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Landlord Certification Form <br /> Landlord's Name: <br /> Mailing Address (address where you want check mailed) <br /> Contact Name Position <br /> Telephone Alt. Phone <br /> Tenant Name <br /> Rental Address <br /> Monthly Rent$ Total Past Due $ <br /> Most Recent Payment by Tenant$ Date of Last Payment <br /> Total Past Due as of today$ Month's include <br /> Late Charges $ <br /> How long has tenant lived at property? <br /> If assistance is approved, will you continue renting to the tenant? <br /> A check will be distributed through the mail within 10 business days to the <br /> mailing address you have listed above. The check will be dispensed from the <br /> local Dove, Inc. office. If you have any questions, please contact the finance <br /> department at 217-428-6616. <br /> By acknowledgement below, l agree to continued partnership with the tenant <br /> based on lease agreement compliance. <br /> X Date <br /> Landlord or Property Manager <br />