Apartment Name______________________________ Tenant Name______________________________

House Address _______________________________ Apartment Number ____________________________

Move-in Date ________________________________ Move-out Date _____________________________
 

		IN			OUT
CONDITION	CLEAN	DIRTY	DAMAGE	CLEAN	DIRTY	DAMAGE
LIVING ROOM
Drapes
Carpet/Flooring
Paint
Lights
Windows
Other
KITCHEN - DINING AREA
Refrigerator
Range
Sink & Counter Top
Cabinets
Flooring
Paint
Windows
Vent Fan
Other
BEDROOM
Drapes
Carpet/Flooring
Closets
Windows
Paint
Lights
Other
BEDROOM
Drapes
Carpet/Flooring
Closets
Windows
Paint
Lights
Other
BATHROOM
Bath Fixtures
Vent Fan
Medicine Cabinet
Grout
Flooring
Paint
Other

General Comments: _______________________________________________________________________________________

___________________________________________________________________________________________________________

________________________________________________________________ ___________________________________
Tenant Signature Date

________________________________________________________________ ___________________________________
Resident Manager/Owner Signature Date