200809274 - Laserfiche WebLink

Browse

200809274 TRUST ACCOUNT VERIFICATION 20 I&lfli); 8 lIi:IJItJ'ENANT A~ .,:", TO: Phone Number Name & Address of Financial Institution Fax Number RE: Applicant/Tenant Name Social Security Number Unit # (if assib'lled) I hereby authorize release of my trust account infonnation. Signature of Applicant/Tenant Date The individual named directly above is an applicant/tenant of a housing prof,>Tam that requires verification of income, The infonnation provided will remain confidential and will be used solely for the purpose of detennining eligibility for occupancy. Your prompt response is crucial and greatly appreciated. Signature of Owner's Representative Return Form To: Trust Account Number: Date Established: Is the applicant the grantor or the beneficiary? What type of trust is this? D Grantor D Revocable D Beneficiary D Irrevocable D Both Cash Value*: $ Market Value: $ DNo $ $ Does the applicant/tenant have access to the lump sum amount in the trust? DYes Is the applicant/tenant receiving periodic payments? DYes D No If yes, what amount: Is the trust earning interest and/or dividends? DYes D No If yes, what amount: (this includes reinvested interest/dividends) Frequency: % Frequency: *Cash Value is the current value less the cost to turn the asset into cash, Additional Remarks: (please indicate any anticipated changes.) Signature Printed Name & Title Date Financial Institution Name and Address Phone # Fax # E-mail NOTE: Section 1001 of Title 18 ofthe U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency ofthe United States as to any matter within its jurisdiction. (Updated 11/07)