Security Deposit Receipt Form

Security Deposit Amount

Enter the Amount of the Security Deposit

Date

Date the Security Deposit was Received

Tenant

Enter the Name(s) of the Tenant(s) that made the Deposit

This is the person who paid the Security Deposit

Bank Details

This is the details of the bank and account that will be holding the Security Deposit

Enter the Name of the Bank where the Funds will be held

What is the Nine (9) digit Account Number the funds will be Deposited?

This is for verification purposes. The landlord must inform the Tenant of the Account Number along with the Bank Branch Name and Address in order to be in compliance with State law.

Branch Location

Enter the Mailing Address of the Bank Branch where the Funds are being held

Street Address

Address Line 2

City

State

ZIP Code

This is the mailing address of the bank branch where the account was created.

Landlord/Manager/Agent

Enter the Name of the Individual that is Accepting the Security Deposit

Tenancy Start Date

This is the first (1st) day the Tenant(s) moved into the property

Enter the Beginning Date of the Tenancy

This is the first (1st) day the Tenant moved-in to the Premises.

Interest Rate

Will the Tenant's Security Deposit be collecting Interest?

Will the Tenant's Security Deposit be collecting Interest? YesNo

Select 'Yes' only if the interest will be the benefit of the Tenant.

Will there be a Minimum Interest Rate?

Will there be a Minimum Interest Rate? YesNo

Enter the Minimum Interest Rate

Also known as an 'Annual Interest Rate'

Sign or Print

Landlord's Signature

Clear

Please draw your signature.

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