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FORM #16 - Confirmation of 30-Day Notice


  • Tenant(s):
  • Tenant(s):
  • Address: Unit:
  • City: , OREGON Zip:

DATE: ______________________ We hereby acknowledge receipt of your 30-day notice as required by law. Your rent is paid to: ____________________. Balance owing to and including move-out date is: $ ______________. The amount is due on or before: ______________________. Your move-out date is: ______________________.

The refund of your deposit will be based, in part, on cleaning the following items after moving out:

  • ___ Appliances inside and out, and underneath.
  • ___ Cabinets and drawers inside, outside and on top, including garage, if applicable.
  • ___ Interior & exterior light fixtures. All bulbs must be present and working, and the proper type for fixture.
  • ___ Ceilings, walls, baseboards, door casings, and trim.
  • ___ Window coverings and blinds.
  • ___ Heating units vacuumed as necessary. Filters cleaned and/or replaced as needed.
  • ___ Fireplace, woodstove and hearth area. If contract states, have fireplace professionally cleaned & inspected.
  • ___ Plumbing fixtures (sinks, tub, showers, toilets and faucets).
  • ___ Knobs, handles, light switches, outlet and switch plates.
  • ___ Shower tile, tubs and enclosures including tracks and doors.
  • ___ Windows inside and out, including windowsills, tracks and window screens.
  • ___ Interior and exterior doors inside and out including tracks and trim.
  • ___ Porches, decks, patios, walkways and garage swept and cleaned.
  • ___ Cobwebs or debris removed from exterior of unit.
  • ___ Floors vacuumed, swept, mopped (waxed if necessary).

Also, complete the following:

  • ___ Garbage, trash, debris, or firewood removed to appropriate receptacles.
  • ___ Lawn and grounds trimmed, mowed and beds weeded, if applicable. All pet waste picked up and disposed of.
  • ___ Return all house keys, mail, pool or other access keys and/or fobs and garage door openers.

Other considerations:

  • Report any needed repairs, i.e., leaks, drips, caulking, or malfunctioning appliances.
  • If there are tenant-made alterations, consult with Owner/Agent well in advance to determine whether alteration needs to be returned to original condition or if change may remain.
  • 10-year lithium batteries must be present and working in Smoke and Carbon Monoxide Alarms. Tenant(s) will be charged for replacement of regular 9V batteries. Any alarms that are missing or removed, or for which batteries have been removed, shall incur a fee of $250 per alarm.
  • If any belongings are left at property after the transfer of possession, Tenant(s) may be charged for storage and/or disposal.
  • Once possession has been transferred to Owner/Agent, Tenant(s) will not be allowed to return to the property without the permission of Owner/Agent for any reason, including retrieval of items left behind, additional cleaning, or repairs.
  • If Tenant(s) fails to clean the property or causes damages, the Owner/Agent may charge rent for loss of use for the time it takes to prepare the unit to rentable condition.
  • Owner/Agent may charge a reasonable hourly rate for their own performance of cleaning or repairs as allowed by law.
  • The final accounting of any deposits paid will occur within 31 days after the last tenant moves out of the rental unit or the date of termination, whichever is later. Tenant is responsible to provide a forwarding address.

Owner/Agent Signature: ___________________________ Date: __________________

  • Owner/Agent:
  • Address:
  • City: , State: Zip:
  • Telephone: Email:

     

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1462 Commercial St. NE, Salem, OR 97301
Phone: 503-364-5468 | Fax: 503-585-8119

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