Landlord Verification Form printable pdf download

Landlord Verification Form

Housing Authority

LANDLORD VERIFICATION FORM

Name of Applicant:

Current Address:

Name of Landlord

Are you a relative or friend of the applicant? If so, please describe relationship:

Current Landlord

Previous Landlord

Other

Dates of Applicant's Tenancy: From

Does (Did) the Applicant have a lease? ❑ YES ❑ NO

Rent Payment

A. Amount of monthly rent:

B. Does (did) applicant pay rent on time?

❑ YES ❑ NO

C. Has(had) he/she ever paid l late?

❑ YES ❑ NO

How late?

How often?

D. Have (had) you ever begun/completed eviction for non-payment? ❑ YES ❑ NO

E. Was a Court judgment rendered in your favor for eviction for non-payment? ❑ YES ❑ NO

F. Do you provide any of the utilities for the unit?

❑ YES ❑ NO

G. Have tenant-paid utilities ever been disconnected?

❑ YES ❑ NO

2. Caring for the Unit

A. Does (did) the applicant keep the unit clean, safe and sanitary? ❑ YES ❑ NO

B. Has (had) the applicant damaged the unit?

❑ YES ❑ NO

Describe:

Cost to repair? $

How often?

C. Has (had) the applicant paid for the damage?

❑ YES ❑ NO

D. Will (did) you keep any security deposit?

❑ YES ❑ NO

E. Does (did) the applicant have problems with insect/rodent infestation? ❑ YES ❑ NO

F. Does (did) the applicant's housekeeping contribute to infestation? ❑ YES ❑ NO

G. Did the applicant make any alterations to the unit without your permission? ❑ YES ❑ NO

General

A. Is (was)the applicant listed on the lease for the unit ?

❑ YES ❑ NO

B. Does (did) the applicant permit persons other than those on the lease to live in the unit on a

regular basis?

❑ YES ❑ NO

PHA Verification Information

Landlord Verification Form

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