SECURITY DEPOSIT REFUND
TO:_________________________________________________________________
FOR PREMISES LOCATED AT:____________________________________________________________________
Apt.:_____ City:___________________________________________ Zip:_______________
SECURITY DEPOSIT.................................................................................................$ _________________
INTEREST ON DEPOSIT @ __________ % ..............................................................$ _________________
TOTAL SECURITY DEPOSIT ....................................................................................$ _________________
Rent Due From ___________________ to___________________ $ ___________
Late fees due......................................... ....................................... $ ___________
CIeaning................................................ ....................................... $ ___________
Carpets.................................................. ....................................... $ ___________
Painting ................................................. ....................................... $ ___________
Drapes................................................... ....................................... $ ___________
Other:________________________________________________ $ ___________
TOTAL CHARGES .....................................................................................................$ _________________
BALANCE DUE OWNER ...........................................................................................$ _________________
BALANCE DUE RESIDENT .......................................................................................$ _________________
PLEASE REMIT YOUR CHECK IMMEDIATELY TO:
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
City, State, Zip:_____________________________________________________________________
Pursuant to Civil Code 1950.5, Owner, on the _____ day of________________, 20_____ hereby furnished the above
statement of security deposit disposition of monies to former residents .
Owner/Agent _________________________________________________________ Date _____________________
AOA Form No. 133 ? Apartment Owners Association of Southern California
San Fernando Valley: (818)988-9200 ? Los Angeles: (323)937-8811 ? Long Beach: (562)597-2422 ? Garden Grove: (714)539-6000 ? San Diego: (619)294-7900