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Generic Claim on Security Deposit Itemization (Deductions for Repairs and Cleaning)

Date: _________________, 19___ To: ____________________ From: ____________________ Property Address: ___________________________________ Rental Period: ______________________________________

1. Security Deposit Received: $____________________ 2. Interest on Deposit (if required by lease or law): $____________________ 3. TOTAL CREDIT (sum of lines 1 and 2): $____________________ 4. Itemized Repairs and Related Losses: Item Cost of repair _________________________________________________________ _________________________________________________________ _________________________________________________________

_________________________________________________________

_________________________________________________________ Total Repair Cost: $__________________ 5. Necessary Cleaning: _________________________________________________________ _________________________________________________________ _________________________________________________________

Total Cleaning Cost: $__________________

6. Amount Owed (line 3 minus the sum of lines 4 and 5) ___ a. Total Amount Tenant Owes Landlord: $____________________ ___ b. Total Amount Landlord Owes Tenant: $____________________

Comments: _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________