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Landlord Verification Form: All Information Is Kept Confidential

This landlord verification form provides details on a tenant's outstanding rent and fees. The tenant owes rent for February through June 2022 but the specific amounts for rent, late fees, and court fees are not included. The landlord agrees to retain the tenant if they pay the total verified delinquency, which is valid through a specified date. The landlord also commits to dismissing any pending eviction claims against the tenant within 5 days of receiving payment and agrees not to file a new eviction complaint before the payment due date.

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93 views1 page

Landlord Verification Form: All Information Is Kept Confidential

This landlord verification form provides details on a tenant's outstanding rent and fees. The tenant owes rent for February through June 2022 but the specific amounts for rent, late fees, and court fees are not included. The landlord agrees to retain the tenant if they pay the total verified delinquency, which is valid through a specified date. The landlord also commits to dismissing any pending eviction claims against the tenant within 5 days of receiving payment and agrees not to file a new eviction complaint before the payment due date.

Uploaded by

dave
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LANDLORD VERIFICATION FORM

ALL INFORMATION IS KEPT CONFIDENTIAL

TENANT/CLIENT NAME

PROPERTY ADDRESS

WHAT MONTHS DOES THE TENANT CURRENTLY OWE?


February 2022, March 2022, April 2022, May 2022, June 2022

Please break down the outstanding Rent, Late, and Legal fee charges and what date these are valid through:

Rent Charge Type Amount Owed

Delinquent Rent Amount $

Late Fees $

Court Fees $

Total Verified Delinquency $

These amounts are good through: (MM-DD-YYYY)

Landlord’s Commitment:

I, (Landlord Name) would like to retain


(Tenant Name) as my tenant. I have agreed to accept the amount
above (a) for rent, a deposit or to bring their account current. I understand that this amount cannot change prior
to the good through date, and agree to accept this amount through / / 2020. I understand that if
funds are coming from more than one source, I may receive payment in more than one part. However, I am not
obligated to accept any payment or partial payment that I receive after the good through date. In the event that
I receive a partial payment but am not paid in full by the good through date, I will be obligated to return any
funds that I have received from Lakewood Community Services Center, and agree to return any funds received
from any source for an applicant who does not become a tenant. I am not required to refund a reasonable fee
charged for a credit and/or background check for prospective tenants. I further understand that I am able to
refuse to accept personal checks from tenants, prospective tenants, or third parties and require those amounts to
be paid in certified funds, but agree to accept checks tendered by Lakewood Community Services Center or any
other 501(c)(3) organization or governmental entity.

In the event that an eviction is pending in court, I will dismiss my claims against the Defendant within 5 business
days of receipt of the payment amount listed above. I also agree not to file a complaint for eviction prior to the
date quoted in the prior paragraph.

Signed,

Landlord Signature Date

Landlord Name Phone #

Mailing Address E-mail Address

Revised 2020

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