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): Costs (estimated) ___________________ ___________________ ___________________ ___________________
Tenant-Related Damages ___________________________________ ___________________________________ ___________________________________ ___________________________________ [
] 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 _____________________________________. Date: ______________ Date: ______________
[
SIGNATURES: Landlord: _____________________ Telephone: ______________ Tenant: ______________________ Telephone:______________