Dear Landlord:
The person below has applied for housing in our complex. It is our policy to check and verify all previous landlord references before approving and determining the applicant’s eligibility. Please fill out the area below and return this form as soon as possible. Thank you for your time and cooperation. 
Applicant’s Name:_____________________________________________________________________
INFORMATION REQUIRED:
Dates of applicant’s tenancy:  From______________________ To ______________________________
Amount of Rent Payments: $___________________________ Were utilities included? Y or N
Were there late payments? Y or N    If yes, how late? ______________ How often? _________________
Security Deposit Amount: $_______________ Was it Refunded? Y or N  Amount Refunded $__________
Was residence damaged? Y or N  Amount? ___________________________ Were damages paid? Y or N
Was residence kept clean? Y or N  	Was it cleaned upon vacating? Y or N
Have or did you ever initiate eviction or request resident to move?  Y or N
Reason:______________________________________________________________________________
Does or did resident permit persons other than lease listed to live in residence? Y or N
Relatives/Friends?_____________________________________________________________________
Does or did the resident interfere with the rights or quiet enjoyment of neighbors? Y or N
Explain:______________________________________________________________________________
Did the resident give you any false information?  Y or N
Explain:______________________________________________________________________________
Were there ever any disturbance calls involving Police, etc? Y or N
Explain: ______________________________________________________________________________
Please list the number of people residing and names if available:________________________________
_____________________________________________________________________________________
Would you rent to this applicant again? Y or N      
Do you have the applicant’s place of residence prior to this? Y or N
Did you obtain references? Y or N
Are you related to this applicant or their immediate family?  Y or N

Signature:______________________________________________  Date:_________________________