Please Note: Fields on this form are NOT calculated automatically.
Please Note: Fields on this form are NOT calculated automatically.
Section #1 -Deposits Paid
Section #2 - Last Month’s Rent Deposit, Prepaid Rent
Section #3 - Rent Proration
Section #4 - Rent Deposit or Prepaid Rent
(Skip this if Section #2 is $0)
Section #5 - Deductions to Security Deposit
Section #6 - Pet Deposit Balance
(Skip this if Pet Deposit from Section #1 is $0)
Section #7 - Other Deposit Balance
(Skip this if Other Deposit from Section #1 is $0)
Section #8 - Other Deposit Balance
(Skip this if Other Deposit from Section #1 is $0)
Section #9 - Security Deposit Balance
(Skip this if Security Deposit from Section #1 is $0)
In accordance with ORS 90, Owner/Agent may claim: unpaid rent, utilities/services, fees, cleaning, landscaping damages, damages to rental unit, pet damages and recover rent for the days necessary to prepare the rental unit for re-renting. Owner/Agent must provide Tenant(s) an accounting within 31 days of termination or surrender of the property.
Section #10 - Final Balance Due Owner/Agent
Section #11 - Refund Due Tenant(s)
If Tenants are due a refund (see Section #11), a check is enclosed for the total amount of the refund. Depositing or cashing the check constitutes acceptance as payment in full.
If there is a balance due the Owner/Agent (see Section #10), the total amount owing is due immediately and must be paid within 10 days. If payment in full is not received within 10 days, appropriate legal and/or other actions may be taken to collect the amount owed. Actions may include, but are not limited to; filing a Small Claims suit, Wage Garnishment, assigning to a Collection Agency and/or reporting to a Credit Reporting Agency.
If you can not make the payment in full within 10 days, the Owner/Agent may be willing to make payment arrangements. Contact Owner IMMEDIATELY for payment options.
Please Note: Signature field must be filled in and signed after printing.
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| Owner/Agent Signature: |
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Date: |
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