THE UNDERSIGNED, as Lesee in that certain Lease Agreement executed concurrently herewith, as a condition for Lessor's execution of said Lease for the premises known as ________________________________________________________, and hereby agrees to the following:

1. Lesee shall deposit with the undersigned Lessor the sum of __________________________________________ Dollars ($________________________) as a security deposit to secure the faithful performance of Lessee's promises and duties contained herein and more particulary set forth in the Lease referred to above.

2. It is understood the deposit amount will not be used to cover the last month's rent and any other items. It is to be held by the LANDLORD to secure TENANT'S compliance with Lease terms and for application against damages as specified below.

3. The TENANT understands and acknowledges that the LANDLORD would suffer damages if this agreement is terminated before the expiration of the term provided for in the Lease. Therefore, the parties agree that if this lease agreement is terminated before the expiration of the term provided for, deposit money will be FORFEITED.

4. Upon termination of the tenancy created by said Lease, the Lessor may deduct from the security deposit amounts sufficient to pay:

a. Any damages to the premises for which Lessee is responsible.

b. Any unpaid bills which become a lien against the premises due to the Lessee's occupancy which may include, without limitation, electrical bills, fuel bills, phone charges, mechanics' or materialmen's liens, or any other types of liens or security interests created by Lesee.

c. Any costs of re-renting the premises after breach of the Lease by Lessee.

d. Any court costs incurred by Lessor connected with its terminating the tenancy or regaining possession of the premises.

e. Any costs incurred in cleaning the premises.

f. Any costs incurred in replacing any keys or locks for any reason.

g. Any late fees or penalties incurred by Lessee and unpaid at the time of termination.

h. Any other damages of Lessor which may then be a permitted use of the security deposit under the laws of the State of Kansas, including attorney’s fees.

5. Upon termination of the tenancy, a written itemization of any deductions from the security deposit and the reasons therefore together shall be mailed to the Lessee within 14 days of termination of tenancy. Any remaining deposit shall be refunded within 30 days of termination of lease.

6. If Lessee fails to provide forwarding address at termination of the tenancy, Lessor shall not be responsible for any failure to refund deposit. Deposit will be refunded as required by the Tenant-Landlord Act, however, it is not possible to mail a refund if we do not have a forwarding address.

7. If Lessee breaks the lease in any way and owes money to the LANDLORD, this will be reported to the credit bureau. The amount owed will appear on Lessee's permanent credit record as an unpaid collection.

8. I understand that the deposit will be forfeited if tenant changes their mind and no longer wishes to rent the dwelling. In addition, rent for any days apartment was held will be due and payable.

9. If the Early Termination Clause is utilized, the following applies: a. under 3 months , lose all deposit; b. 3 to 6 months, lose one-half deposit; c. over 6 months, deposit refund is based on all other terms of the lease.

10. Should the deposit be seized or garnished, the lease will be terminated immediately.

I have read the above and accept its terms.

Tenant _________________________________ Date_____________________

Landlord________________________________ Date_____________________

Date of occupancy _____________________

A downloadable copy of this agreement can be obtained in one of the formats below. Click on the link in the appropriate format needed: