Massachusetts Move-In Condition Statement and Move-Out Comparison

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.

MASSACHUSETTS MOVE-IN CONDITION STATEMENT

Before use: This is a concise condition statement. For a longer version with a detachable tenant damage-list page, use the Massachusetts Move-In Statement of Condition and Move-Out Record. The landlord or agent completes and signs this separate statement when accepting a residential security deposit. Give it to the tenant upon receipt of the deposit or within ten days after tenancy begins, whichever is later. Include all existing damage and any existing state sanitary or building code violation certified by a local board of health or building official or adjudicated by a court. Use a separate deposit receipt.

Premises: [STREET ADDRESS, UNIT, CITY, ZIP]

Landlord or agent: [NAME, MAILING ADDRESS, CONTACT]

Tenant(s): [NAMES]

Tenancy begins: [__/__/____] Security deposit received: [__/__/____]

Inspection date: [__/__/____] Statement delivered: [__/__/____] by [METHOD]

Existing condition and damage

Describe the present condition and every known damaged item. Identify the room, location, size or extent, and related dated photographs. Attach signed continuation pages if needed.

Existing certified or adjudicated code violations: [ISSUING BODY, DATE, IDENTIFIER, VIOLATION AND CURRENT CONDITION / NONE KNOWN]. Attach the relevant record when available.

Continuation pages and photographs: [IDENTIFY / NONE]

I have recorded the present condition and existing damage described above.

Landlord or agent signature: [SIGNATURE] Printed name and role: [NAME / ROLE] Date: [__/__/____]

Tenant response

The tenant returns this statement within fifteen days after receiving it or moving in, whichever is later. If it is incorrect or incomplete, attach a separate signed list of damage the tenant believes exists. A signed list is part of this response.

☐ I agree that the landlord's list is correct and complete.

☐ I disagree or add existing damage in the separate signed list identified here: [TITLE, PAGES, DATE].

Tenant signature: [SIGNATURE] Date: [__/__/____]

Additional tenant signature: [SIGNATURE / NOT APPLICABLE] Date: [__/__/____]

Tenant response delivered to landlord or agent: [__/__/____] by [METHOD]; received by [NAME].

If the tenant supplies a separate damage list, the landlord or agent returns a copy within fifteen days after receiving it, with either signed agreement or a clear statement of disagreement attached.

☐ I agree with the tenant's attached list. ☐ My signed disagreement is attached.

Landlord or agent signature: [SIGNATURE] Date: [__/__/____]

Copy returned to tenant: [__/__/____] by [METHOD]

Move-out comparison record

This section records observations for comparison. It is separate from the sworn, itemized damages list and cost evidence required for a damage deduction under § 15B(4).

Possession ended: [__/__/____] Inspection date: [__/__/____] People present: [NAMES]

Additional signed pages and photos: [IDENTIFY / NONE]

Tenant's response or disagreement: [DETAILS / ATTACHED / NONE]

Landlord or agent signature: [SIGNATURE] Date: [__/__/____]

Tenant signature, acknowledging receipt of this record only: [SIGNATURE / DECLINED] Date: [__/__/____]

Copies delivered: [RECIPIENTS, DATES, METHODS]

Official source

• M.G.L. c. 186, § 15B