One Page Landlord Reference Form
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1P.A. Community Housing Society Inc.
th
425 - 13
Street East
LANDLORD REFERENCE FORM
Phone # 922-5440
Prince Albert, Sask. S6V 1E2
Fax #
922-4434
Name of Tenant(s) #1
#2
Address
City
Postal Code
Length of Tenancy: From D____M____Y____ To D_____M______Y_____ Number of Occupants _____ Adults ____ Children
RENT HISTORY
HOUSEKEEPING SKILLS
YARD CARE
Excellent
Good
Poor
Excellent
Good
Poor
Excellent
Good
Poor
COMPLAINTS:
Yes
No How Many? __________ If Yes, what type?
NOTICE TO VACATE:
Proper Notice Given
Short Notice Given
Eviction
Other
LEASE VIOLATION NOTICES:
Yes
No How Many? _________ If Yes, what type?
DAMAGE DEPOSIT:
Returned
Not Returned
OUTSTANDING BALANCE UPON VACATING: $_______________ Rent $ ______________ Damages $______________ Cleaning
COMMENTS
Certify that the above is true and correct.
_________________________________
_________________________________
________________
Signature of Landlord
Printed Name of Landlord
Phone Number
Date
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Parent category: Legal