the landlord for the full amount of rent for the Premises if the other Roommates fail to pay their
share.
4. Security Deposit. The total security deposit for the Premises is $_________. Each Roommate
has paid all or a portion of the deposit as follows:
Roommate Name Amount of Deposit Paid Name of Person Paid
_________________ _________________ _________________
_________________ _________________ _________________
_________________ _________________ _________________
Each Roommate will receive a his/her share of the deposit when the landlord returns it at the end
of the tenancy. Any deductions from the deposit will be shared by all the Roommates in proportion
to the amount of deposit paid; however, any damage caused by one of the Roommates will be paid
only by that Roommate. The deposit (check one) □ does □ does not include last month’s rent.
5. Early Termination of Tenancy. If one Roommate elects to leave before the end of the lease
term described in paragraph 2, (check one) it □ is □ is not that Roommate’s responsibility to find a
replacement tenant. The departing Roommate (check one) □ will □ will not continue to be
responsible for his/her share of the rent until the end of the lease term or a replacement roommate
starts paying rent, whichever occurs first. All of the remaining Roommates (check one) □ will □ will
not have the right to approve the replacement roommate. Approval of a replacement roommate
may not be withheld unreasonably, but the replacement roommate must satisfy the following
criteria:
___________________________________________________________________
___________________________________________________________________.
The landlord’s prior written approval is required to change Roommates, and (check one) □ the
departing Roommate □ the remaining Roommate(s) is/are responsible for obtaining that approval.
6. Living Arrangements. The bedroom(s) will be allocated as follows:
___________________________________________________________________
___________________________________________________________________.
Special "house rules" about sharing space, furniture, appliances, and food in the Premises are:
___________________________________________________________________
___________________________________________________________________.
7. Overnight Guests. Each Roommate (check one) □ does □ does not need to obtain permission
from the other Roommate(s) prior to the stay of any overnight guest(s). No overnight guest(s)
may stay longer than ______ nights per week without the permission of the other Roommate(s).
8. Utility and Telephone Charges. Each Roommate agrees to pay _______% of the following
utility charges (check all that apply): □ gas □ electricity □ water. Each Roommate will pay
_______% of the monthly telephone (land line) service charges and will pay for all of those
telephone (land line) charges for which s/he is directly and individually responsible.