________________
  ___________________________________                ___________________
  ___________________________________                ___________________

    [   ] Tenant currently owes $_____________ in unpaid rent from
          ______________. Late charges may not be included.
           (dates)

    [   ] The tenant and I have inspected the unit and there are no
          problems. We have agreed the tenant will vacate the unit on
          _____________________________________.

SIGNATURES:
Landlord: _____________________        Date: ______________
Telephone: ______________

Tenant: ______________________         Date: ______________
Telephone:______________

								
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