Form 3: Statement of Condition

[Pages:2]Form 3: Statement of Condition

How to Use This Form

If your landlord takes a security deposit from you, she is required by law to give you a Statement of Condition. If she does not, you can use the form on the next page to document the condition of your apartment when you first move in.

How to Fill Out This Form

When you first move in, examine every room of the place you are renting and all the common areas you share with other tenants. Use Booklet 2: Housing Code Checklist to help you. It will tell you what to look for. As you examine each room, write down any problems that you see. Date and sign this statement. Make a copy for your records and send a copy to your landlord. Note: If there are conditions that are serious, you should notify your landlord as soon as possible. If there are only minor problems (such as small holes in the wall), you may want to consider waiting until you have been in your apartment for awhile, have paid the rent, and your landlord sees that you are a responsible tenant before you give her this statement. You should still, however, complete the statement as soon as you move in and indicate even minor problems in the statement.

632 Form 3

STATEMENT OF CONDITION

TO: _________________________________ RE: _________________________________

Landlord

Unit #

_________________________________

Address

_________________________________

Address

_________________________________

City

Zip

_________________________________

City

Zip

This is a statement of the condition of the premises listed above as of ______________ (date) when I moved in.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Date: ___________________________________________ Tenant Signature: _________________________________

Form 3 633

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