Form 13/14 "Notice of Landlord's Claim for Security Deposit" - Saskatchewan, Canada

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Notice of Landlord's Claim
Form 13/14
for Security Deposit
Office of Residential Tenancies
The Residential Tenancies Act, 2006
This form must be delivered to the tenant within 7 business days after the day on which a landlord has actual
knowledge, or should reasonably have known, the tenant has vacated the premises.
If any portion of the security deposit is guaranteed by SOCIAL SERVICES a copy of this claim MUST be delivered
to the Office of Residential Tenancies within 7 business days of the tenancy ending.
All information provided in this application is public. Please read carefully and ANSWER FULLY.
A. Tenant Information
First Name:
Last Name:
Primary Phone Number:
Alternate Phone Number:
Email:
Present Mailing Address:
Suite No.:
City/Town/Village/Hamlet:
Province:
Postal Code:
Other Tenant names:
(Include Social Services Case No. beside other tenants' names, if applicable)
Social Services Guarantee Case No.
:
Date Letter Withdrawn
:
(if applicable)
(if applicable)
B. Rental Property Information
Street Address (Land Location):
Suite No.:
City/Town/Village/Hamlet:
Province:
Postal Code:
Tenancy start (dd/mm/yy):
End/Last known day (dd/mm/yy):
Lease agreement (Please attach.)
C. Landlord Information
Landlord/Agent name (full legal name):
Mailing/Service Address:
Suite No.:
Province:
Postal Code:
City/Town/Village/Hamlet:
Primary Phone Number:
Alternate Phone Number:
Email:
TENANCY INFORMATION
1. List the dates the security deposit was paid to the landlord and the amount ($):
Date:
Amount:
Date:
Amount:
2. Did Social Services guarantee any of the security deposit? No
How much?
Yes
3. What was the monthly rent when the tenancy started?
4. How much was the security deposit?
5. Did the tenant(s) provide a written notice to vacate? No
Yes
Last known date of tenancy?
If no notice was provided, how and when did you learn that the tenant(s) had left?
6. Was a move-out inspection done with the tenant?
A “move-in” inspection was completed with the tenant, a copy of which is attached.
A “move-out” inspection was completed with the tenant, a copy of which is attached OR
No “move-out” inspection was done because
7. Was any of the security deposit returned?
No
Yes
How much?
(attach proof)
Continue to Page 2…
September 2021 Form 13/14 - Page 1 of 2
Notice of Landlord's Claim
Form 13/14
for Security Deposit
Office of Residential Tenancies
The Residential Tenancies Act, 2006
This form must be delivered to the tenant within 7 business days after the day on which a landlord has actual
knowledge, or should reasonably have known, the tenant has vacated the premises.
If any portion of the security deposit is guaranteed by SOCIAL SERVICES a copy of this claim MUST be delivered
to the Office of Residential Tenancies within 7 business days of the tenancy ending.
All information provided in this application is public. Please read carefully and ANSWER FULLY.
A. Tenant Information
First Name:
Last Name:
Primary Phone Number:
Alternate Phone Number:
Email:
Present Mailing Address:
Suite No.:
City/Town/Village/Hamlet:
Province:
Postal Code:
Other Tenant names:
(Include Social Services Case No. beside other tenants' names, if applicable)
Social Services Guarantee Case No.
:
Date Letter Withdrawn
:
(if applicable)
(if applicable)
B. Rental Property Information
Street Address (Land Location):
Suite No.:
City/Town/Village/Hamlet:
Province:
Postal Code:
Tenancy start (dd/mm/yy):
End/Last known day (dd/mm/yy):
Lease agreement (Please attach.)
C. Landlord Information
Landlord/Agent name (full legal name):
Mailing/Service Address:
Suite No.:
Province:
Postal Code:
City/Town/Village/Hamlet:
Primary Phone Number:
Alternate Phone Number:
Email:
TENANCY INFORMATION
1. List the dates the security deposit was paid to the landlord and the amount ($):
Date:
Amount:
Date:
Amount:
2. Did Social Services guarantee any of the security deposit? No
How much?
Yes
3. What was the monthly rent when the tenancy started?
4. How much was the security deposit?
5. Did the tenant(s) provide a written notice to vacate? No
Yes
Last known date of tenancy?
If no notice was provided, how and when did you learn that the tenant(s) had left?
6. Was a move-out inspection done with the tenant?
A “move-in” inspection was completed with the tenant, a copy of which is attached.
A “move-out” inspection was completed with the tenant, a copy of which is attached OR
No “move-out” inspection was done because
7. Was any of the security deposit returned?
No
Yes
How much?
(attach proof)
Continue to Page 2…
September 2021 Form 13/14 - Page 1 of 2
Notice of Landlord's Claim for Security Deposit - Cont'd
Form 13/14
Office of Residential Tenancies
CLAIM DETAILS
Rent arrears/loss
:
Total $
(specify - “month/amount”)
Cleaning: # of hours:
$
Supplies:
$
Carpet cleaning
: $
(beyond reasonable wear and tear)
Total cleaning costs: $
Other cleaning costs:
$
Damages/repair: Item
$
$
$
$
$
Total damages/repair costs: $
Other costs/losses (specify):
Total other costs: $
If you require more space for details, please attach additional pages.
TOTAL CLAIM: $
I certify all of the information on this form to be true and correct:
Signature of Landlord or Agent
Date
Tenant's Dispute Notice
I/We
,
, dispute the landlord’s claim to the
(tenant/s)
security deposit (and interest, if applicable) and request a hearing into this matter for the return of $
.
Present Mailing Address:
Suite No.:
City/Town/Village/Hamlet:
Province:
Postal Code:
Alternate Phone Number:
Primary Phone Number:
Email:
Special accommodations (physical accessibility, translator, etc.):
• Proof of payment of your security deposit MUST be included.
• Photographic evidence must be numbered with a detailed explanation underneath each image and submitted
on one document (PDF or Word).
• The ORT may contact you for clarification of the facts and your application may be rejected if information or
required documents are not submitted at time of application.
• Orders issued by the ORT are enforced by the claimant.
Signature of tenant
Date of application
Complete and submit Page 1 AND 2 of this application along with a $50 filing fee (use the Credit Card Payment Form) to proceed with a hearing for
the return of your security deposit (you may claim the $50 application fee at the hearing). Use the Application for Fee Waiver to apply for a Fee Waiver
Certificate under The Fee Waiver Act, if eligible.
If you wish to file a claim other than for your security deposit, complete and submit a Form 9 along with supporting evidence.
Office of Residential Tenancies
Mailing address: 304 - 1855 Victoria Avenue, Regina, SK S4P 3T2
Toll Free: 1-888-215-2222; Outside SK call: 306-787-2699
Email:
ort@gov.sk.ca
For office use only
Received by:
September 2021 Form 13/14 - Page 2 of 2
Page of 2