AUTHORIZATION FOR RELEASE OF INFORMATION CRIMINAL & CREDIT RECORDS CHECK As stated in the Tenant Selection Policy, any applicant being screened for a dwelling unit will be subject to a criminal records check. The following is authorization.I/We,First Name *Last Name *hereby authorize a criminal and credit background check.Head of Household Social Security #Date of BirthSignatureStart signing your signature hereYour browser does not support e-Signature field.DateCo-Applicant Social Security #Date of BirthSignatureStart signing your signature hereYour browser does not support e-Signature field.DateTitle 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at 208 (a) (6), (7) and (8). Violations of these provisions are cited as violations of 42 USC 408 (a), (6), (7) and (8). After you submit this form successfully. You will then be forwarded automatically to Step 3 of the application process.Send Message
