Approved for use under rule 10-2.1(a) of the Rules Regulating The Florida Bar The Florida Bar 2010Form 12 To: Tenant222s Name Address City, State, Zip Code From: Date: This is a notice of my intention to impose a claim for damages in the amount of $ [insert amount of damages] upon your security deposit due to [insert damage done to premises or other reason for claiming security deposit] This notice is sent to you as required by section 83.49(3), Florida Statutes . You are hereby notified that you must object in writing to the deduction from your security deposit within 15 days from the time you receive this notice or I will be authorized to deduct my claim from your security deposit. Your objection must be sent to [insert Landlord222s address]. Signature Name of Landlord/ Property Manager (circle one) Address City, State, Zip Code () Phone Number This form was completed with the assistance of: Name: Address: Telephone No.: () American LegalNet, Inc. www.FormsWorkFlow.com