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BANK VERIFICATION

THIS SECTION TO BE COMPLETED
BY TENANT AND EXECUTED BY MANAGEMENT

 
 
 

      
Name & Address of Financial Institution                                                                       
Phone Number

 
 
 
 
 
 

                 
Fax Number

TO: 

RE:           

 

                            

 
 

                                     
Applicant/Tenant Name

                                             
Social Security Number

 
 
 

                            

 
 

                                     
Applicant/Tenant Name

                                             
Social Security Number

 
 
 
 

                
Unit # (if assigned)

I hereby authorize release of my asset information.

           
________________________________________                 
____________________________________

Signature of Applicant/Tenant      Date

             
________________________________________                  
____________________________________

Signature of Applicant/Tenant      Date

The individual named directly above is an applicant/tenant of a housing
program that requires verification of income. The information provided
will remain confidential and will be used solely for the purpose of
determining eligibility for occupancy. Your prompt response is crucial
and greatly appreciated.

 

________________________________________   

          Signature of
Owners Representative   

       Return Form To: 

THIS SECTION TO BE COMPLETED BY FINANCIAL INSTITUTION 

SAVINGS ACCOUNT:      SAVINGS ACCOUNT:

Acct #:   ____________________________   Acct #:              
_______________________________

Current Balance $   ____________________________   Current
Balance $ _______________________________

Current % Rate ____________________________   Current % Rate    
_______________________________

CHECKING ACCOUNT:      CHECKING ACCOUNT:

Acct #: ______________________     Acct #: ______________________

Average Balance for the Past Six Months: $ ______________________ Average
Balance for the Past Six Months: $______________________

Current Balance: $ ____________________    Current Balance:     $ ____________________

Rate of Interest:       _________ %     Rate of Interest:       _________
%       

Please list other asset accounts below (Certificates of Deposit, Money
Market Accounts, etc.)

Account            
        Type of         
Rate of

Number           
Balance              
Account         Interest                 
Cash Value*

_________________________ $______________            
___________________            
___________%        $________________

_________________________ $______________            
___________________            
___________%        $________________

_________________________ $______________            
___________________            
___________%              
$________________

*NOTE: CASH VALUE IS THE CURRENT VALUE MINUS ANY PENALTIES FOR
EARLY WITHDRAWAL.

Signature

Printed Name & Title

Date

Bank Name
and Address

Phone #

Fax #

E-mail

NOTE:  Section 1001
of Title 18 of the U.S. Code makes it a criminal offense to make willful
false statements or misrepresentations to any Department or Agency of
the United States as to any matter within its jurisdiction.                   (Updated 11/07)