Landlord’s Verification Form
We would appreciate your cooperation in providing us with the Landlord’s Verification Information for
one of your past resident(s). This information is required as a part of our application approval process.
Thank you for your cooperation.
PART I: To be completed by Tenant
Authorization to Release Information
Tenant’s Name(s)
I, ___________________________,
give my permission to the requester
to obtain & verify this information.
Tenant’s Address
City
Zip Code
Tenant's Signature
Date
PART II: To be completed by Landlord
To the best of my knowledge the following people & pets live here. Please provide the number of
persons in this household and, if possible, provide their names. And list pet and type.
Total rent for this address is
$
Month
Week
Other _______(specify)
Utilities Included?
YES
NO
Would You Rent to Applicant Again?
YES
NO
Security Expected To Be Paid in Full?
YES
NO
Length of Residency?
Payment History
Late
On-time
Condition of Apartment During Residency: (describe)_________________________________________
______________________________________________________________________________________
Comments: ____________________________________________________________________________
______________________________________________________________________________________
Landlord’s Signature
Date
Point of Contact (Name)
Landlord’s Name (print)
Daytime Telephone
Fax
Landlord’s Address
City
Zip Code
Please Return to:
DAN LONG
Fax: 530-325-3954
649 STARSTONE DR
LAKE MARY