200809274 - Laserfiche WebLink

Browse

200809274: BANK VERIFICATION 2\(811)68 TO: Name & Address of Financial Institution Phone Number Fax Number 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 Si!,'llature 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 Owner's Representative Return Form To: SA VINGS ACCOUNT: Acct#: Current Balance $ Current % Rate SA VINGS ACCOUNT: Acct #: Current Balance $ Current % Rate CHECKING ACCOUNT; Acct #: Average Balance for the Past Six Months: $ Current Balance: $ Rate of Interest: % CHECKING ACCOUNT: Acct #: A verage Balance for the Past Six Months: $ Current Balance: $ Rate ofInterest: % Please list other asset accounts below (Certificates of Deposit, Money Market Accounts, etc.) Account Type of Rate of Number Balance Account Interest $ $ $ Cash Value.o % % % $ $ $ .oNOTE; CASH VALUE IS THE CURRENT VALUE MINUS ANY PENAL TIES FOR EARLY WTTHDRA W AL. 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 misrepresemations to any Oepanmem or Agency oflhe United States as to any matter within its jurisdiction. (Updated 11107)