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Privacy Act Notice: This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective tenant under its program. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval as a prospective tenant may be delayed or rejected.

Instructions: Applicant: Please complete Part I.  Click "Save my form and resume later"(at top or bottom of page) - provide email address and password - copy the link from the browser window and send all information (link, email, and password) to your landlord or rental agent.
Landlord – Please complete Part II, and return directly to Art Minton Realty, LLC, named in Part I, Item 2 by clicking submit at the bottom of the form.


2. From: Art Minton Realty, LLC

P.O. Box 16294

Jackson, MS 39236-6294

3. Information to be verified
4. By signing below, you authorize your current/previous landlord to release your rental history to Art Minton Realty, LLC.

We have received a rental application from the above individual(s), to who we understand you rent. In addition to the information requested below please furnish us with any information you might have that will assist us in our decision.

*Your printed name is your signature for the purposes of this document.