Housing Confirmation

Name of landlord: ________________________________

Address: ________________________________________

Address: ________________________________________

Telephone Number: _______________________________

To whom it may concern: 
I acknowledge that I am able and willing to provide living accommodations for (parolee's name): __________________________________________________ at (address of accommodations): _______________________ (city, state, zip): ____________________________________ for at least (period of time): ____________________. The accommodations are (room, apartment, house, etc.) ________________________________ for which the parolee will be obligated to pay rental/room/board of $ ____________ per (time period) __________.

My relationship to the parolee, if any is: __________________.

Sincerely yours:

(sign) __________________________________________