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| Apartment Number (*) |
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| First Name (*) |
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| Last Name (*) |
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| Your Email (*) |
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| Phone (*) |
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KITCHEN: If there are issues with any of the items below, please check the appropriate box
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BATHROOM #1: If there are issues with any of the items below, please check the appropriate box
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BATHROOM #2: If there are issues with any of the items below, please check the appropriate box
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LIVING ROOM: If there are issues with any of the items below, please check the appropriate box
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BEDROOM #1: If there are issues with any of the items below, please check the appropriate box
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BEDROOM #2: If there are issues with any of the items below, please check the appropriate box
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BEDROOM #3: If there are issues with any of the items below, please check the appropriate box
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OTHER: If there are issues with any of the items below, please check the appropriate box
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| I was present at the time of inspection and agree to the items listed here within except as noted in the space above (*) |
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| Please type the letters you see in the image. |
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