Minnesota Residential Lease Application Page 3
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4WAIVER & RELEASE
I authorize the landlord and/or its agents to obtain all necessary information from the following
entities, individuals, and organizations for the purpose of verifying and evaluating the information for my initial
lease application, lease renewal, ongoing compliance with rental criteria, and/or to collect any outstanding amounts
due as a result of non-compliance with a lease:
• Employer(s)
• Landlord(s)
• Banking Institutions
• Creditors and/or Mortgagees
• References
• Department of Motor Vehicles
• Educational Institutions
• Credit reporting agencies
• Criminal record search for the states of:_____________________________________________________
• Federal Government agencies (including but not limited to the Social Security Administration and Public
Housing agencies)
• Minnesota Public Assistance agencies that sponsor programs in which I am or have been enrolled
• Other public or private housing assistance agencies to which I have applied for assistance
• Any other parties either listed on m y rental application or subsequently determined to be a source or
potential source of information to document or verify my income, assets, credit, residence address(es), or
other information useful for evaluation of my application and/or collecting outstanding debts owed.
Information from the following tenant screening service may be used to determine the acceptance or rejection of
your application: _____________________
_____________________
I agree to indemnify and hold harmless the landlord, its authorized agents, and all parties who release
information to the landlord in connection with the release, evaluation, and use of this information.
This waiver and release shall remain active and valid for as long as I lease from or have funds due to the landlord.
Signature
Date
Social Security Number
Date of Birth
Page 4 of this document is a Receipt of Residential Lease Application Fee that is completed and given to the Applicant at the time of application.
Page 3 of 4
07-2013
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