To be completed by Landlord/Management Company:
The following information is strictly confidential:
1. Is the above name a: Leaseholder Occupant Co-Signer
2. Is the applicant's Social Security Number same as above? Yes _____ or No ______
3. Date Original lease began: ___________________ Date lease expires ___________________
4. Has tenant given proper notice to vacate? Yes _____ or No ______
5. Has tenant vacated? Yes _____ or No ______ If so on what date? _____________
6. Was tenant evicted? Yes ______ or No ______
7. Monthly rent amount _____________________
8. Number of late and/or court notices in the past 12 months ________________________
9. Is any balance due at this time? Yes _____ or No ______ If so, what is the total amount due? ________________
10. Is there enough security deposit to cover the balance? Yes ______ or No _______
11. Were there any damages? Yes ______ or No _______
12. Any problems during residency? Yes ______ or No ______
Noise _______ Behavior _______ Traffic _______ Housekeeping _______
Illegal Occupants ________ Illegal Activities ________
13. Was there any BED BUG activity in this resident's unit at any time during their residency? Yes _______ or No _______
14. Name and title of the person verifiying: ______________________________________
15. Would you rent to this person again in the future? Yes _______ or No ________
Please return this form as soon as possible. Thank you for your time.
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Rental Manager Name Phone Number
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Rental Manager Signature Date