050319 04/10 MJ
REQUEST TO RELEASE TENANT INFORMATION TO
PROSPECTIVE LANDLORD
Federal regulations require the Housing Authority (when requested by a
prospective landlord) to release specific tenant information (to prospective
landlords) to assist in the tenant screening process. Requests for tenant
information for purposes other than initial screening cannot be honored.
The landlord needs to complete this request to obtain the information. The request must be submitted to the Housing
Authority. Once this request is received, the Housing Authority will review the request to determine that it is for
screening purposes. If you are requesting information for a tenant you now house, the request will be denied. Once the
determination has been made, the information will be mailed to the landlord.
The Housing Authority will release the following tenant information:
• Current tenant address
• Name and address of tenant’s current and prior landlord(s) if known.
_______________________________________ __________________________________
Prospective Landlord Name (Printed) Landlord Mailing Address (Street)
X______________________________________ __________________________________
Prospective Landlord’s Signature City, State, Zip Code
I, the above-listed landlord, am requesting the Housing Authority provide tenant information on:
_______________________________________ __________________________________
Prospective Tenant Name (Printed) Tenant Social Security Number
For the purpose of renting the following address:
___________________________________________________________________________________
Street City
HOUSING AUTHORITY USE ONLY
INFORMATION TO BE SUPPLIED:
Current Landlord Address:
Previous Landlord Address:
HOUSING AUTHORITY COMMENTS:
No match found for listed tenant name:
Date Requested Information Mailed :
cc: Tenant File
