Ashley Manor Apartments

Criminal Background Check

R e l e a s e F o r m

NAME(print)______________________________________________________________________

Last First Middle Maiden

ADDRESS_____________________________________________________________________

Street City State Zip

PREVIOUS ADDRESS ______________________________________________

ALIASES OR OTHER NAMES USED ______________________________________________

DATE OF BIRTH _____________________________ RACE___________________SEX___

SOCIAL SECURITY #___________________________________

DRIVER’S LICENSE #____________________________________________ STATE________

In connection with my application for resident or commercial leasing with you, I understand that inquiries are to be made on myself including criminal convictions, motor vehicle, and other reports. Further, I understand that you will be requesting information from various Federal, State, and other agencies that maintain records concerning my past activities relating to my credit, criminal, civil, education, and other experiences. If approved, I understand periodic background checks may also be performed during my time of tenancy. The above information is for identification purposes only and will not be used to violate any state or federal equal opportunity laws.

I authorize without reservation any party or agency contacted by this company to furnish the above-mentioned information.

X_________________________________________

Applicant Signature

_________________________________________

Date