Intent to Vacate

Housing Authority of McDonough County

Agreement to Terminate Dwelling Lease
I,Name , hereby declare my Agreement to Terminate my Dwelling Lease for the unit identified as Full Street address, city .
I will vacate my apartment on:

MonthDayYear
Date
I understand per my Lease Agreement, that I will be responsible for owing 30 days rent from today's date

MonthDayYear
Date
Until:

MonthDayYear
Date
An Occupancy Inspection will be conducted on

MonthDayYear
The day after your vacate date.
Cleaning Charges

I understand that I must pay for labor and materials necessary to address conditions beyond normal wear and tear in the apartment I am vacating. If I do not pay for such charges, 1 understand that they will be deducted from my security deposit. In an effort to reduce costs to our residents, a Pre-Move Out inspection of your unit is encouraged.

I understand I have the right to request a "Pre-Move Out" inspection on my unit.
I hereby request a Pre-Move Out Inspection

YesNo
Re-admittance

I understand that ifl wish to be re-admitted in the future to any development under the management of the Housing Authority of McDonough County, I will have to make a new application for admission and go on a waiting list until I am contacted for a vacancy.

Certify

I have read or have had read to me and I fully understand the above stated rules and regulations of the Housing Authority of McDonough County governing the vacating of an apartment.
Any refund may be mailed to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State
Zip
Home Phone
Cell Phone #
Email Address
example@example.com
Why are you leaving?
Signature of Head or Co head of Household

Clear
Date

MonthDayYear
Date
Should be Empty: