McMinn-Meigs Assist Program - Landlord

Current Page 1
Complete

Landlord Verification

LANDLORD'S CONTACT INFORMATION

Name

Company

Phone

Your Address

Address 2

City

State

Zip Code

APPLICANT'S INFORMATION

Name

Address

City

State

Zip Code

Date Applicant Began Living at Residence:

Amount of Monthly Rent: $

Are Utilities Included:

Yes

Date Rent Became Delinquent:

Total Amount of Rent in Arrears: $

Has an Eviction Notice Been Issued:

Yes

Date Issued:

If Yes, Was Eviction Notice For Non-Payment:

Yes

If Rent Is Paid In Full, Will Tenant Be Evicted For Other Reasons:

Yes

What Is Minimum Amount Tenant Needs To Avoid Eviction For 30 Days: $

Is The Property Receiving Any Type of Federal Housing Assistance:

Yes

If Yes, Indicate Type/Program:

Address Check Should Be Mailed to:

Address

City/Town

State/Province

ZIP/Postal Code

Country

I certify that the information provided is true and accurate, and understand any false statements or false information provided by me on this application will result in immediate denial of my application for this program.

Yes

The information collected through this application will be used solely for the purpose of evaluating and selecting applicants. Personal data provided in the application may be reviewed by authorized members of the selection committee and individuals directly involved in the evaluation process. Applicant information will not be shared, sold, or disclosed to any third party except as necessary to administer and evaluate the application. All application materials will be handled confidentially and maintained in accordance with applicable privacy and data protection practices. By submitting an application, applicants acknowledge and consent to the collection, use, and limited sharing of their information for the purpose of application review, evaluation, and selection.

Yes

Landlord/Representative Signature:

Sign above

CAPTCHA

Math question (16 + 3 =) Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.