Landlord Verification Form

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Community Name*

Office Number*

Fax Number*

Authorization for landlord to release information

Applicant Signature*

Date*

Applicant Signature

Date

Current/Previous Landlord Reference

Are there other Lease Holders on lease with Applicant(s)

Length of Occupancy

Current Lease Expiration

Proper Notice Given

Monthly rental rate

Number of times late

Average days late

Filed in court

How many times?

Was the resident evicted or is there an eviction pending

Did this resident or one of their guests violate any community rules? (Explain)

If the resident broke a lease, did they leave owing money?

If left owing money, has the debt been satisfied?

Name

First Last

Signature

Title

Phone

Date