Security Deposit Statement (Sec. 535.300 RSMo.)

Date: ________________________

From (landlord/manager):

To:

Premises address:

Amount of security deposit	$
DEDUCTIONS FROM SECURITY DEPOSIT
DESCRIPTION	AMOUNT
$(	)
$(	)
$(	)
$(	)
$(	)
$(	)
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$(	)
$(	)
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$(	)
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$(	)
$(	)
TOTAL DEDUCTIONS FROM SECURITY DEPOSIT	$(	)
SECURITY DEPOSIT REFUND (IF ANY)	$
AMOUNT OWED (Please promptly remit payment to landlord/manager at above address)	$