Damage & Vacancy Loss Claim Form

 

Part 1 - Owner & Tenant Information

 
 

Street Address

 
 
 
 
Phone
 
 
 
 

Tenant Street Address

 
 
 
 
 
 

(if a vacancy loss claim)

 
 
 
 

 

Part 2: Security Deposit

 

deposit held by owner/ manager:

 
 

Part 3: Damage Claim

 

completed?

 

Enter the amount charged to the tenant for tenant-caused damages beyond normal wear & tear (Include receipts or estimates of damages claimed).

 

Enter the amount charged to the tenant for cleaning costs above and beyond normal wear and tear. (Include a copy of receipts or estimates of cleaning costs claimed).

 

Part 4: Vacancy Loss Claim

 

A Vacancy Loss may be claimed ONLY under the following conditions:


1. The tenant moved without cause during the term of lease without a mutual rescission or 30 day notice.


2. The tenant moved at the end of the lease term without providing 30-day notice.


3. The owner evicted the tenant through court action that could not be prevented by mediation attempts by local

service providers.


**The property owner MUST submit verification that an attempt has been made to re-lease the unit (e.g. leasing reports, online listing, Padmission relisting, etc.)

 

 

Which scenario are you filing a vacancy loss claim for?

 
 
 
 
 
 
 
 

Part 5: Verification of Claim Parameters

 
 
 
 

Upload itemized bill(s), photos that clearly display all damages, repair estimates, repair quotes, and receipts

Drop your files here
 

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.

 
 
 

Note to Owner/Manager:


● Allow 10 business days for Welcome Home, Neighbor to process this claim.


● Please attach all required documentation to expedite the processing of this claim.


● Thank you for your assistance and cooperation.