10-28-99 Regular Meeing and Public Hearing

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LAKESIDE CENTER INC. APPLICANT RELEASE AND CONSENT I/We . the undersigned hereby authorize . to release without liability, (employer or other source) information regarding my/our employment income, and/or assets to (owner or agent) for purposes of verifying information provided as part of my/our apartment. rental application. EOURMATION COVERED I/We understand that previous or current information regarding me/us may be needed:. Verifications and inquiries that may be requested include, but are not limited: to personal identity, employment income and assets, medical or childcare allowances. UWe understand that this authorization can not be used to obtain any information about me/us that is not pertinent to my eligibility for and continued participation as a Qualified Tenant. GROUPS OF INDIVIDUALS THAT MAY BE ASKED The groups of individuals that may be asked to release the above information include, but are not limited to: Past and Present Employers State Unemployment Agencies Criminal History Welfare Agencies Retirement Systems I Support and Alimony Providers Veterans Administration Social Security Administration Medical & Childcare Providers Previous Landlords Bank or other Financial Institution CONDITIONS We agree that a photocopy of this authorization"may be used for the purpose stated above. The original of this authorization[ is on file and will stay in effect for a year and one month from the date signed. I/We understand, I/We have a right to review this file and correct any information that.I/We can prove is incorrect.. Signatures Head of Household Spouse Adult Member (Print Name) (Print Name) (Print Name) Date Date Im Adult Member (Print Name) Date Note: This General Consent may not be used to request a copy of a Tax return. If a copy of a Tax return is needed. IRS Form 4506. "Requests for Copy of Tax Form" must be prepared.and signed separately. DOC. 223