Rental or Lease - Receipt for Monies Owed

[Street Address] [City/State/Zip]

Date: ________________________

To: __________________________
[Street Address]
[City/State/Zip]

RE: Unit # _______

The Owner hereby accepts payment in the amount of $ _______ for the following:

Rent from ________ to ________.............. $______

Late Fee : [Late Fee]........................$______

NSF Check Fee : [Bounce Check Fee]...........$______

Security Deposit.............................$______

Other ____________________________.......... $______

Other ____________________________.......... $______

Other ____________________________.......... $______

Other ____________________________.......... $______

TOTAL........................................$______

ALL CHECKS MUST BE MADE OUT TO [Fict./dba/Owner Name].

_________________________
Owner

_________________________
Tenant