Security Deposit Receipt

___________
Date

Name: __________________
Address: _________________
City, State: __________________

Dear ____________________:

Your security deposit in the amount of $_________ was received on __________________. The Landlord
deposited this security deposit on ______________________ in a separate account at
_________________________ (Bank Name) located at the following address: _____________________
_________________________.

The Account Number in which this security deposit is being held is _______________________. Said
security deposit shall remain in this account for the full duration of the lease executed on the ____ day
of ________________, 20__.

Sincerely,

________________________ ______________________________
Landlord’s Signature Printed Name