You have 7 days from your move-in date to amend this form. If no amendment is made, the move-in condition shall be deemed accepted by all parties. All amendments must be done in writing and agreed to:

Property Address: ____________________________________________________________ Unit # _______

Resident Name: _________________________________________________ Move-in Date ____________

CODES: E=Excellent F=Fair P= Poor NP=New Paint (Items considered Good unless noted otherwise)

Resident Signature: _________________________ _________________________ Date: ____________

Agent Signature: _________________________ Date: ____________

Move-Out Date: _______________

Name & Forwarding Address: ______________________________________ Phone: ___________

_______________________________________________________________

Total Security Deposit on Record: $ ________________

Less: Deposit held for unpaid rent $ __________

$ _________ per day for ______ days

Cleaning $ __________

Carpet Cleaning $ __________

Paint Pro-ration $ __________

Damage $ __________

Other $ __________

Other $ __________

Total Charges $ ________________

Total Refund or Amount Owed $ ________________

If you disagree with this determination, please contact our office in writing as soon as possible. As soon as we receive your written statement, we will contact you. Be sure to include your phone number. Thank you for renting from Overseas Realty, Inc.

Date Mailed: __________ Check # __________