RESIDENTIAL MONTH-TO-MONTH LEASE

AGREEMENT
I. THE PARTIES. This residential lease agreement ("Agreement"), dated
_______________________________, 20_____, by and between:

LANDLORD: The Landlord is an individual known as Tomas Alicea of 12216 Valleywood Drive,
Wheaton, Maryland, 20902, hereinafter known as the "Landlord", and

TENANT(S): An individual known as Drew Simpson, hereinafter known as the "Tenant(s)", agree to
the following:

II. OCCUPANT(S). The Premises described in Section III is to be occupied strictly as a residential
dwelling by the Tenant(s) and no other individuals ("Occupant(s)").

III. LEASED PREMISES. The Landlord hereby rents to the Tenant(s), subject to the terms and
conditions of this Agreement, a room in a shared living situation with a property and mailing address of
12216 Valleywood Drive, Wheaton, Maryland, 20902, consisting of 1 bathroom(s) and 1 bedroom(s)
(the "Premises"). The Landlord shall send the Tenant(s) any notices to the Premises' aforesaid mailing
address.

IV. PURPOSE. The Tenant(s) and any Occupant(s) may only use the Premises as a residential
dwelling. It may not be used for storage, manufacturing of any type of food or product, professional
service(s), or for any commercial use, unless otherwise stated in this Agreement.

V. FURNISHINGS. The Premises is furnished with the following:

Bedroom Set, Dining Room Set, Kitchen Set (Including Pots, Pans, Glasses, Mugs, Dishes, etc.),
Living Room Set, Rugs and Carpets (Not Wall-to-Wall), Shelving Unit, all of which shall be on the
Premises upon the move-in date of the Tenant(s) ("Furnishings").

Any damage caused by the Tenant(s) to the Furnishings from negligence, carelessness, accidents, or
abuse shall be the responsibility of the Tenant(s).

VI. APPLIANCES. The Landlord shall provide the following appliances:

Air Conditioner Equipment, Boiler(s), Dishwasher, Dryer (for laundry), Fan(s), Furnace, Garbage
Disposal, Lighting Fixtures, Microwave, Oven, Refrigerator, Smoke Detector(s), Stove, Thermostats
and Controls, Washer (for laundry), all of which shall be on the Premises and functional upon the
move-in date of the Tenant(s) ("Appliances and Fixtures").

Any damage caused by the Tenant(s) to the Appliances and Fixtures from negligence, carelessness,
accidents, or abuse shall be the responsibility of the Tenant(s).

VII. LEASE TERM. The term of this Agreement shall be a month-to-month arrangement (tenancy-at-
will) beginning on __________________________, and ending at any time the Landlord or Tenant(s)
terminates the Agreement in the manner described in Section XXVII ("Lease Term").
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VIII. RENT. Tenant(s) shall pay the Landlord a monthly rent of $1,200.00 ("Rent"). The Rent will be
due on the First (1st) of every month ("Rent Due Date"), and Rent shall be paid via the following
instructions:

Rental payments may be made by the following means (in the preferred order):
Cash
Check
Venmo (To simplify my tax-filing, please DO NOT use the word "Rent" in the payment)
Paypal (To simplify my tax-filing, please indicate that the money is NOT for goods or services)
Zelle (To simplify my tax-filing, please indicate that the money is NOT for goods or services)

IX. NON-SUFFICIENT FUNDS (NSF CHECKS). If the Tenant(s) attempts to pay Rent with a
check, electronic transaction, or through any other means authorized by this Agreement, that fails to
clear the transaction of Rent funds due to non-sufficient funds ("NSF"), there shall be no fee.

X. LATE FEE. If the Tenant(s) fails to pay Rent on the Rent Due Date, there shall be a late fee
assessed by the Landlord in the amount of:

5% percent of Rent per occurrence for each Rent payment that is late after the 7th day following the
Rent Due Date.

XI. FIRST (1ST) MONTH'S RENT. First (1st) month's Rent payment shall be due by the Tenant(s)
upon the execution of this Agreement.

XII. PRE-PAYMENT. The Landlord shall not require any pre-payment of Rent by the Tenant(s).

XIII. PRORATION PERIOD. The Tenant(s) will not move into the Premises before the start of the
Lease Term.

XIV. SECURITY DEPOSIT. A security deposit in the amount of $1,200.00, which is equal to one
month's Rent, shall be required from the Tenant(s) at the execution of this Agreement for the faithful
performance of all its terms and conditions ("Security Deposit"). The Security Deposit shall be returned
to the Tenant(s) within 30 days after this Agreement has terminated. The Security Deposit shall be
returned in full, and in the manner prescribed by state and local laws, upon the end or termination of
the Lease Term, unless the Landlord intends on imposing a claim on the Security Deposit for any
damages. The Security Deposit shall not be credited towards Rent unless the Landlord gives their
written consent. See attached move-in inspection.

XV. POSSESSION. Tenant(s) shall make reasonable efforts to examine the condition of the Premises
before taking possession. Once the Tenant(s) takes possession of the Premises, the Tenant(s)
acknowledges the Premises is in acceptable order and consents to take possession of the Premises in its
current condition unless otherwise stated herein. Failure of the Landlord to deliver possession of the
Premises to the Tenant(s) at the start of the Lease Term shall terminate this Agreement at the option of
the Tenant(s). Furthermore, under such failure to deliver possession by the Landlord, and if the
Tenant(s) opts to cancel this Agreement, any Security Deposit required under Section XIV of this
Agreement shall be returned to the Tenant(s) along with any other pre-paid Rent and fees, including
any fees paid by the Tenant(s) in connection with the application process before the execution of this
Agreement.

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XVI. OPTION TO PURCHASE. The Tenant(s) shall NOT have the right to purchase the Premises
unless the Landlord and Tenant(s) agree otherwise in writing.

XVII. ACCESS. Upon the start of the Proration Period or the Lease Term, whichever is earlier, the
Landlord agrees to give access to the Tenant(s) in the form of keys, fobs, cards, or any type of keyless
security entry device needed to enter the Premises and any designated common areas. Duplicate copies
of the access forms hereof may be authorized only under the consent of the Landlord, and, if any
replacements are needed, the Landlord may provide them for a reasonable fee. At the end of this
Agreement, any keys, fobs, cards, or keyless entry devices provided to the Tenant(s) shall be returned
to the Landlord or a fee will be billed directly to the Tenant(s) or deducted from the Security Deposit.

XVIII. MOVE-IN INSPECTION. Before the Tenant(s) accepts possession as described in Section
XV of this Agreement, or shortly thereafter if agreed upon, the Landlord and Tenant(s) shall perform an
inspection documenting the present condition of all Appliances, Fixtures, Furnishings, and any existing
damage within the Premises.

XIX. SUBLETTING. The Tenant(s) shall NOT have the right to sublet the Premises or any part
thereof without the prior written consent of the Landlord. If consent is granted by the Landlord, the
Tenant(s) will be responsible for all actions and liabilities of the sublessee, including but not limited to
any damage to the Premises, nonpayment of Rent, and eviction procedures. In the event of an eviction,
the Tenant(s) shall be responsible for all court filing fees, legal representation, and any other fees
associated with removing the sublessee. The express written consent from the Landlord for one sublet
agreement shall not authorize consent for any subsequent sublet agreements, and in such case, the
Tenant(s) must seek consent from the Landlord for the subsequent sublet agreement.

XX. ABANDONMENT. If the Tenant(s) abandons or otherwise vacates the Premises for a period
equal to the minimum period set by state law or seven (7) days, whichever is less, the Landlord shall
have the right to terminate this Agreement immediately and remove all personal belongings, including
any personal property of the Tenant(s), from the Premises in the manner prescribed by state and local
laws.

XXI. ASSIGNMENT. The Tenant(s) shall NOT assign or otherwise transfer the residential lease
interest described in this Agreement without first obtaining the written consent of the Landlord. Written
consent from the Landlord for one assignment shall not authorize consent for any subsequent
assignments, and in such case, the Tenant(s) must seek consent from the Landlord for subsequent
assignments.

XXII. PARKING. The Landlord shall not provide parking to the Tenant(s).

XXIII. RIGHT OF ENTRY. The Landlord shall have the right to enter the Premises during normal
working hours by providing notice in accordance with the minimum state requirements in order to
conduct inspections, make necessary repairs, alterations or improvements, supply services as
previously agreed, and for any other reasonable purposes. The Landlord may exhibit the Premises to
prospective purchasers, mortgagees, or lessees upon reasonable notice to the Tenant(s).

XXIV. SALE OF PROPERTY. If the Premises is sold, the Tenant(s) is to be notified of the new owner
and the new property manager, if any, and their contact details for repairs and maintenance shall be
forwarded to the Tenant(s). If the Premises is conveyed to another party, the new owner shall not have

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the right to terminate this Agreement and it shall continue under the terms and conditions agreed upon
by the Landlord and Tenant(s).

XXV. UTILITIES. The Landlord agrees to pay for the following utilities and services:

Electricity, Lawn Care, Sewage, Snow Removal, Trash Removal, all of which shall be provided by the
Landlord ("Utilities and Services"). All other utilities and services will be the shared responsibility of
the Tenant(s) and The Landlord.

XXVI. MAINTENANCE, REPAIRS, OR ALTERATIONS. The Tenant(s) at all times shall, at their
own expense unless otherwise stated in this Agreement, maintain the Premises in a clean and sanitary
manner, and shall surrender the same at termination hereof, in as good condition as received, normal
wear and tear excepted. The Tenant(s) may not make any alterations to the Premises without the written
consent of the Landlord. The Landlord shall be responsible for structural repairs to defects in the
interior and exterior of the Premises.

The Landlord shall place fresh batteries in all battery-operated smoke detectors before the Tenant(s)
moves into the Premises. After the initial placement of the fresh batteries, it is the responsibility of the
Tenant(s) to replace batteries if and when needed. Additionally, a monthly cursory inspection may be
required for all fire extinguishers to make sure they are fully operational and charged.

XXVII. TERMINATION. The Lease Term of this Agreement shall continue until the Landlord or
Tenant(s) furnishes unto the other party at least 30 days' notice, in writing, of the Landlord's or
Tenant's(s') intent to terminate this Agreement.

XXVIII. PETS. The Tenant(s) shall not be allowed to have pets on the Premises or common areas
except those that are necessary for individuals with disabilities.

XXIX. WASTE. The Tenant(s) agrees not to commit waste on the Premises, maintain, or permit to be
maintained, a nuisance thereon, or use, or permit the Premises to be used, in an unlawful manner.

XXX. NOISE. The Tenant(s) agrees to abide by any and all local, county, and state noise ordinances.

XXXI. GUESTS. There shall be no other persons living on the Premises other than any authorized
Tenant(s) and Occupant(s). Guests of the Tenant(s) are allowed to visit and stay on the Premises for a
period of no more than forty-eight hours, unless the Landlord approves otherwise ("Guest(s)").

XXXII. SMOKING POLICY. Smoking on the Premises is permitted but only in the following areas:
Outside

XXXIII. COMPLIANCE WITH LAW. For the entire duration of the Lease Term, the Tenant(s)
agrees to comply with any present and future laws, ordinances, orders, rules, regulations, and
requirements of the federal, state, county, city, and municipal governments or any of their departments,
bureaus, boards, commissions, and officials thereof with respect to the Premises, or the use or
occupancy thereof, whether said compliance shall be ordered or directed to or against the Tenant(s), the
Landlord, or both.

XXXIV. DEFAULT. If the Tenant(s) fails to comply with any of the financial, material, or
miscellaneous provisions of this Agreement, or any present rules and regulations of the tenancy under
this Agreement in general that may be hereafter prescribed by the Landlord, or materially fails to

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comply with any duties imposed on the Tenant(s) by statute, regulations, ordinances, orders, or any
other mandates imposed by federal, state, and local governments, within the timeframe after delivery of
a written notice to quit by the Landlord specifying noncompliance with this Agreement and indicating
the intention of the Landlord to terminate the Agreement by reason thereof, the Landlord may terminate
this Agreement. If the Tenant(s) fails to pay Rent upon the Rent Due Date, and the default continues for
the timeframe specified in the written notice to quit thereafter, the Landlord may, at their option,
declare the entire balance (compiling all months applicable to this Agreement) of Rent payable
hereunder to be immediately due. The Landlord may exercise any and all rights and remedies available
to the Landlord at law or in equity, and the Landlord may terminate this Agreement immediately by
exercising the rights and remedies thereof.

The Tenant(s) shall be in default if any of the following applies: (a) Tenant(s) does not pay Rent on the
Rent Due Date and after the state- or locally-mandated grace period, if any, or if the Tenant(s) fails to
pay any other dues owed in accordance with respective local and state laws and this Agreement; (b)
Tenant(s), Occupant(s), or any Guest(s) thereof, violate the terms and conditions of this Agreement, or
any local ordinances, fire-safety or health codes, or violate any criminal laws, regardless of whether
arrest or conviction occurs; (c) Tenant(s) abandons the Premises as described in Section XX of this
Agreement; (d) Tenant(s) gives incorrect or false information in their rental application, if any; (e)
Tenant(s), Occupant(s), or Guest(s) thereof, is arrested, convicted, or given deferred adjudication for a
criminal offense involving actual or potential physical harm to a person, or involving possession,
manufacture, or delivery of a controlled substance, marijuana, or drug paraphernalia under state statute;
(f) any illegal drugs or paraphernalia are found in the Premises or on the person of the Tenant(s),
Occupant(s), or Guest(s) thereof, while on the Premises; and (g) as otherwise allowed by local, state,
and federal law.

XXXV. MULTIPLE TENANT(S) OR OCCUPANT(S). Each individual that is considered a

Tenant(s) or Occupant(s) in this Agreement is jointly and individually liable for all of this Agreement's
obligations, including but not limited to Rent monies. If any Tenant(s), Occupant(s), or guests thereof,
violates this Agreement, the Tenant(s) is considered to have violated this Agreement. Landlord’s
requests and notices to the Tenant(s) or any of the Occupant(s) of legal age constitutes notice to the
Tenant(s). Notices and requests from the Tenant(s), or anyone of the Occupant(s), including repair
requests and entry permissions, constitutes notice from the Tenant(s). In eviction suits, the Tenant(s) is
considered the agent of the Premises for the service of process.

XXXVI. DISPUTES. If a dispute arises during or after the Lease Term between the Landlord and
Tenant(s), they shall agree to hold negotiations amongst themselves in "good faith" before any
litigation.

XXXVII. SEVERABILITY. If any provision of this Agreement or the application thereof shall, for
any reason and to any extent, be invalid or unenforceable, neither the remainder of this Agreement, nor
the application of the provision to other persons, entities, or circumstances shall be affected thereby, but
instead, shall be enforced to the maximum extent permitted by law.

XXXVIII. SURRENDER OF PREMISES. The Tenant(s) has surrendered the Premises when (a) the
move-out date has passed and no persons are living in the Premises within the Landlord’s reasonable
judgment, or (b) access to the Premises has been turned to Landlord, whichever of (a) or (b) comes
first. Upon the expiration of the Lease Term, the Tenant(s) shall surrender the Premises in better or
equal condition as it was at the commencement of this Agreement, albeit with reasonable use, wear-
and-tear, and damages caused by the natural elements excepted.

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XXXIX. RETALIATION. The Landlord is prohibited from making any type of retaliatory acts against
the Tenant(s), including, but not limited to, restricting access to the Premises, decreasing or canceling
Utilities and Services, failure to repair Appliances and Fixtures, or any other deliberate acts that could
be considered unjustified and retaliatory against the Tenant(s).

XL. WAIVER. The Landlord's waiver of a breach of any covenant or duty imposed on the Tenant(s)
under this Agreement shall not constitute, or be construed as, a waiver of a breach of any other
covenant or duty imposed on the Tenant(s), or of any subsequent breach of the same covenant or duty.
No provision, covenant, or clause of this Agreement shall be considered waived unless such a waiver is
expressed in writing as a formal amendment to this Agreement and executed by the Tenant(s) and
Landlord.

XLI. EQUAL OPPORTUNITY. The Landlord shall make reasonable accommodations in rules,
policies, practices, and services under this Agreement for Tenant(s) or Occupant(s) with a proven
record of a physical or mental "handicap" as defined in 42 U.S.C.A. §§ 3604-3607 ("Handicaps"),
provided such accommodations are reasonably within the Landlord's financial and practical means. The
Landlord may issue consent to the Tenant(s) to make reasonable modifications to the Premises, at the
Tenant(s) expense, to afford the Tenant(s) or any Occupant(s) with Handicaps the full enjoyment of the
Premises. Any Handicaps of the Tenant(s) or Occupant(s) should be disclosed and presented to the
Landlord, in writing, in order to seek the most appropriate route for providing any accommodations to
the Premises. Landlord shall not discriminate against the Tenant(s) with Handicaps during the course of
the Lease Term or in the rental application process. Further, the Landlord shall not discriminate against
the Tenant(s) during the Lease Term or in the rental application process based on race, color, national
origin, religion, sex, familial status, or any other status protected by law.

XLII. HAZARDOUS MATERIALS. The Tenant(s) agrees not to possess any type of personal
property that could be considered a fire hazard on the Premises, such as a substance with highly
flammable or explosive characteristics. Items prohibited from being brought into the Premises, other
than for everyday cooking or those needed for operating an appliance, includes, but is not limited to,
compressed gas, gasoline, fuel, propane, kerosene, motor oil, fireworks, or any other similar item or
related substance in the form of a liquid, solid, or gas.

XLIII. WATERBEDS. The Tenant(s) is not permitted to furnish the Premises with waterbeds.

XLIV. INDEMNIFICATION. The Landlord shall not be liable for any damage or injury to the
Tenant(s), Occupant(s), any Guest(s), or any other persons, nor shall Landlord be liable for any damage
to any property that occurs on the Premises, its common areas, or any part thereof, and the Tenant(s)
agrees to hold the Landlord harmless from any claims or damages unless caused solely by the
Landlord's negligence. It is therefore recommended Tenant(s), at their expense, purchase renter's
insurance.

XLV. COVENANTS. The covenants and conditions herein contained shall apply to and bind the heirs,
legal representatives, and assigns of the parties hereto, and all covenants are to be construed as
conditions of this Agreement.

XLVI. NOTICES. Any notice sent from the Landlord or the Tenant(s) to the other party shall be
addressed to the underneath mailing addresses.

Landlord's Mailing Address and Contact Information:

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Tomas Alicea
12216 Valleywood Drive, Wheaton, Maryland, 20902
Phone Number: N/A Email: N/A

Tenant's(s') Mailing Address:

Drew Simpson
12216 Valleywood Drive, Wheaton, Maryland, 20902

Landlord's Agent / Property Manager: The Landlord does not have or otherwise authorize an agent
or property manager, and all contact with regards to any repair, maintenance, or complaint must be
communicated directly to the Landlord using the above-mentioned contact information.

XLVII. PREMISES DEEMED UNINHABITABLE. If the Premises is deemed uninhabitable due to

damages beyond reasonable repair, the Tenant(s) shall be able to terminate this Agreement by written
notice to the Landlord. If said damage was caused by negligence of the Tenant(s), Occupant(s), or their
Guest(s), the Tenant(s) shall be liable to the Landlord for all pertinent repairs and for the loss of income
due to restoring the Premises back to a livable condition in addition to any other losses that can be
proved by the Landlord.

XLVIII. SERVICEMEMBERS CIVIL RELIEF ACT. In the event the Tenant(s) is currently, or
hereafter becomes, a member of the United States Armed Forces on extended active duty and hereafter
the Tenant(s) receives permanent change of station (PCS) orders to depart from the area where the
Premises is located, or is relieved from active duty, retires or separates from the military, is ordered into
military housing, or receives deployment orders, then in any of these events, the Tenant(s) may
terminate this Agreement by giving thirty (30) days' written notice to the Landlord. The Tenant(s) shall
also furnish unto the Landlord a copy of the official orders, or a letter signed by the commanding
officer of the Tenant(s), reflecting the change that warrants termination of this Agreement under this
clause. The Tenant(s) shall pay prorated Rent for any days in which the Tenant(s) occupies the Premises
past the beginning of the Lease Term. Further, any Security Deposit shall be returned, deducted, or
otherwise retained in accordance with Section XIV of this Agreement.

XLIX. LEAD-BASED PAINT. The Premises was constructed before 1978 and therefore the Lead-
Based Paint Disclosure that is attached to this Agreement must be authorized.

L. GOVERNING LAW. This Agreement shall be subject to and governed by the laws of the State of
Maryland.

LI. AGENCY RELATIONSHIP. Neither the Landlord nor the Tenant(s) utilized the services of a real
estate agency or a real estate agent to negotiate, draft, or execute this Agreement.

LII. ADDITIONAL TERMS AND CONDITIONS. There are no further terms or conditions that will
be added to this Agreement other than any attachments or addendums attached.

LIII. ENTIRE AGREEMENT. This Agreement contains all the terms, conditions, covenants, and
provisions agreed on by the Landlord, Tenant(s), and any other relevant party to this Agreement,
relating to its subject matter, including any attachments or addendums. This Agreement replaces any
and all previous discussions, understandings, and oral agreements. The Landlord and Tenant(s) agree to
this Agreement and shall be bound until the end of the Lease Term.

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The parties have agreed and duly executed this Agreement on _______________________________,
20_____.

Landlord's Signature: _____________________________

Tomas Alicea

Tenant's Signature: _____________________________

Drew Simpson

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 AGREEMENT TO GUARANTEE THIS LEASE
In consideration of the execution of this Agreement by and between Landlord and Tenant(s) and for
valuable and good consideration, the receipt of which is hereby acknowledged, Martin Simpson,
hereinafter known as the “Guarantor(s)”, hereby unconditionally guarantee to Landlord and Landlord’s
agents, successors and assigns, the prompt payment of Rent or other sums that become due pursuant to
this Agreement, including any and all court costs and attorney fees included in enforcing the Agreement
and consent to any changes, modifications or alterations of any terms, conditions, covenants, or
provisions in this Agreement agreed to by Landlord and Tenant(s) along with waiving any rights to
require Landlord and Landlord’s agents, if any, to proceed against the Tenant(s) for any default
occurring under this Agreement before seeking to enforce this Guarantee.

Guarantor's Signature: _____________________________

Martin Simpson

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 AMOUNT ($) DUE AT SIGNING

Security Deposit: $1,200.00

First (1st) Month's Rent: $1,200.00

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 MOVE-IN CHECKLIST
Property Address: 12216 Valleywood Drive, Wheaton, Maryland, 20902.
Unit Size: 1 Bedroom(s), 1 Bathroom(s).

Move-In Inspection Date: _______________ Move-Out Inspection Date: _______________

In the underneath fields, describe the condition of the space within the Premises along with any specific
damage and repairs needed. Be sure to include any specific damage, such as paint chipping, wall
damage, crack surfaces, and any lessened area or item that could be regarded as damaged at the end of
the Lease Term.

The following abbreviations may be used to fill-out this checklist:

GC - Good Condition; NA - Not Applicable; NC - Needs Cleaning; NR - Needs Repairs;

NP - Needs Painting; SC - Scratched or Cracked; NP - Needs Replacing; NF - Not Functional.

LIVING ROOM
Floors

Condition ________________ Specific Damage __________________________

Walls

Condition ________________ Specific Damage __________________________

Doors

Condition ________________ Specific Damage __________________________

Ceiling

Condition ________________ Specific Damage __________________________

Windows

Condition ________________ Specific Damage __________________________

Light Fixtures

Condition ________________ Specific Damage __________________________

Electrical Outlets

Condition ________________ Specific Damage __________________________

Shades

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Condition ________________ Specific Damage __________________________

Screens

Condition ________________ Specific Damage __________________________

Closet

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

DINING ROOM
Floors

Condition ________________ Specific Damage __________________________

Walls

Condition ________________ Specific Damage __________________________

Doors

Condition ________________ Specific Damage __________________________

Ceiling

Condition ________________ Specific Damage __________________________

Windows

Condition ________________ Specific Damage __________________________

Light Fixtures

Condition ________________ Specific Damage __________________________

Electrical Outlets

Condition ________________ Specific Damage __________________________

Shades

Condition ________________ Specific Damage __________________________

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Screens

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

KITCHEN AREA
Stove and Oven

Condition ________________ Specific Damage __________________________

Refrigerator

Condition ________________ Specific Damage __________________________

Sink and Faucets

Condition ________________ Specific Damage __________________________

Cabinets

Condition ________________ Specific Damage __________________________

Counters

Condition ________________ Specific Damage __________________________

Drawers

Condition ________________ Specific Damage __________________________

Exhaust Fan and Light

Condition ________________ Specific Damage __________________________

Fire Alarm(s)

Condition ________________ Specific Damage __________________________

Floors

Condition ________________ Specific Damage __________________________

Walls

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Condition ________________ Specific Damage __________________________

Doors

Condition ________________ Specific Damage __________________________

Ceiling

Condition ________________ Specific Damage __________________________

Windows

Condition ________________ Specific Damage __________________________

Light Fixtures

Condition ________________ Specific Damage __________________________

Electrical Outlets

Condition ________________ Specific Damage __________________________

Curtains

Condition ________________ Specific Damage __________________________

Screens

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

BEDROOM(S)
Floors

Condition ________________ Specific Damage __________________________

Walls

Condition ________________ Specific Damage __________________________

Doors

Condition ________________ Specific Damage __________________________

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Ceiling

Condition ________________ Specific Damage __________________________

Windows

Condition ________________ Specific Damage __________________________

Light Fixtures

Condition ________________ Specific Damage __________________________

Electrical Outlets

Condition ________________ Specific Damage __________________________

Shades

Condition ________________ Specific Damage __________________________

Screens

Condition ________________ Specific Damage __________________________

Closet

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

BATHROOM(S)
Sinks and Faucets

Condition ________________ Specific Damage __________________________

Shower / Tub

Condition ________________ Specific Damage __________________________

Mirror(s)

Condition ________________ Specific Damage __________________________

Towel Rack

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Condition ________________ Specific Damage __________________________

Toilet

Condition ________________ Specific Damage __________________________

Floors

Condition ________________ Specific Damage __________________________

Walls

Condition ________________ Specific Damage __________________________

Doors

Condition ________________ Specific Damage __________________________

Ceiling

Condition ________________ Specific Damage __________________________

Windows

Condition ________________ Specific Damage __________________________

Light Fixtures

Condition ________________ Specific Damage __________________________

Electrical Outlets

Condition ________________ Specific Damage __________________________

Closets / Cabinets

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

MECHANICAL
Heating

Condition ________________ Specific Damage __________________________

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AC Unit(s)

Condition ________________ Specific Damage __________________________

Hot Water Heater

Condition ________________ Specific Damage __________________________

Smoke Alarm(s) and Smoke Detector(s)

Condition ________________ Specific Damage __________________________

Door Bell

Condition ________________ Specific Damage __________________________

Furnace

Condition ________________ Specific Damage __________________________

Thermostat(s)

Condition ________________ Specific Damage __________________________

Other

____________ | Condition _____________ Specific Damage__________________________

____________ | Condition _____________ Specific Damage__________________________

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I, the undersigned and primary or only Tenant(s) of this Agreement, have sufficiently inspected the
Premises and confirm above-stated information. Tenant(s) understand that unless otherwise stated
herein, damages may be the responsibility of the Tenant(s) and may be deducted from any Security
Deposit in accordance with the terms of this Agreement and by law.

Tenant's Signature: _____________________________

Print Name: _____________________________

I, the undersigned Landlord of this Agreement, have sufficiently inspected the Premises and confirm
above-stated information.

Landlord's Signature: _____________________________

Print Name: _____________________________

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 LEAD-BASED PAINT DISCLOSURE
Disclosure of Information on Lead-Based Paint and Lead-Based Paint Hazards Lead Warning
Statement

WARNING! LEAD FROM PAINT, DUST, AND SOIL CAN BE DANGEROUS IF NOT
MANAGED PROPERLY.

Housing built before 1978 may contain lead-based paint. Lead from paint, paint chips, and dust can
pose health hazards if not managed properly. Lead exposure is especially harmful to young children
and pregnant women. Before renting pre-1978 housing, lessors must disclose the presence of known
lead-based paint and/or lead-based paint hazards in the dwelling. Lessees must also receive a federally
approved pamphlet on lead poisoning prevention.

Landlord acknowledges that Landlord has been informed of Landlord's obligations. Landlord is aware
that Landlord must retain a copy of this disclosure for not less than three years from the
commencement of the Lease Term.

Landlord's / Lessor’s Disclosure:

(a) Presence of lead-based paint and/or lead-based paint hazards (check (i) or (ii) below):

(i) ______ Known lead-based paint and/or lead-based paint hazards are present in the housing
(explain): ______________________________________________________________

(ii) _____ Landlord has no knowledge of lead-based paint and/or lead-based paint hazards in
the housing.

(b) Records and reports available to the Landlord (check (i) or (ii) below):

(i) ______ Landlord has provided the lessee with all available records and reports pertaining to
lead-based paint and/or lead-based paint hazards in the housing (list documents below).
______________________________________________________________________

(ii) _____ Landlord has no reports or records pertaining to lead-based paint and/or lead-based
paint hazards in the housing.

Tenant(s) / Lessee’s Acknowledgment (Initial):

(c) ________ Tenant(s) has received copies of all information listed above.

(d) ________ Tenant(s) has received the pamphlet Protect Your Family From Lead in Your
Home.

(e) ________ Tenant(s) has read the Lead Warning Statement above and understands its
contents.

Agent’s Acknowledgment (If Any) (Initial):

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 (f) ________ Each real estate agent has informed the Landlord of the Landlord’s obligations
under 42 U.S.C. 4852(d) and Landlord is aware of their responsibility to ensure compliance.

Certification of Accuracy:

The following parties have reviewed the information above and certify, to the best of their knowledge,
that the information they have provided is true and accurate.

Landlord's Signature: _____________________________

Tenant's Signature: _____________________________

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