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THIS IS NOT A DAMAGE CLAIM

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HOUSING AUTHORITY OF THE CITY OF LOS ANGELES
PRE-VACATE UNIT INSPECTION
THIS IS NOT A DAMAGE CLAIM
UNIT ADDRESS
:
DATE:
OWNER: If your tenant was under the Certificate Program and the start date of your HAP Contract was prior to 1
January 1996, you may be eligible to file a claim with the Housing Authority. You must contact your Section 8
Advisor within 48 hours of the vacate to file a claim. You are not eligible for a claim if you return any part of the
security deposit to the tenant.
☞
PLEASE KEEP THE BLUE COPY OF THIS FORM
.
☜
TENANT’S NAME
:
CLIENT NO
:
VENDOR NO
:
TENANT: Even though you are authorized to move into your new unit, the new contract can not begin unless you
have completely vacated this unit. Please make arrangements with your present landlord to complete this form.
☞
PLEASE RETURN THE WHITE AND YELLOW COPIES OF THIS FORM TO YOUR ADVISOR.
☜
THE OWNER (OR OWNER’S REPRESENTATIVE) AND THE RESIDENT HAVE JOINTLY INSPECTED THE ABOVE UNIT,
THE ASSIGNED GROUNDS (IF ANY), STOVE AND REFRIGERATOR (IF APPLICABLE) AND FIND THAT ALL ARE:
ACCEPTABLE
NOT ACCEPTABLE - INDICATE DEFICIENCIES BELOW:
REFRIGERATOR:
STOVE:
KITCHEN:
DINING ROOM:
LIVING ROOM:
HALL(S):
BATHROOMS:
BEDROOM:
BEDROOM:
BEDROOM:
OTHER ROOMS:
GARAGE:
EXTERIOR:
DATE KEYS WERE ORIGINAL SECURITY DEPOSIT: $
RETURNED:
☜
Interest on Security Deposit (if any): $
TOTAL = ORIGINAL + INTEREST: $
OWNER:
YOU ARE NOT ELIGIBLE FOR A CLAIM IF YOU RETURN ANY PART OF THE SECURITY DEPOSIT TO THE TENANT.
DATE THROUGH WHICH RENT WAS PAID:
.
SECURITY DEPOSIT TO BE RETURNED:
$
COMMENTS:
X
( )
OWNER/REPRESENTATIVE’S SIGNATURE DATE PHONE
TENANT: I UNDERSTAND THAT I MAY BE CHARGED FOR DAMAGES, REPAIRS AND REPLACEMENTS CAUSED BY
OTHER THAN NORMAL WEAR AND TEAR.
X
( )
TENANT’S SIGNATURE DATE NEW PHONE NUMBER
HAPP-M8 (6/97)
AUTORIDAD DE LA VIVIENDA DE LA CIUDAD DE LOS ANGELES
INSPECCION DE PRE-DESOCUPACION DE LA UNIDAD
ESTE NO ES UN RECLAMO DE DAÑOS
DOMICILIO DE
UNIDAD
______________________________________________
FECHA:
______________________
DUEÑO: Si su inquilino estaba bajo el Programa de Certificados y la fecha de comienzo del Contrato HAP fue antes del1 de
Enero de 1996, usted podría satisfacer los requisitos para presentar un reclamo con la Autoridad de la Vivienda. Para
presentar un reclamo, debe ponerse en contacto con su Asesor de la Sección 8 dentro de 48 horas de la desocupación. Usted
no tiene derecho a presentar un reclamo si regresa alguna parte del depósito de seguridad al inquilino.
☞
POR FAVOR GUARDE LA COPIA AZUL DE ESTE FORMULARIO.
☜
NOMBRE DE INQUILINO:
# DE CLIENTE: # DE VENDEDOR:
INQUILINO: Aunque usted está autorizado a mudarse a su nueva unidad, el nuevo contrato no puede empezar al menos que usted
haya desocupado por completo su unidad. Por favor haga arreglos con su propietario para completar este formulario.
☞
POR FAVOR REGRESE LAS COPIAS BLANCAS Y AMARILLAS DE ESTE FORMULARIO A SU ASESOR.
☜
EL DUEÑO (O REPRESENTANTE DEL DUEÑO) Y EL RESIDENTE CONJUNTAMENTE HAN INSPECCIONADO LA UNIDAD
ANTES MENCIONADA, LOS TERRENOS ASIGNADOS (SI LOS HAY), ESTUFA Y REFRIGERADOR (SI CORRESPONDE) Y
DETERMINAN QUE TODO ES:
ACEPTABLE
NO ACEPTABLE - INDIQUE DEFICIENCIAS A CONTINUACIÓN:
REFRIGERADOR:
ESTUFA:
COCINA:
COMEDOR:
SALA:
PASILLO (S):
BAOS:
RECAMARA:
RECAMARA:
RECAMARA:
OTROS:
CUARTOS:
GARAJE:
EXTERIOR:
DIA DE DEVOLUCIÓN DEPOSITO ORIGINAL DE SEGURIDAD: $
DE LLAVES:
☜
Interés en el Depósito de Seguridad(si hay): $
TOTAL = ORIGINAL + INTERES:
$
DUEÑO: USTED NO REUNE LOS REQUISITOS PARA PRESENTAR UN RECLAMO SI REGRESA ALGUNA PARTE DEL DEPOSITO DE
SEGURIDAD AL INQUILINO.
FECHA EN QUE FUE PAGADO EL ALQUILER:
.
DEPOSITO DE SEGURIDAD A REGRESAR:
$ .
COMENTARIOS:
X
( )
FIRMA DE DUEÑO/REPRESENTANTE FECHA TELEFONO
INQUILINO: ENTIENDO QUE SE ME PUEDE COBRAR POR DAÑOS, REPARACIONES, Y REEMPLAZOS CAUSADOS POR
MOTIVOS FUERA DEL USO Y DESGASTE NORMAL.
X
( )
FIRMA DE INQUILINO FECHA NUEVO NUMERO DE TELEFONO
HAPP-M8 (7/97)
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THIS IS NOT A DAMAGE CLAIM

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Completed 13 April 2021

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