What if I lack receipts?

If receipts are unavailable, document the repair process with dated photos and a written work order. Courts weigh contemporaneous evidence more heavily than retrospective estimates, so include as much corroborating detail as possible.

Can I eSign the form?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states, provided intent, consent, attribution, and reliable record retention are satisfied.

When must I send the itemized list?

State laws set specific deadlines (commonly 14–45 days). Failure to meet the deadline may trigger statutory penalties or require full deposit refund; check your state statute for exact timing.

Notarization is generally unnecessary for deposit claims. Use a notary only when a state-specific rule or the lease expressly requires notarized acknowledgement.

How long should I keep records?

Retain the form and supporting documents for at least three years after move-out for tax and dispute purposes; extend retention if records include HIPAA-protected information or if state law mandates a longer period.

What if the tenant disputes the deductions?

Attempt informal resolution with evidence first; if unresolved, the matter commonly proceeds to small claims court or mediation where itemized receipts, photos, and the signed claim form are primary evidence.

Electronic Signature
Templates
Real estate
Security Deposit Claim Form

Security Deposit Claim Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

SECURITY DEPOSIT CLAIM FORM

Parties

Landlord / Property Manager Name Landlord Contact Address Landlord Phone Tenant Name Tenant Contact Address Tenant Phone / Email

Property Identification

Property Address

Parcel / APN: Unit/Apartment:

Legal Description of Property

Lease and Deposit Information

Lease Start Date: Lease End Date:

Move-in Date: Move-out Date:

Original Security Deposit Amount

Date Deposit Received: Method of Payment:

Claim Type & Summary

Claim Type: Tenant claim for return of deposit Landlord statement of deductions

Summary of Claim

Itemized Deductions (if landlord is claiming)

For each deduction provide description, vendor/contractor, invoice date, invoice number and amount. Attach supporting invoices or receipts and list attachment IDs below.

Deduction 1 — Description

Vendor/Contractor: Invoice Date: Invoice #: Amount:

Deduction 2 — Description

Vendor/Contractor: Invoice Date: Invoice #: Amount:

Deduction 3 — Description

Vendor/Contractor: Invoice Date: Invoice #: Amount:

Total Deductions (sum of above)

Tenant Claim Details (if tenant is claiming return)

Amount of Deposit Tenant Requests Returned Reason for Claim / Dispute of Deductions Attachments (list invoice, receipt, photo IDs or other supports)

Disclosures

Prior known conditions (check all that apply and describe):

Lead paint present prior to tenancy Mold or moisture damage present prior to tenancy Prior structural or water damage

If checked above, explain condition and dates

Certifications, Notices, and Remedies

Certification: The undersigned certifies under penalty of perjury that the information provided in this form is true and complete to the best of the signer’s knowledge. Supporting documents attached to this claim are accurate copies of invoices, receipts, or photographs relied upon to calculate the amount claimed.

Notice to Landlord: If claiming deductions, Landlord must provide an itemized statement of charges and copies of invoices or receipts supporting deductions. If the itemized statement and supporting documentation are not furnished within the period required by applicable law, the Tenant may be entitled to the return of the security deposit in full and may pursue remedies provided by law.

Notice to Tenant: If payment of the claimed amount is made by Landlord, the Tenant may be required to execute a release of further claims as a condition of payment. Acceptance of payment does not necessarily waive the Tenant’s rights unless a separate written release is executed and delivered.

Claim Filed Date Preferred Method of Remittance

Check mailed to Tenant address above ACH / electronic transfer Other:

Acknowledgements

By signing below, the Tenant requests return of the security deposit in the amount specified herein or, if Landlord claims deductions, acknowledges receipt of the attached itemization and supporting documentation. Each party acknowledges that false statements in this form may give rise to civil liability and other remedies.

Tenant Printed Name:

By:

Date:

Landlord Printed Name:

By:

Date:

What the Security Deposit Claim Form Is

A Security Deposit Claim Form documents a landlord or property manager’s itemized claim against a tenant’s security deposit after tenancy ends. It records amounts withheld for unpaid rent, damage beyond normal wear and tear, cleaning, or unpaid utilities, and attaches supporting receipts or invoices. The form helps meet statutory notice and accounting requirements, creates a clear paper trail for dispute resolution, and serves as the basis for refunding any remaining deposit. Use it whenever any portion of a deposit is retained or when the landlord returns the balance with an itemized statement.

Why a Formal Claim Form Matters

A clear Security Deposit Claim Form provides a documented explanation of deductions, reduces disputes, and supports compliance with state landlord–tenant rules. It standardizes communication and preserves evidence should the matter proceed to mediation or small claims court.

Who Completes and Receives This Form

Landlords, property managers, and leasing agents prepare the form; tenants receive it along with any partial refund and supporting documentation.

Independent landlords who manage small portfolios and need a consistent accounting record for each tenancy.
Property management companies processing move-outs for multiple units and tracking deductions centrally.
Tenants who request clarification or dispute deductions and need the itemized basis for a claim or defense.

Use the form as the official record sent within the timeframes required by state law to avoid statutory penalties and to support transparent dispute resolution.

Core Parts of a Professional Security Deposit Claim Form

A complete form groups tenant and property details, an itemized list of deductions with amounts and receipts, refund calculation, signatures, and routing instructions. Consistent fields reduce errors and speed processing.

Tenant Details

Full name, forwarding address, contact phone and email so refunds or notices can be delivered and service validated.

Property Details

Property address, unit number, lease dates, and tenancy termination date for clear record tying the claim to the lease.

Itemized Deductions

Line-by-line description of each charge, date of expense, dollar amount, and reference to attached receipts or invoices.

Calculation Summary

Original deposit amount, total deductions, any prior partial refunds, and the net refund due or balance owed.

Supporting Documents

Attach receipts, repair invoices, work orders, and photographs showing damage and repair costs for evidentiary support.

Signatures & Dates

Signature block for the landlord or authorized agent and date; tenant signature or acknowledgement where required by policy or state law.

Essential Fields to Include

Tenant Name: Full legal name

Forwarding Address: Street, city, state, ZIP

Property Address: Unit and street address

Deposit Amount: Original security deposit

Deduction Summary: Total withheld

Net Refund: Amount to tenant

Step-by-Step: Completing the Form

Follow these steps to prepare, document, and deliver a compliant Security Deposit Claim Form.

01

Gather Records: Collect lease, prior payment history, repair receipts, and photos.
02

Itemize Charges: Create line items for each deduction with amounts and dates.
03

Prepare Calculation: Compute total deductions and net refund or balance due.
04

Deliver Notice: Send the form and attachments to the tenant within the state-required timeframe.

How to Customize an Online Workflow

Configure an online workflow so claims are consistent, routed for approval, and stored with receipts.

Field	Configuration
Autofill Tenant	Populate from lease database by tenant ID
Conditional Items	Show repair fields only when 'Damage' selected
Attach Receipts	Require upload for any deduction over $50
Sign & Audit	Capture eSignature, timestamp, and audit trail

Where to Send the Completed Form

After completion, route the form to the tenant, property file, and accounting system. Choose delivery based on legal preference and recordkeeping policies.

Email Delivery: Send signed PDF to tenant email and store in tenant record
Certified Mail: Use when state law or lease requires proof of delivery
Accounting Archive: Attach receipts and update deposit ledger
Court or Mediation: Produce file if dispute escalates

Digital Signing and Technical Requirements

Choose an eSignature platform that preserves an audit trail, attaches supporting files, and retains records in searchable form.

File Formats: PDF preferred; Word DOCX acceptable for data entry
Authentication: Email link or SMS code; stronger ID if required
Integrations: Connect to property management and accounting systems

Ensure any chosen platform complies with ESIGN (15 U.S.C. §7001) and state UETA or equivalent rules for electronic records and signatures.

Typical Timelines and Notice Deadlines

States set different deadlines for returning deposits and issuing itemized deduction statements. Confirm your jurisdictional requirements before finalizing a claim.

Return Window Varies:

Most states require an itemized statement within 14–45 days

Delivery Method:

Some states prescribe mail or hand delivery; check local statute

Dispute Period:

Tenant typically has 30–60 days to contest deductions

Small Claims:

Claims often filed in small claims court when dispute unresolved

Record Retention:

Keep records for the period required by state and federal law

Common Preparation Mistakes

Failing to attach receipts or photos, which weakens the evidence for each deduction.
Using vague descriptions (e.g., 'cleaning') instead of itemized, dated line items tied to invoices.
Missing statutory deadlines for itemized statements and refunds, exposing the landlord to penalties.
Mismatched tenant names or incorrect forwarding addresses that prevent proper delivery of the notice.

Consequences of an Incorrect or Late Claim

Statutory Damages: Some states impose penalty damages for wrongful withholding

Attorney Fees: Court awards may include tenant attorney fees where statute allows

Repayment Orders: Court may order refund of deposit plus interest

Administrative Fines: Local agencies may levy fines for noncompliance

Reputational Risk: Tenant complaints and negative reviews can affect occupancy

Evidence Gaps: Lack of receipts weakens the landlord’s position in disputes

eSignature Vendor Comparison for Completing the Form

Cost and feature differences matter when choosing an eSignature provider to complete and store Security Deposit Claim Forms. signNow is listed first for direct comparison.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Available (Business Premium)	Available	Available	Available	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA required)	Yes	Yes	No	No

Frequently Asked Questions

Answers to common questions about preparing, delivering, and defending Security Deposit Claim Forms.

Need help? Contact support

What if I lack receipts?
If receipts are unavailable, document the repair process with dated photos and a written work order. Courts weigh contemporaneous evidence more heavily than retrospective estimates, so include as much corroborating detail as possible.
Can I eSign the form?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states, provided intent, consent, attribution, and reliable record retention are satisfied.
When must I send the itemized list?
State laws set specific deadlines (commonly 14–45 days). Failure to meet the deadline may trigger statutory penalties or require full deposit refund; check your state statute for exact timing.
Do I need a notary?
Notarization is generally unnecessary for deposit claims. Use a notary only when a state-specific rule or the lease expressly requires notarized acknowledgement.
How long should I keep records?
Retain the form and supporting documents for at least three years after move-out for tax and dispute purposes; extend retention if records include HIPAA-protected information or if state law mandates a longer period.
What if the tenant disputes the deductions?
Attempt informal resolution with evidence first; if unresolved, the matter commonly proceeds to small claims court or mediation where itemized receipts, photos, and the signed claim form are primary evidence.

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