Senior Citizen Housing Rental Verification Request Form
Applicant Information
Full Name
Date of Birth
Current Address
Phone Number
Current Landlord Information
Landlord/Management Name
Phone Number
Address
Rental History
Rental Address
Length of Stay
Monthly Rent
Lease Dates
Reason for Leaving
Verification Questions
Is the applicant current on rent payments?
Any lease violations or complaints?
Did the tenant maintain the unit in good condition?
Additional Comments
Applicant Signature
Date
Landlord/Manager Signature
Date