Rental History Request
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1EQUAL HOUSING
OPPORTUNITY
Rental History Request
THIS RENTAL HISTORY REQUEST IS FROM
Property Name:
Fax Number:
Property Address:
Property Office Phone Number:
THIS RENTAL HISTORY REQUEST IS TO
Property Name:
Fax Number:
Attention:
Message:
RENTAL HISTORY REQUEST
To Whom It May Concern:
The resident ________________________________________ who lives/lived on your property at this address
__________________________________________________ has applied to lease an apartment home at
______________________________________________. We are requesting your assistance in answering the
questions listed below. Please also see the signature of the applicant authorizing the release of this information.
Please fill out this form and fax it back to the number listed above. Your assistance is greatly appreciated.
AUTHORIZATION TO RELEASE RENTAL HISTORY INFORMATION
I ________________________________________ hereby authorize any former landlord to provide the information
requested below to _________________________________________ for the purpose of verifying my rental history.
Signature
Printed Name
Date
INFORMATION REQUESTED
For what time period was this person a resident at your property? From____/______/______ To ____/_____/_____
Was proper notice to vacate given?
_______Yes
______No
Had this person’s lease expired at the time he/she vacated your property?
_______Yes
______No
Were this person’s obligations paid as agreed?
_______Yes
______No
If Not:
Current Balance Due $_____________________
Number of late payments:________________________________________________
Number of payments over 30 days late:_____________________________________
Number of NSF checks:_________________________________________________
Was this person ever in jeopardy of being evicted from your property? _______Yes
______No
Please list the number and type of pets this person owned while at your property
Comments:
Completed by: ____________________________Signature: ______________________________________ Date: ____/____/______
Thank you very much for your time.
Revision 1 – June 2011
Page 3 of 5
Rental Application Packet
Exhibit #1
MK 3.170
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