Tenants________________________________________________________________________
Landlord__________________________________________________Telephone_____________
| Outside and Entrance | Hallways | Living Room | Dining Room |
|---|---|---|---|
| and Stairways | |||
| Sidewalk____ | Floor ____ | Floor ____ | |
| Yard ____ | Floor____ | Walls ____ | Walls____ |
| Porch and Railings ____ | Walls____ | Ceiling ____ | Ceiling ____ |
| Mailbox ____ | Ceiling ____ | Doors ____ | Doors ____ |
| Doorbell ____ | Lights ____ | Windows ____ | Windows ____ |
| Door____ | Outlets ____ | Screens____ | Screens ____ |
| Door Glass ____ | Windows ____ | Storms ____ | Storms ____ |
| Door Lock ____ | Screens ____ | Carpet ____ | Carpet ____ |
| Keys ____ | Storms ____ | Curtains____ | Curtains____ |
| Door Screen ____ | Other: ____ | Lights ____ | Lights ____ |
| Door Storm ____ | Outlets ____ | Outlets ____ | |
| Light ____ | Furniture (list in full): | Furniture (list in full): | |
|
| |||
| Trash Can ____ | |||
| Other: | |||
| Kitchen | Bathroom | Bedroom | Bedroom |
|---|---|---|---|
| Floor____ | Floor____ | Floor____ | Floor____ |
| Walls____ | Walls____ | Walls____ | Walls____ |
| Ceiling____ | Ceiling____ | Ceiling____ | Ceiling____ |
| Refrigerator____ | Bathtub ____ | Doors____ | Doors____ |
| Stove____ | Shower____ | Carpet____ | Carpet____ |
| Burners____ | Sink____ | Curtains ____ | Curtains____ |
| Exhaust Fan____ | Toilet ____ | Mirror____ | Mirror____ |
| Cabinets____ | Mirror____ | Bed____ | Bed____ |
| Counters____ | Lights____ | Frame____ | Frame____ |
| Curtains ____ | Curtains____ | Box Spring ____ | Box Spring____ |
| Lights____ | Towel racks____ | Mattress____ | Mattress____ |
| Sink____ | Cabinets____ | Closet____ | Closet____ |
| Outlets____ | Door____ | Windows____ | Windows____ |
| Windows____ | Windows____ | Screens____ | Screens____ |
| Screens____ | Screens____ | Storms____ | Storms____ |
| Storm____ | Storm ____ | Outlets____ | Outlets____ |
| Furniture (list in full): | Outlets____ | Lights ____ | Lights____ |
| Other: | Other: | Furniture (list in full): | Furniture (list in full): |
| Photos | |
| Witnesses_________________________________________ | Date_____________________________________ |
| Notary____________________________________________ | Date_____________________________________ |
| Landlord__________________________________________ | Date_____________________________________ |
| Tenant___________________________________________ | Date____________________________________ |