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V6 : 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.

V6 : ACTUAL DAMAGES INVOICE
Rev.4/16

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