Notice of Intent to Impose a Claim on Security Deposit - Example

[Brad Rabinowitz]

For those who have filed this form, and I'm sure it's many of you, how is it filled out legally and thoroughly in situations where the security deposit does not cover the damages owed? Being that the form is strictly a tool used to impose a claim on the security deposit specifically, is the below example correct? This difference would need to be settled in small claims, but as it relates to the form, what's right and wrong?