RENTAL APPLICATION
CONSENT: I authorize and direct any business; individual; or federal, state, or local agency, department, or
organization to release to Housing Development Corporation MidAtlantic as Management Agent for River Run
Meadows Apartments any information or materials needed to complete and verify my application for tenancy, my
eligibility and continued eligibility for tenancy, and my certification and recertification for assistance, if applicable. I
give my consent for the release of such information about the minor children in my care who live with me. I
understand and agree that this authorization or the information obtained with its use may be given to and used by
any federal, state, or local housing assistance agency and the owner and management agent in administering and
enforcing program and owner and management agent rules and policies.
INFORMATION COVERED: I understand that, depending on program policies and requirements, previous or
current information regarding me or my household may be needed. Verifications and inquiries that may be
requested include but are not limited to:
Identity and Marital Status Employment, Income and Assets Credit and Criminal Activity Criminal History
Residences and Rental Activity Medical or Child Care Allowances Social Security Numbers Sexual Offender Status
GROUPS OR INDIVIDUALS THAT MAY BE ASKED: The groups or individuals that may be asked to release the
above information (depending on program requirements) include but are not limited to:
Previous Landlords (including Public Housing Agencies) Past and Present Employers Veterans’ Administration
Banks and other Financial Institutions Welfare Agencies Retirement Systems
Post Offices Social Security Administration State Unemployment Agencies
Schools and Colleges Utility Companies Support and Alimony Providers
Credit Providers and Credit Bureaus Medical and Child Care Providers
Police Departments and Other Agencies which Retain Criminal Background Histories and Sexual Offender Registries
COMPUTER MATCHING NOTICE AND CONSENT: I understand and agree that HUD or a Public Housing
Authority (PHA) may conduct matching programs to verify the information supplied for my certification or
recertification. If a computer match is done, I understand that I have a right to notification of any adverse
information found and a chance to disprove incorrect information. HUD or the PHA may in the course of its duties
exchange such automated information with other Federal, state, or local agencies, including but not limited to: State
Employment Security Agencies, Department of Defense, Office of Personnel Management, the U.S. Postal Service,
the Social Security Agency, and state welfare and food stamp agencies.
CONDITIONS: I agree that a photocopy of this authorization may be used for the purposes stated above. The
original of this authorization is on file with the management office and will stay in effect for a year and one month
from the date signed. I understand I have a right to review my file and correct any information that I can prove is
incorrect.
SIGNATURES:
Head of Household (Print Name) Date
Co-Applicant (Print Name) Date
Other Adult Member (Print Name) Date
I hereby certify that the following are minor children living with me:
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, “REQUEST FOR COPY OF TAX RETURN” MUST BE
PREPARED AND SIGNED SEPARATELY.