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Address: _____________________________________________  Date:__________

We are scheduled to do our semi annual home inspection of your premises on the following date ___________________.   We will be inspecting the following areas and items to see if they are in the same clean satisfactory condition as when you moved in. We again thank you for your cooperation.

                        Satisfactory                                          Satisfactory

                        Yes      No                                           Yes      No

Entrance Door                                                         Bedroom #1                           

Knocker/Bell                                                           Ceiling                                   

Peephole                                                                   Walls                                     

Deadbolt Lock                                                       Floors                                    

Living Room                                                            Windows                                           

Ceiling                                                                         Screen                                    

Walls                                                                            Elec. Fixtures                         

Floors                                                                          Bedroom #2                           

Windows                                                                   Ceiling

Screen                                                                        Screen                                       

Elec. Fixtures                                                        Floors 

Din Rm/Bedrms #3                                           Window

Ceiling                                                                       Screen                                    

Walls                                                                          Elec. Fixtures                         

Floors                                                                        Bathroom                               

Windows                                                                Ceiling                                   

Screen                                                                    Walls                                     

Elec. Fixtures                                                     Floors                                    

Kitchen                                                                  Windows                     _                    

Stove                                                                      Screen                                    

Refrigerator                                                      Elec. Fixtures                         

Cabinets                                                              Medicine Cab.                       

Sink                                                                        Mirror                                    

Counter Tops                                                   Tub                                        

Ceiling                                                                  Sink                                       

Walls                                                                     Shower                                  

Floors                                                                   General                                              

Windows                                                            Porch/Balcony                       

Screen                                                                 Heating System                                  

Elec. Fixtures                                                  Water Heater                          

General                                                                Front Yard                             

Back Door                                                          Back Yard                             

Mail Box                                                              Garage/Driveway                               

Special Remarks (Cleaning or Repairs needed)                                                        

Resident has been given a copy of this report and can give any explanation if he or she so desires on the back of this form.  Tenant will be held responsible for any detriment or damage to the property reported that was not present at original move-in date.

Owner/Manager                                                                                   Date

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