Consent For Release Of Information Prospective Tenant(S)
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1Consent for Release of Information
Prospective Tenant(s)
We, the undersigned applicant(s), authorize all persons or companies to release without liability, all information regarding
our employment, income and/or assets. The information may be released only to the rental dwelling owner, or their
agent/broker. The purpose of releasing the information is to verify information on a rental application being made by us.
Information Covered
We understand that previous or current information may be needed. Verification and inquires that may be requested
include, but are not limited to: Personal identity, employment, income assets and allowance for child or medical purposes.
This consent form may not be used to request a copy of a tax return.
Groups or individuals who may be asked to release the above information include, but are not limited to:
Present and past employers
State unemployment agencies
Financial institutions
Welfare agencies
Retirement systems
Credit reporting agencies
Veterans Administration
Public housing agencies
Criminal reporting agencies
Present and past landlords
Social Security Administration
The above information may only be released to the rental dwelling owner, or their agent named below:
Rental dwelling owner/agent name: __________________________________________________________________
Owner/agent address: _____________________________________________________________________________
Owner/agent telephone: ____________________________ Owner/agent fax: ________________________________
Owner/agent e-mail: _______________________________________________________________________________
Applicant signature(s)
Head of Household (print name)
Signature
Social Security #
Date
Birth date: _____________________ Current address: ___________________________________________________
City
State
Zip
Monthly rent (of property applying for): $___________________
Months at current residence: ______________
Monthly income: $___________________
Number of months employed (with current employer): ___________
Spouse/Other Adult Member
Signature
Social Security #
Date
(print name)
Birth date: _____________________ Current address: ___________________________________________________
City
State
Zip
Monthly rent (of property applying for): $___________________
Months at current residence: ______________
Monthly income: $___________________
Number of months employed (with current employer): ___________
07/2012
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Parent category: Legal