Records the condition of the home, the keys, the meter readings and the furniture and appliances on the day it changes hands.
for the home at ______________________________
City of ____________, date ____________ 20___, time ___:___
Under the agreement dated ____________ 20___ (lease / daily rental / sale), ______________________________ (who hands over) hands over, and ______________________________ (who receives) receives, the home at the address above.
Overall condition: ☐ good ☐ needs cosmetic repair ☐ other: ______________________________
Remarks (walls, floors, ceilings, windows, doors, plumbing, wiring): ______________________________
| Item | Number |
|---|---|
| Building entrance keys | |
| Apartment door keys | |
| Intercom keys / fobs | |
| Mailbox key | |
| Gate or parking remotes | |
| Other: |
| Meter | Meter No. | Reading |
|---|---|---|
| Electricity, day rate | ||
| Electricity, night rate | ||
| Gas | ||
| Cold water | ||
| Hot water | ||
| Other: |
| No. | Item | Number | Condition | Remarks |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 | ||||
| 9 | ||||
| 10 |
Photos or video taken on this date: ☐ yes, ___ files, kept by both sides ☐ no
Other remarks: ______________________________
The person receiving the home has checked it and has no other claims about its condition.
Handed over: ____________________ (signature) ______________________________ (name)
Received: ____________________ (signature) ______________________________ (name)