Request for Verification of Rent or Mortgage 1 Part-1 Request 2 Part-2 To be completed by Landlord/Creditor 3 Additional Information To (Name and address of Landlord/Creditor) From (Name and address of Landlord/Creditor) Title Lenders Number Information to be verified MortgageLand ContractRentalOther Property Address Account in the Name of Account Number Name of Applicant(s) Address of Applicant(s) [uacf7_step_end] Rental Account Tenant has rented since To Amount of Rent $ Per Is rent in arrears? YesNo Is account satisfactory? YesNo Mortgage Account Date mortgage originated Original Mortgage amount $ Current Mortgage Balance $ Monthly payment P&I only $ Payment with taxes and ins. $ Is mortgage current? YesNo Is mortgage assumable?YesNo Satisfactory account YesNo Land Contract Interest Rate Fixed ARM FHA VA FNMA CONV Number of late payments Insurance Agent *Number of times account has been 30 days overdues in the last 12 months [uacf7_step_end] Additional information which may be of assistance in determining applicants creditworthiness Title Date Signature of Creditor [uacf7_step_end] Δ