SECURITY DEPOSIT RECEIPT
FROM LANDLORD(S): _________________________________________________________________________
TO TENANT(S): _______________________________________________________________________________
DATE: ________________________________________________________________________________________
PROPERTY ADDRESS: ________________________________________________________________________
______________________________________________________________________________________________
AMOUNT OF SECURITY DEPOSIT: $__________________________________________________________
Landlord agrees to place security deposit in a segregated account in a Financial Institution.
The security deposit will be held in the following Location/Branch:
NAME OF FINANCIAL INSTITUTION: _________________________________________________________
ADDRESS OF FINANCIAL INSTITUTION: ______________________________________________________
______________________________________________________________________________________________
LANDLORD NAME: __________________________________________________________________________
LANDLORD ADDRESS: _______________________________________________________________________
______________________________________________________________________________________________
LANDLORD PHONE: _________________________________________________________________________
LANDLORD EMAIL: __________________________________________________________________________
SIGNATURE: _________________________________________________________________________________