STEP 1 · INTAKE CONTROLS ● Updates live as you type Enter parties, deposit, deductions & repair items

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Residential deposit dispositionCiv. Code § 1950.5(g)

Itemized Statement of Security Deposit Disposition

California residential tenancy · Civil Code § 1950.5 as amended by AB 12 (2023) · All blanks are required unless marked optional.

§ 1 Parties, premises, and tenancy

Landlord or Property Manager *

Capacity *

Tenant Name(s) *

Rental Property Address *

Tenancy Start (deposit collected) *

Monthly Rent *

Landlord Return Address (optional)

§ 2 Deposit received and AB 12 cap status

Security Deposit Received *

Small-landlord declaration optional

Ownership form

Rental properties

Dwelling units

The tenant is a service member, which removes the two-month exception

Cap pending

Lawful maximum$0.00

Excess collected$0.00

Enter the tenancy start, monthly rent, and deposit to check the one-month cap.

§ 3 Vacate date, 21-day deadline, and delivery

Move-out date *

Delivery or mailing date optional

Delivery method

Delivery destination optional

21 calendar days

No date yet

Enter the move-out date to start the clock.

§ 4 Itemized deduction schedule

Deductions are limited to unpaid rent, repair of damage beyond ordinary wear and tear, and cleaning to move-in condition. Paint and carpet are prorated over their useful life.

4 of 12 rows

STEP 2 · YOUR DISPOSITION Statutory status & certified disposition statement

§ 5 Refund, documentation, depreciation, and status

Reconciliation of security deposit
Security deposit held	$0.00
Less unpaid rent	$0.00
Less cleaning	$0.00
Less repairs	$0.00
Less paint, prorated	$0.00
Less carpet, prorated	$0.00
Less landlord labor	$0.00
Total deductions	$0.00
Refund due to tenant	$0.00
Balance owed by tenant	$0.00

Awaiting figures

Receipts and invoices: Items of $125.00 or more for repairs or cleaning need receipts or invoices with the statement.
Useful-life depreciation: No paint or carpet items are scheduled.
Statutory timing: The 21-day clock is not yet set.
Potential bad-faith exposure: If a court finds bad-faith retention, § 1950.5(l) permits statutory damages of up to twice the deposit in addition to actual damages. Enter the deposit to size this exposure.

§ 6 Attestation, proof of service, and certification

I declare that the itemization above is true and correct to the best of my knowledge, and that the deductions reflect amounts reasonably necessary under Civil Code § 1950.5(b).

Declarant Title or capacity optional Date signed

Signature

Proof of service

The statement will be served on the date and by the method recorded in § 3.

Served by optional

Practitioner proof and exhibits Pro

Tracking or certificate of mailing optional Label attached receipts as Exhibits A, B, C

Locked on the free draft. Pro enables tracking entries and exhibit lettering.

Official certification

Print this instrument without the draft watermark, with a completed certification seal, tracked proof of service, and lettered receipt exhibits.

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Certify with Pro

Feature	Free	Pro · $29 per month
Core § 1950.5 calculation	Included	Included
CSV export and print	Included (draft watermark)	Included, clean print
Official certification seal	Not included	Included
Proof of service and receipt exhibits	Not included	Included
Multiple records and case files	One draft at a time	Unlimited certified records