Tenant Payment Verification
Please complete for your Tennant requesting financial assistance with rent, deposit, or eviction prevention from Yellowstone Country Assistance Network. To provide this assistance, Yellowstone Country Assistance Network verifies the tenant’s relationship with you and that you have the legal right to rent property listed on this document. This form is not a guarantee of payment. Any assistance approved and provided is intended to directly benefit the low-income tenant, not the landlord/company.
Name of Tenant
Amount of Rent Due
Amount of Deposit Due
Only if requesting deposit help
Total Rent & Deposit Due
Only if asking for rent and deposit help
How many months is the amount due covering?
Date Rent/Deposit is/was due
THIS IS NOT A CONTRACT OR A LEASE. Be sure to read this form carefully before completing and signing it. Anyone who makes false statements to obtain or help another person get assistance, for which they are not eligible, is subject to the penalties under the laws of the State of Wyoming. Completion of this landlord verification is required to be considered for housing assistance from Yellowstone Country Assistance Network.
Should be Empty: