Security Deposit Refund Form

When a tenant moves from the residence, use this sample security deposit refund form to itemize damages and repairs and to calculate the balance of security deposit after deductions.
Tenant Name: _________
Address: __________________________________
City: ___________ State: ______ Zip code: ______

Forwarding Address: __________________________________
City: ___________ State: ______ Zip code: ______

Deductions were made from your security deposit for the following items:

Damages: _________________
Other: __________
_________________
_________________

Please be aware that these sample letters and forms may have legal and financial implications. Please consult with your own legal advisor if you have any questions or concerns regarding the use of any of these letters and forms.