Escolar Documentos
Profissional Documentos
Cultura Documentos
Date: _______________
Address: ___________________________________
___________________________________
___________________________________
Appliances:
____ Dishwasher:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Range:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Stovetop:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Oven:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Microwave:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Refrigerator:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Freezer:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Washer/dryer:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Washer:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
____ Dryer:
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
_____________
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
_____________
Year: _____ Make: _________ Model: ________ Serial: ______________ Replacement cost: ________
Landlord owned furnature, rugs, equipment, tools etc.: YES (see attached inventory) / NONE
Room by room pages attached
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
Kitchen
Bathroom #1
Bathroom #2
Living room
Hallway
Bedroom #1
Bedroom #2
Bedroom #3
Basement
Other (specify): _______________________________________________________
__________________________________________________________________________
Total number of attached pages: _________
___________________________________
REFRIGERATOR clean and empty this date? YES / NO / NOT APPLICABLE
Estimaed cost to clean at end of occupancy, if necessary: $ __________.
Known damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: _______________
Number of ice trays: _________
Photos available? YES / NO / ATTACHED
OVEN clean this date? YES / NO / NOT APPLICABLE
Estimaed cost to clean at end of occupancy, if necessary: $ __________.
Known damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: _______________
Number of oven racks: __________
Broiler pan YES / NO
Photos available? YES / NO / ATTACHED
STOVE OR RANGE TOP clean this date? YES / NO / NOT APPLICABLE
Estimaed cost to clean at end of occupancy, if necessary: $ __________.
Known damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: _______________
Photos available? YES / NO / ATTACHED
MICROWAVE clean this date? YES / NO / NOT APPLICABLE
Estimaed cost to clean at end of occupancy, if necessary: $ __________.
Known damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: _______________
Photos available? YES / NO / ATTACHED
DISHWASHER clean and empty this date? YES / NO / NOT APPLICABLE
Estimaed cost to clean at end of occupancy, if necessary: $ __________.
Known damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: _______________
Photos available? YES / NO / ATTACHED
Page 1 of 2 (plus any attachments) - Kitchen
___________________________________
Room identification ____________________________ clean and empty this date? YES / NO
Number of windows: _______________
Window glass: _____________________________________________________________________________
Windo blinds, shades, drapes, curtans:___________________________________________________________
Window screens:____________________________________________________________________________
Carpets:___________________________________________________________________________________
Ceiling fan or light fixtures:____________________________________________________________________
Closets and closet doors:______________________________________________________________________
Walls:_____________________________________________________________________________________
Other nown damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: ________________
Estimated room cleaning cost, if necessary: ________________
Photos available? YES / NO / ATTACHED
Room identification ____________________________ clean and empty this date? YES / NO
Number of windows: _______________
Window glass: _____________________________________________________________________________
Windo blinds, shades, drapes, curtans:___________________________________________________________
Window screens:____________________________________________________________________________
Carpets:___________________________________________________________________________________
Ceiling fan or light fixtures:____________________________________________________________________
Closets and closet doors:______________________________________________________________________
Walls:_____________________________________________________________________________________
Other nown damage or defects this date: __________________________________________________
_______________________________________________________________________________
Estimated repair cost, if applicable: ________________
Estimated room cleaning cost, if necessary: ________________
Photos available? YES / NO / ATTACHED