SECURITY DEPOSIT REFUND FORM
Resident’s Name: ______________________________________________________________________________
Address: ____________________________________________________________________ Unit No.__________
City: ________________________________________________________ CA, Zip Code: ____________________
FORWARDING Address:________________________________________________________ Unit No.__________
City: ________________________________________________State:_______ Zip Code: ____________________
The following is an itemized statement of your deposit account:
1.Date tenancy began:_________________________ Date keys turned in: _______________________________
2.Total of all deposits paid: $____________________
3.Deductions:
Repairs
Painting
Cleaning
Carpet Cleaning
Drape Cleaning
Miscellaneous
Unpaid Rent
Court Judgement
TOTAL DEDUCTIONS
Your check is enclosed in the amount of $______________.
Please make your check in the amount of $_____________ payable to _________________________________
within 21 days of receipt of this statement.
Documents to support deductions for repairs or cleaning together are not required when the total does not exceed $125.
“AS REQUIRED BY LAW, YOU ARE HEREBY NOTIFIED THAT A NEGATIVE CREDIT REPORT REFLECTING ON YOUR CREDIT HISTORY MAY BE SUBMITTED TO A CREDIT REPORTING AGENCY IF YOU FAIL TO FULFILL THE TERMS OF YOUR CREDIT OBLIGATIONS,” CC1785.26(c)(2)
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Owner/Agent |
Date |
UNAUTHORIZED USE PROHIBITED
For Members Only
Approved Form #22.0
Rev. 05-2011