ORHA Logo

Complete Your Custom ORHA Rental Form

shopping cart

Please Fill In the Form

 

Form23 : ACTUAL DAMAGES INVOICE

 

Required entries are indicated by blue icons or *

et al (and all others)
Owner/Agent has sustained the following damages:
 
Breach of Contract:
 
Action Taken:
 
Date Action Taken:
 

Please Note: This form does not calculate totals.

Repair Cost
 
Materials
 
quantity
 X 
materials cost
 = 
sub-total
Time Incurred
 
hours/minutes
 X 
charge per hour
 = 
sub-total
Cost of Forms
 
# of forms
 X 
form cost
 = 
sub-total
Copying/Printing
 
quantity
 X 
cost
 = 
sub-total
Total Mileage
 
total miles
 X 
IRS mileage rate
 = 
sub-total
First Class Postage
 
# of stamps
 X 
cost
 = 
sub-total
TOTAL DUE
 
Due Date:
 
(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:

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.

Form23 : 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
  

© 2019-2022 Oregon Rental Housing Association - All Rights Reserved
PO Box 20862, Keizer, OR 97307
eMail: forms@oregonrentalhousing.com