Real Estate Income Verification Form

Real Estate Income Verification Form

Property Identification

Property Address:

Unit/Suite:    Parcel / APN:

Applicant / Resident Information

Phone:    Email:

Date of Birth:    SSN (last 4):

Authorization to Release Income Information (Applicant)

Applicant Name: hereby authorizes current and prior employers, payroll processors, and other income sources to release wage, salary and employment information to the property owner, manager, or agent identified above for the purpose of verifying income for tenancy qualification. This authorization remains effective for 60 days from the date of applicant signature below.

Income Sources to be Verified

Wages / Salary    Self‑Employment Income    Social Security / Disability / Pension    Other (specify below)

Employment / Income Verification (To be completed by Employer or Income Source)

Employer Contact:    Phone:

Employee/Payee Name:    Position/Title:

Date Hired:    Employment Status: Full‑time   Part‑time   Seasonal/Temporary   Contract/1099

Pay Frequency: Weekly   Biweekly   Semi‑monthly   Monthly

Base Gross Pay (per pay period):    Net Pay (per pay period):

Overtime Average (Y/N): Yes   No    Average Overtime Amount (per period):

Bonuses / Commissions (Y/N): Yes   No    Typical Bonus/Commission (periodic average):

Year‑to‑Date Gross Earnings:    Average Hours Per Week:

Is employee expected to remain employed? Yes   No

Income Documentation Provided

Pay stubs    W‑2 / 1099    Tax returns    Bank statements    Other

Employer / Verifier Certification

The undersigned certifies that the information provided on this form is true and correct to the best of their knowledge and that the records relied upon in completing this verification are accurate employer records. This verification is provided in response to the applicant's authorization and is limited to the income and employment information requested herein.

Verifier Company:    Verifier Phone:

Disclosures and Notices

By signing below, Applicant certifies that the information provided in this form is complete and accurate and authorizes release of income and employment information to the property owner, manager, or agent for the purposes of qualification and ongoing tenancy evaluation. Employer or verifier acknowledges that this verification is provided pursuant to applicant authorization and may be relied upon by the property owner or manager.

Applicant understands that falsification of income information may constitute grounds for denial of tenancy or termination of lease and may subject applicant to civil remedies. Employer and verifier shall not be liable to applicant or landlord for good faith release of records in response to this authorization.

Default; Governing Law; Entire Agreement

This form is a limited authorization and verification instrument and does not create a landlord‑employee relationship. Any disputes arising out of this verification shall be governed by the law of the state in which the property is located. This document constitutes the entire agreement between the parties with respect to the matters contained herein and supersedes all prior agreements and understandings, whether written or oral, relating to such matters.

Optional Additional Comments

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