FORM 12 NOTICE OF INTENTION TO IMPOSE CLAIM ON SECURITY DEPOSIT A Landlord must return a Tenant's security deposit, together with interest if otherwise required, to the Tenant no more than 15 days after the Tenant leaves the leased property. The Landlord may claim all or a portion of the security deposit only after giving the Tenant written notice, by certified mail to the Tenant's last known mailing address, of the Landlord's intention to keep the deposit and the reason for keeping it. The Landlord's notice must be sent within 30 days of the date Tenant vacates the leased property. If the Landlord does not send the notice within the 30-day period the Landlord cannot keep the security deposit. If the Tenant does not object to the notice within 15 days after receipt of the Landlord's notice of intention to impose a claim on the deposit, the Landlord may then keep the amount stated in the notice and must send the rest of the deposit to the Tenant within 30 days after the date of the notice. SOURCE: Section 83.49(3) Florida Statutes (2007) FORM NOTES ARE FOR INFORMATIONAL PURPOSES ONLY AND MAY NOT COMPLETELY DESCRIBE REQUIREMENTS OF FLORIDA LAW. YOU SHOULD CONSULT AN ATTORNEY AS NEEDED. American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF INTENTION TO IMPOSE CLAIM ON SECURITY DEPOSIT To: Tenant's Name Address City, State, Zip Code Date: This is a notice of my intention to impose a claim for damage 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 �83.49(3), Florida Statutes. You are hereby notified that you must object in writing to this 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 Landlord's address]. ______________________________________ Landlord's Name _______________________ Address _______________________________ ______________________________________ Phone Number _________________________ Approved for use under rule 10-2.1(a) of the Rules Regulating The Florida Bar The Florida Bar 2010 This form was completed with the assistance of: Name: Address: Telephone Number: American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF INTENTION TO IMPOSE CLAIM ON SECURITY DEPOSIT To: Tenant's Name Address City, State, Zip Code Date: This is a notice of my intention to impose a claim for damage in the amount of $____________ upon your security deposit due to __________________________________________________________________________. This notice is sent to you as required by �83.49(3), Florida Statutes. You are hereby notified that you must object in writing to this 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 ____________________ _________________________________________________. ______________________________________ Landlord's Name _______________________ Address _______________________________ ______________________________________ Phone Number _________________________ Approved for use under rule 10-2.1(a) of the Rules Regulating The Florida Bar The Florida Bar 2010 This form was completed with the assistance of: Name: Address: Telephone Number: American LegalNet, Inc. www.FormsWorkFlow.com