Welcome

1

Name:    First Name *     Last Name *
Email:    Email *
Phone Number:    Area Code     Phone Number

2

Are you a Massachusetts tenant seeking the return of your security deposit?* This field is required.

YESNO

3

We're sorry. Based on the information you provided, our firm is unable to assist you with your matter. The legal intake ends here.

4

Who is your landlord?* This field is required.

5

Have you moved out of the property?* This field is required.

YESNO

6

When did you move out of the property?* This field is required.

Date

7

Did you have a lease?* This field is required.

YESNO

8

When did your lease end?

Date

9

Has it been more than 30 days since you vacated the property?* This field is required.

YESNO

10

Please note that landlords have 30 days to return your security deposit after the termination of the tenancy. However, you may continue with the questionnaire to determine if your landlord unlawfully handled your security deposit, which may entitle you to its full return and/or additional damages.

11

I paid a security deposit of    .
I paid first month's rent in the amount of .
I paid last month's rent in the amount of     .

Check here if your security deposit was more than one month's rent:    Yes

12

Was your security deposit placed in an interest bearing account?

Yes

No

Unsure

13

Did you receive a statement of conditions within 10 days of moving in?The statement of conditions usually contains a paragraph like this: "'This is a statement of the condition of the premises you have leased or rented. You should read it carefully in order to see if it is correct. If it is correct you must sign it. This will show that you agree that the list is correct and complete. If it is not correct, you must attach a separate signed list of any damage which you believe exists in the premises. This statement must be returned to the lessor or his agent within fifteen days after you receive this list or within fifteen days after you move in, whichever is later. If you do not return this list, within the specified time period, a court may later view your failure to return the list as your agreement that the list is complete and correct in any suit which you may bring to recover the security deposit.''

Yes

No

Unsure

14

To your knowledge, was the security deposit deposited into an interest-bearing account separate from the landlord's funds?

Yes

No

Unsure

15

Did you receive a receipt with all of the following: (1) name of the bank, (2) address of the bank, (3) amount of the deposit; (4) the account number; and (5) amount of interest payable within 30 days of depositing the money?

Yes

No

Unsure

16

Did you pay last month's rent?

YESNO

17

Did you receive a receipt for last month's rent?The receipt should contain: the amount of such rent, the date on which it was received, its intended application as rent for the last month of the tenancy, the name of the person receiving it and, in the case of an agent, the name of the lessor for whom the rent is received, and a description of the rented or leased premises, and a statement indicating that the tenant is entitled to interest on said rent payment at the rate of five per cent per year or other such lesser amount of interest as has been received from the bank where the deposit has been held payable in accordance with the provisions of this clause, and a statement indicating that the tenant should provide the lessor with a forwarding address at the termination of the tenancy indicating where such interest may be given or sent.

Yes

No

Unsure

18

Did you receive interest on your last month's rent, either at 5% a year or at the indicated interest on the bank account that it was deposited in?

Yes

No

Unsure

19

Did you receive your security deposit back in full?

Yes, within 30 days of moving out

Yes, but after 30 days of moving out

No, my landlord deducted from my security deposit

No, I have not received any part of my security deposit

20

Were the deductions for ANYTHING OTHER THAN: (1) unpaid rent or water charges; (2) unpaid increase in real estate taxes which you were obligated to pay pursuant to a tax escalation clause; (3) a reasonable amount necessary to repair any damage?

YESNO

21

Check all that apply:

I received a written explanation of the deductions from my landlord

I received it within 30 days of vacating

The form was signed under the penalty of perjury

I disagree with the deductions

22

Please describe the nature of the deductions.

23

Have you sent a demand letter or request for return of the security deposit?DO NOT send a demand letter to your landlord if you are filling out this form. A demand letter without the advice or review of an attorney may impact your recovery. Please note that if you have sent a demand letter, we cannot consult with you until thirty days after the demand letter is sent.

YESNO

24

When did you send the demand letter?

Date

25

Please add anything you think might help us evaluate your claim.If you answered "Unsure" to any questions, this would be a great time to tell us what you remember!

26

Please upload copies of your lease, proof of security deposit payment, photos of the condition of the apartment, and any other documents you think may be helpful for us as we assess your claim. In the event you have a possible claim, someone from Clifford Law PC will be in touch.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

27

How did you hear about us?