Damage & Vacancy Loss Claim Form

Damage & Vacancy Loss Claim Form

Please file a claim for eligible damage or vacancy losses for a unit leased through the LIFT initiative.

Part 1: Owner & Tenant Information

Owner/Manager First & Last Name*

Mailing Address of Company/Owner*

Phone Number*

Email Address*

Tenant Name*

Unit Address this Claim is For*

Monthly Contract Rent*

What is the reason for moving out?*

Part 2: Security Deposit

Enter the amount of the refundable security deposit held by owner:*

Enter the amount of the refundable pet deposit (if applicable)

Part 3: Damage Claim

Enter the beginning date of the lease*

Enter the end date of the lease*

Enter the amount charged to the tenant for tenant-caused damages beyond normal wear and tear.

This may include cleaning costs, extermination costs, and legal fees under certain circumstances.

Part 4: Vacancy Loss

Select which circumstance you are filing for vacancy loss:

Vacancy Loss is only eligible for the below scenarios. Vacancy loss is not rental assistance and cannot pay late rent when a tenant is still occupying the unit.

Select or enter value

Enter the date the unit was discovered vacant or the tenant moved.

Enter the date of the last payment received on behalf of the tenant

How long was the unit vacant during the month following the last month payment was received on behalf of the tenant?

(If the tenant vacated in April, you would count the days vacant in May).

Vacancy Loss Calculation: Contract Rent divided by 30 days x days vacant:

Vacancy loss is capped at one month of rent. Owners are required to upload proof of re-listing the unit to LIFT or other sources to be eligible for this benefit.

Part 5: Verification of Claims

Did you contact Milwaukee County upon discovering the unit was vacant/damaged?*

Select or enter value

Did you itemize and bill the tenant for damages incurred that exceeded their security deposit? (Include a copy with this form).*

Select or enter value

Upload receipts, repair estimates, and invoices to substantiate amount claimed.*

If requesting damage reimbursement for labor, at least two quotes must be provided to show a competitive rate was paid.

Drag and drop files here or

Part 6: Signature

I hereby certify that the foregoing information is true and correct to the best of my knowledge and belief and that all claims have not been previously paid. I agree and understand that inquiries may be made to verify statements herein.*

Type name below for e-signature

Send me a copy of my responses

Privacy Notice|Report Abuse