"Security Deposit Refund Form - Aqa"

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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 for balance due, if any, 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 (Rev. 04/06) ­ Copyright 2006 ­ Apartment Owners Association of California ­ www.aoausa.com 
▪ San Fernando Valley (818)988­9200  ▪    Los Angeles (323)937­8811 ▪   L ong Beach (562)597­2422 ▪    Garden Grove (714)539­6000 ▪ San Diego (619)280­7007 ▪ Northern California (510)769­7521 
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 for balance due, if any, 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 (Rev. 04/06) ­ Copyright 2006 ­ Apartment Owners Association of California ­ www.aoausa.com 
▪ San Fernando Valley (818)988­9200  ▪    Los Angeles (323)937­8811 ▪   L ong Beach (562)597­2422 ▪    Garden Grove (714)539­6000 ▪ San Diego (619)280­7007 ▪ Northern California (510)769­7521