Landlord Verification Form - Independence at Town Center

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*
MM slash DD slash YYYY
Applicant Signature
Date
MM slash DD slash YYYY
To be filled by Landlord
Current/Previous Landlord Reference
- Conventional
- Subsidized
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?
Verification completed by:
Name
First Last
Signature
Title
Phone
Date
CAPTCHA

Authorization for landlord to release information