Free security deposit return letter 27
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SECURITY DEPOSIT REFUND FORM
Resident’s Name: ____________________________________________________________________
Address: __________________________________________________________ Apt. No.__________
City: _____________________________________

State: ____________

Zip: ________________

FORWARDING Address: _____________________________________________ Apt. No.__________
City: _____________________________________

State: ____________

Zip: ________________

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:
TYPE

DESCRIPTION

COST

Repairs

Painting:
Cleaning:
Carpet Cleaning:
Drape Cleaning:
Miscellaneous:
Unpaid Rent:
Court Judgment:
Total Deductions

❏ Your check is enclosed in the amount of $____________.
❏ Please make your check in the amount of $____________ payable to ________________________
_________________