form updated December 26, 2010
TENANTS
Name                                   _________________________________________________
Unit address                       _________________________________________________
                                     _________________________________________________
Forwarding address          _________________________________________________
                                      _________________________________________________

Date 30 day notice was received __________________________________
Was 30 days notice given?                ___ yes              __ no
If no, how many days lacking?  __________  Tenants will be responsible to pay rent for these days unless new tenant has been
found and is paying rent for these days.

Deposit collected                                                                                                                          

Minus:

Unpaid rent

Unpaid late charges

Unpaid utilities

Rent for days until new tenant was found,
if broke lease or insufficient notice given

Advertising costs (if lease broken)

Cleaning fee

Lawn mowing/trimming ($50)             
                                           
Other charges _________________

Other charges _________________

Other charges _________________

Total deductions

Total returned to tenant     
             

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________


_________________________________________          _______________
signature of property manager                                                   date