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PROOF OF RESIDENCE

LANDLORD STATEMENT
DATE:_________________________________________________________________
NAME OF TENANT(S):___________________________________________________

FULL ADDRESS:

RENTAL AMOUNT:
RENT IS PAID:

MONTHLY________WEEKLY__________OTHER__________

LANDLORD PHONE #:
LANDLORD ADDRESS:

SIGNATURE OF LANDLORD:

PRINTED NAME:

LANDLORD ADDRESS: __________________________________________________


LANDLORD PHONE NO.:_________________________________________________

FE: Forms\porlandlordstatement 6/05