Security Deposit
Notice to Tenant
(Termination of Tenancy)
To: _____________________________
________________________________
YOU MUST RESPOND TO THIS NOTICE BY MAIL WITHIN ____ DAYS AFTER RECEIPT OF SAME, OTHERWISE
YOU WILL FORFEIT THE AMOUNT CLAIMED FOR DAMAGES.
On ,____________________20___ , your occupancy of the premises commonly known as
___________________________________________ terminated. Pursuant to statute this notice is
given to advise you of items charged against your security deposit as follows:
Items claimed against security deposit:
Item of Damage or Other Obligation Against Security Deposit |
Estimated Cost of Repairs (on Item of Damage) |
Amount Charged |
Basis of Charge |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
_______________ |
None of the damages itemized were claimed on a previous termination
inventory checklist.
Deduction of $ ___________ charged against tenant's security deposit, as above specified,
results in a balance of such deposit in the amount of $ ________. A check or money order
for such balance is enclosed herewith.
Dated: __________, 20_________
Landlord
_______________________________