SECURITY DEPOSIT REFUND
ON VACATING RESIDENTIAL PREMISES
Prepared by: Agent ____________________________
NOTE: This itemized statement of the security deposit’s disposition, including documentation of charges deducted,
must be given to the Tenants by the Landlord within 21 days after a Tenant vacates residential property. [California
Civil Code §1950.5(f)]
Use of this form in a timely and proper fashion avoids Landlord liability for a 2% monthly penalty on any portion of
the security deposit wrongfully retained.
DATE: _____________, 20______, at _____________________________________________________, California.
To Tenant: _____________________________________________________________________________________
Items left blank or unchecked are not ap plica ble.
1. This is notice to Tenant of any Landlord deductions from the security deposit under the following agreement: