Security Deposit Refund
Address of Rental Unit: ________________________________
This is a notice that the owner of the above property intends to not refund your security deposit in the
amount of $_____________ because of the following reasons:
Reason for Deduction
Amount of Deduction
If you object to any of the above deductions, you must state your objection in writing within 14 days of
receiving this notice.
Please send your written objection to this address below:
My signature below states that I have sent a notice to the above tenant.
Landlord’s Printed Name