SECURITY DEPOSIT ITEMIZATION & DISPOSITION STATEMENT
(New Hampshire – N.H. Rev. Stat. Ann. § 540-A:6–8)
[// GUIDANCE: This court-ready template satisfies New Hampshire’s statutory obligations for returning or accounting for a residential tenant’s security deposit. Complete every bracketed field, attach supporting documentation, and send by certified mail (return-receipt requested) to the Tenant’s last known address within the statutory deadline.]
I. DOCUMENT HEADER
-
Parties
1.1 Landlord: [LANDLORD LEGAL NAME], a [LEGAL ENTITY TYPE] with a principal address at [LANDLORD ADDRESS, NH ZIP] (“Landlord”).
1.2 Tenant: [TENANT FULL LEGAL NAME(S)] with a last known mailing address of [TENANT FORWARDING ADDRESS] (“Tenant”). -
Premises
Street Address: [PREMISES ADDRESS, UNIT #, CITY, NH ZIP] (“Premises”). -
Lease Details
Commencement Date: [LEASE START DATE]
Termination/Surrender Date: [LEASE END OR SURRENDER DATE] -
Security Deposit
4.1 Original Deposit Amount: $[AMOUNT] (the “Deposit”)
4.2 Deposit Receipt Date: [DATE RECEIVED]
4.3 Escrow Account: [FINANCIAL INSTITUTION, ACCOUNT # (last 4 digits)] -
Effective Date of Statement
[DATE MAILED/DELIVERED] (“Effective Date”).
II. DEFINITIONS
“Deposit” – The funds delivered by Tenant to Landlord as a security deposit pursuant to N.H. Rev. Stat. Ann. § 540-A:6.
“Normal Wear and Tear” – Deterioration that occurs without negligence, carelessness, accident, or abuse by Tenant, occupants, or guests.
“Termination Date” – The later of (i) the lease end date, or (ii) the date Tenant delivers possession of the Premises to Landlord.
“Itemization Period” – Thirty (30) calendar days after the Termination Date, as prescribed by N.H. Rev. Stat. Ann. § 540-A:7, or twenty (20) days if the Premises became uninhabitable due to fire, natural disaster, or condemnation.
III. OPERATIVE PROVISIONS
3.1 Compliance Certification
Landlord hereby certifies that this Statement is delivered within the Itemization Period and that all deductions enumerated herein are lawful, reasonable, and limited to amounts permitted under N.H. Rev. Stat. Ann. § 540-A:7.
3.2 Itemized Deductions
| # | Description of Damage / Charge | Date Observed | Vendor / Invoice # | Cost | Amount Deducted |
|---|---|---|---|---|---|
| 1 | [e.g., Repair drywall hole in bedroom wall] | [MM/DD/YYYY] | [ABC Contractors, Inv. #1234] | $[XXX.XX] | $[XXX.XX] |
| 2 | [e.g., Professional carpet cleaning (excessive staining)] | [MM/DD/YYYY] | [XYZ Carpet Co., Inv. #5678] | $[XXX.XX] | $[XXX.XX] |
| 3 | [e.g., Unpaid rent for Month/Year] | N/A | N/A | $[XXX.XX] | $[XXX.XX] |
| 4 | [ADD ROWS AS NEEDED] |
Total Deductions: $[TOTAL DEDUCTIONS]
3.3 Refund Calculation
a. Original Deposit: $[AMOUNT]
b. Less Total Deductions: – $[TOTAL DEDUCTIONS]
c. Balance Due to Tenant: $[REFUND AMOUNT]
[ ] Enclosed is Landlord’s check #[CHECK #] in the amount of $[REFUND AMOUNT] payable to Tenant.
[ ] No balance is due; deductions fully exhaust the Deposit.
[ ] Tenant owes an additional balance of $[AMOUNT] (invoice attached); payment is due within ten (10) days of receipt of this Statement.
3.4 Supporting Documentation
Copies of receipts, invoices, and photographs substantiating each deduction are attached as Exhibits A- through A- and incorporated by reference. Tenant may inspect original receipts at Landlord’s office during normal business hours upon three (3) business days’ written notice.
IV. REPRESENTATIONS & WARRANTIES
4.1 Authority. Landlord represents that it is the rightful holder of the Deposit and authorized to issue this Statement.
4.2 Accuracy. Landlord warrants the accuracy and completeness of the itemization and that no deduction represents Normal Wear and Tear.
4.3 Statutory Compliance. Landlord represents that the Deposit has been held and accounted for in conformity with N.H. Rev. Stat. Ann. §§ 540-A:6–8.
V. COVENANTS & NOTICE PROCEDURES
5.1 Tenant Objections. Tenant shall deliver any written objection to the deductions within fifteen (15) calendar days of receipt of this Statement to [LANDLORD DISPUTE ADDRESS] via certified mail. Failure to timely object shall not constitute a waiver of Tenant’s statutory rights.
5.2 Landlord Response. Within twenty (20) days of receiving Tenant’s objection, Landlord shall (i) issue an additional refund, (ii) provide further documentation, or (iii) restate its position in writing.
VI. DEFAULT & STATUTORY REMEDIES
6.1 Failure to Account or Return Deposit. Pursuant to N.H. Rev. Stat. Ann. § 540-A:8, a landlord who willfully fails to provide the required itemization or refund within the Itemization Period may be liable for double the amount wrongfully withheld, plus court costs and reasonable attorneys’ fees.
6.2 Reservation of Rights. By issuing this Statement, Landlord does not waive and expressly reserves all rights and remedies available at law or in equity.
VII. RISK ALLOCATION
[// GUIDANCE: Indemnification is “not_applicable” per metadata. Liability caps default to statutory penalties; no additional limitation language is included to avoid conflicting with tenant-protective statutes.]
VIII. DISPUTE RESOLUTION
8.1 Governing Law. This Statement and any dispute arising herefrom shall be governed by, and construed in accordance with, the laws of the State of New Hampshire.
8.2 Forum Selection. The parties consent to exclusive jurisdiction and venue in the [COUNTY] Housing Court (or any other court of competent jurisdiction sitting in the State of New Hampshire) for all actions relating to the Deposit.
8.3 Arbitration. Consistent with metadata, arbitration is expressly excluded.
8.4 Jury Waiver. Nothing herein shall be construed as a waiver of any constitutional right to a jury trial.
8.5 Injunctive Relief. Parties shall be limited to money damages with respect to Deposit disputes, absent a separate showing justifying equitable relief.
IX. GENERAL PROVISIONS
9.1 Entire Statement. This document constitutes the complete security deposit accounting required by law and supersedes all prior or contemporaneous communications regarding the Deposit.
9.2 Amendments. Any modification must be in a writing signed by both parties.
9.3 Severability. If any provision of this Statement is held unenforceable, the remainder shall remain in full force.
9.4 Counterparts; Electronic Delivery. This Statement may be executed in counterparts and delivered electronically, each of which shall be deemed an original.
X. EXECUTION BLOCK
Executed as of the Effective Date.
LANDLORD:
[AUTHORIZED SIGNATORY NAME]
[Title] for [LANDLORD LEGAL NAME]
Date: ___
TENANT ACKNOWLEDGMENT OF RECEIPT (optional):
[TENANT NAME]
Date: ___
[// GUIDANCE: Tenant signature is not legally required for validity of the itemization but can reduce disputes over receipt. Landlord must still retain proof of mailing.]
EXHIBIT INDEX
• Exhibit A-1 – Photographs of Premises post-move-out
• Exhibit A-2 – Vendor Invoice(s) & Receipt(s)
• Exhibit A-3 – Lease Agreement (for reference)
[// GUIDANCE: Retain copies of this Statement, exhibits, and USPS mailing receipts for at least three (3) years to defend against statutory claims.]