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HUD 90106 Appendix 5 - Sample Move-In/Move Out Inspection Form
ICR 200902-2502-005 · OMB 2502-0204 · Object 10508102.
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4350.3 REV1 Appendix 5 OMB Approval 2502-0204 Exp. 04/30/2009 Appendix 5: Move-In/Move-Out Inspection Form [Company name] [Company address] Property Apartment No. Item Resident Unit Size Move-In Inspection Date Cost to Correct Condition Move-In Move-Out Inspection Date Move-Out ENTRANCE/HALLS Steps and landings Handrails Doors Hardware/Locks Floors/Coverings Walls/Coverings Ceilings Windows/Coverings Lighting1 Electrical Outlets Closets2 Fire alarms/equipment LIVING ROOM Floor/Coverings Walls/Coverings Ceiling Windows/Covering Lighting1 Electrical outlets 1 of 4 Form HUD-90106 12/2007 4350.3 REV-1 Appendix 5 OMB Approval 2502-0204 Exp. 04/30/2009 Item Condition Move-In Cost to Correct Move-Out DINING ROOM Floor/Coverings Walls/Coverings Ceiling Windows/Coverings Lighting1 Electrical outlets KITCHEN Range Refrigerator Sink/Faucets3 Floor/Coverings Walls/Coverings Ceiling Windows/Coverings Lighting1 Electrical outlets Cabinets Closets/Pantry2 Exhaust fan Fire alarms/equipment BEDROOM(S) Doors and locks Floor/Coverings Walls/Coverings Ceiling Windows/Covering Closets2 Lighting1 Electrical outlets 2 of 4 Form HUD-90106 12/2007 4350.3 REV-1 Appendix 5 OMB Approval 2502-0204 Exp. 04/30/2009 Item Cost to Correct Condition Move-In Move-Out BATHROOM(S) Sink/Faucets3 Shower/Tub3 Curtain rack/Door Towel rack Toilet Doors/Locks Floor/Coverings Walls/Coverings Ceiling Windows/Coverings Closets2 Cabinets Exhaust fan Lighting1 Electrical outlets OTHER EQUIPMENT Heating Equipment Air-conditioning unit(s) Hot-water heater Smoke/Fire alarms Thermostat Door bell TOTAL 1. Fixtures, Bulbs, Switches, and Timers 2. Floor/Walls/Ceiling, Shelves/Rods, Lighting 3. Water pressure and Hot water 3 of 4 Form HUD-90106 12/2007 4350.3 REV-1 Appendix 5 OMB Approval 2502-0204 Exp. 04/30/2009 Move-In Move-Out This unit is in decent, safe and sanitary condition. Any deficiencies identified in this report will be remedied within 30 days of the date the tenant moves into the unit. _______________________________ Manag er's Signature _______________________________ Manag er's Signature Agree with move-out inspection Disagree with move-out inspection I have inspected the apartment and found this unit to be in decent, safe and sanitary condition. Any deficiencies are noted above. I recognize that I am responsible for keeping the apartment in good condition, with the exception of normal wear. In the event of damage, I agree to pay the cost to restore the apartment to its original condition. If disagree, list specific items of disa greement. _______________________________ Re sident's Signature _______________________________ Re sident's Signature _______________________________ Re sident's Signature _______________________________ Re sident's Signature By Date By Prepared Prepared Reviewed Reviewed Prepared Prepared Reviewed Reviewed Date Public reporting burden - HUD is not requesting approval of any burden hours for the move-in/move-out inspection report since use of movein/move-out inspection reports are a standard business practice in the housing rental industry. This information is required to obtain benefits and is voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. The owner/management agent and tenant together conduct a move-in/move-out inspection to document the condition of the unit at the time of move-in/move-out. Conducting move-in/move-out inspections are a standard business practice in the housing rental industry and are used for determining damages caused by the tenant during tenancy and allowable deductions from the tenant’s security deposit held by the owner. This information is authorized by 24 CFR 5.703 and 5.705, 886.123, 886.223 cover unit inspections. This information is considered nonsensitive and does not require any special protection. 4 of 4 Form HUD-90106 12/2007
| File Type | application/pdf |
| File Title | Appendix 5: Move-In/Out Inspection Form |
| Author | Caroline McCarthy |
| File Modified | 2009-04-02 |
| File Created | 2008-04-07 |