FORMS STORE

Complete Your Custom ORHA Rental Form

Please Fill In the Form

Form #23 : ACTUAL DAMAGES INVOICE

Required entries are indicated by blue icons or *

Tenant(s)* (required)

Tenant(s)

et al (and all others)

Property Address* (required)

Unit #

City (Oregon ONLY)

Zip Code

Owner/Agent has sustained the following damages:

Breach of Contract:

Description

Action Taken:

Description

Date Action Taken:

mm/dd/yyyy

Please Note: This form does not calculate totals.

Repair Cost

Sub-Total

Materials

Quantity

Cost

Sub-Total

Time Incurred

Hours/Minutes

Charge Per Hour

Sub-Total

Cost of Forms

# of Forms

Form Cost

Sub-Total

Copying/Printing

Quantity

Cost

Sub-Total

Total Mileage

Total Miles

IRS Mileage Rate

Sub-Total

First Class Postage

# of Stamps

Cost

Sub-Total

TOTAL DUE

Total Amount

Due Date:

mm/dd/yyyy

(30 days from date of notice)

Please Note: Signature field must be filled in and signed after printing.


Owner/Agent Signature:				Date:

MAKE PAYMENTS TO:

Owner/Agent

Address

City

State

Zip

Telephone

In accordance with Oregon Revised Statute 90.401(2): Remedies available to landlord. In addition to the remedies provided in ORS 90.392, 90.394, 90.396 and 90.398, a landlord may recover damages and obtain injunctive relief for any noncompliance by the tenant with the rental agreement or ORS 90.325 or 90.740.

Form #23 : ACTUAL DAMAGES INVOICE

Rev.4/16

Click "Preview Form" below to check your information.
If the form is correct, close the preview to return to this page, then click "Generate PDF". Your form will be created and added to your cart.
From your cart, you can return to the Forms Store to create more forms, delete forms from your cart or purchase the items in your cart.

Preview Form