Date: _________
MOVE-OUT INSPECTION CHARGES
& SECURITY DEPOSIT RETURN AGREEMENT
Complex : ___________________ Apt# : _______ S.D. Held : $ ___________ Instuct : ___________
Name : ______________________ Name : ______________________ Name : ___________________
For Add : ____________________ For Add : ____________________ For Add : _________________
____________________________ ____________________ __________________
Cleaning Charges : Misc. Cleaning :
Bathroom(s) : Steam Cleaning $ _____ ________
1/2 Bath $_____ ________ Walls/Woodwork $ _____ rm ________
Full Bath $_____ ________ Windows $ _____ ea. ________
Floor $_____ ________ Light Fixtures $ _____ ea. ________
Kitchen : Vacuum Carpet $ _____ hr ________
Stove $_____ ________ Misc. Charges :
Refrigerator $_____ ________ Keys $ _____ ea. ________
Floor $_____ ________ Manuals $ _____ ea. ________
Cabinets $_____ ________ Egg/Ice Tray $ _____ ea. ________
Sink $_____ ________ Butter Dish $ _____ ea. ________
Range Vent $_____ ________ Broiler Pan $ _____ ________
Dishwasher $_____ ________ Silverware tray $ _____ ________
Living/Dining Areas : TV Adaptors $ _____ ________
Drapes $_____ ea. ________ Cable Conv. Box $ _____ ________
Fireplace $_____ ________ Fireplace Grate $ _____ ________
Deck/Patio $_____ ________ Light Bulbs $ _____ ea. ________
Other ________ $ ________ ________ Holes in Wall/Screen $ _____ ea. ________
TOTAL : $ ________ TOTAL $ ________
Inspector : ______________________________ Security Deposit Held : $ ___________________
Residents : _________________________ Total Amount Held : $ ____________________
_________________________ Total Charges : $ ____________________
_________________________ Net to be Returned : $ ____________________