Security Deposit Receipt

Date __________________________

Landlord Tenant
Address Address

Name Name
Phone Phone

Description of Lease

The Landlord acknowledges receipt of the sum of $_____________________ paid by the Tenant under the lease
described above.

This Security Deposit payment will be held by the Landlord under the terms of this lease, and unless required by
law, will not bear any interest. This Security Deposit will be repaid when due under the terms of the lease.

Signature of Landlord

By:

Name of Landlord

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