Laserfiche WebLink
REAL ESTATE VERIFICATION 201109462 <br /> ��A s, <br /> �` THiS SEGTION TO BE COMPLET�i3 BY:TENANT AND EXEC�I7TED BY�Iy1ANAGEMENT �� �� <br /> TO: <br /> Name&Address Phone Number <br /> Fax Number <br /> RE: <br /> ApplicandTenant Name Social Security Number <br /> ApplicandTenant Name Social Security Number <br /> Unit#(if assigned) <br /> I hereby authorize release of my real estate information. <br /> Signature of ApplicandTenant Date <br /> Signature of ApplicanUTenant Date <br /> The individual(s)named directly above is an applicandtenant of a housing program that requires verification of income.The information provided will <br /> remain confidential and will be used solely for the purpose oCdeicrmining eligibility for occuuancy.Your prompt response is crucial and greatly <br /> appreciated. <br /> Signature of Owner's Representative <br /> Return Form To: <br /> ;�'T$EIIS SECTIf3N TO BB COMPL'ETED BY CC3UNTY ASSESS�I2/REAI:ES'TA'I'E AGENT .. '° <br /> ,N� �,�` �t <br /> ��: ��,:., <br /> Cash Value*: $ Market Value: $ <br /> Average Assessment Ratio: % <br /> *Cash Value is the current value less the cost to turn the asset into cash. <br /> Please provide documentation of cost incurred in converting this asset to cash. <br /> Additional Remarks: (please indicate any anticipated changes.) <br /> Signature Printed Name&Title Date <br /> Name and Address <br /> Phone# Fax# E-mail <br /> NOTE: Section]001 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 <br /> United States as to any matter within its jurisdictioo. (Updated 12110) <br />