Minnesota Rental Application

Property Address: [[Property Full Address, City, MN ZIP Code]]
Monthly Rent: [[Monthly Rent]]
Desired Move-In Date: [[Desired Move-In Date]]
Application Date: [[Application Date]]
Application / Screening Fee: [[Application Fee Amount]] (non-refundable unless otherwise required by law)

Landlord / Property Manager: [[Landlord or Management Company Name]]
Contact: [[Landlord Phone]] | [[Landlord Email]]

This Rental Application is used to evaluate prospective tenants for the above-referenced residential property in Minnesota. All information will be used solely for screening in accordance with the Fair Credit Reporting Act (FCRA), the Minnesota Human Rights Act (Minn. Stat. § 363A), Minn. Stat. § 504B.173 (applicant screening fees), and other applicable federal and state law.

Important Pre-Application Disclosures (Minn. Stat. § 504B.173)
- Landlord must disclose in writing, prior to accepting any screening fee: (1) the name, address, and telephone number of any tenant screening service to be used (or that none is used); and (2) the criteria on which the rental decision will be based.
- The screening fee must be reasonable and reflect actual costs of screening.
- Landlord must provide a written receipt for the fee upon request (may be incorporated into the form).
- The fee may not be used or deposited until prior applicants have been screened and rejected or offered the unit and declined.
- If no personal reference check or consumer report is obtained, unused portions must be returned.
- If the applicant is rejected for a reason not listed in the pre-disclosed criteria, or if a prior applicant takes the unit, the fee (or unused portion) must be returned.
- Landlord may not charge a screening fee if no unit is available or will be available within a reasonable time.
- Denial may not be based solely on lawful source of income (certain protected classes expanded in Minneapolis/St. Paul).
- Denial may not be based on pending eviction actions that have not resulted in a writ, non-public/expunged files, or destroyed records (per § 504B.173 Subd. 3a).

All user-provided values are `[[Token Name]]` placeholders. Fixed legal disclosures and criteria are written in full.

Screening Criteria Disclosure (to be completed before fee accepted)
The decision to rent will be based on the following criteria (check all that apply and describe thresholds):
- Credit history / score: [[Minimum score or "Satisfactory credit history with no recent bankruptcies"]]
- Income: [[Income-to-rent ratio, e.g. gross monthly income at least 2.5, 3× rent]]
- Employment / stability: [[Current employment or verifiable income source; length of employment]]
- Rental history: [[No evictions within [[X]] years; positive references from prior landlords]]
- Criminal background: [[No convictions for certain offenses within [[X]] years; individualized assessment]]
- Other: [[Describe any additional lawful criteria, e.g. "No pets without approval"]]

Tenant Screening Service (if used):
Name: [[Screening Service Name or "None, references and credit obtained directly"]]
Address: [[Service Address]]
Phone: [[Service Phone]]

Fee Amount and Use: The fee of [[Application Fee Amount]] is charged to cover the actual costs of obtaining consumer reports, credit reports, background checks, reference verifications, and administrative processing. A receipt will be provided upon request.

1. Applicant and Household Information

Primary Applicant Full Legal Name: [[Applicant Full Legal Name]]
Date of Birth: [[Date of Birth]]
Social Security Number (last 4 for ID verification): [[SSN Last 4]] (full SSN required on authorization/consent)
Driver's License / State ID: [[State and Number]]
Current Phone: [[Applicant Phone]]
Email: [[Applicant Email]]
Current Address: [[Current Street, City, State, ZIP]]
Length of time at current address: [[Duration]]

Co-Applicant / Additional Adult Occupants (list all who will reside):
[[Co-Applicant Full Name, DOB, relationship / "None"]]

All Proposed Occupants (including children):
[[Full list of names, ages, relationships or "Applicant only"]]

Emergency Contact:
- Name: [[Emergency Contact Name]]
- Relationship: [[Relationship]]
- Phone: [[Phone]]
- Address: [[Address]]

Current Landlord / Property Manager Reference:
- Name: [[Current Landlord Name]]
- Phone: [[Phone]]
- Email: [[Email]]
- Address: [[Address]]
- Length of tenancy / reason for leaving: [[Details]]

Previous Landlord Reference (past 3, 5 years):
- Name: [[Prior Landlord Name]]
- Phone: [[Phone]]
- Tenancy dates: [[From, To]]
- Address: [[Prior Address]]

2. Employment, Income, and Financial Information

Current Employment / Income Source 1
- Employer / Source: [[Employer Name or "Self-employed / Other"]]
- Position: [[Job Title]]
- Supervisor / HR Contact: [[Name and Phone]]
- Address: [[Employer Address]]
- Dates: [[Start Date]] to Present
- Monthly Gross Income: [[Amount]]

Other Income Sources (e.g., Social Security, alimony, child support, investments)
[[List source and monthly amount or "None"]]

Total Combined Monthly Gross Household Income: [[Total Amount]]

Bank / Financial References (optional or as requested)
- Bank Name: [[Bank Name]]
- Account type and length: [[Details]]

Credit / Financial Obligations (list major monthly payments)
[[Describe or "See attached credit report authorization"]]

3. Residential History (past 3, 5 years)

Provide complete history. Attach additional sheet if needed.

4. Authorization and Release for Consumer Reports (FCRA + Minnesota Law)

FCRA Disclosure and Authorization

I/We authorize [[Landlord or Management Company Name]] and its designated screening agents or consumer reporting agencies to obtain consumer reports, including credit reports, tenant screening reports, criminal background checks, eviction history, employment and income verification, and rental references, for the purpose of evaluating this rental application.

I/We understand that:
- This is a consumer report as defined by the Fair Credit Reporting Act (15 U.S.C. § 1681 et seq.).
- If adverse action (denial, conditional approval, higher deposit, or other) is taken based in whole or in part on information in a consumer report, I/we will be provided a copy of the report and a summary of rights under FCRA.
- I/we may obtain a free copy of my/our credit report annually at www.annualcreditreport.com.
- I/we may dispute inaccurate information directly with the consumer reporting agency.

Minnesota-Specific Authorizations and Acknowledgments
- I/We have received the written screening criteria and tenant screening service information (if any) prior to paying any fee.
- I/We understand that the fee will be returned (or unused portion) if I/we are rejected for a reason not listed in the disclosed criteria, or if another applicant is selected.
- I/We consent to verification of all information provided.
- I/We understand that providing materially false information or omitting material facts may result in denial and liability to Landlord for damages and civil penalties under Minn. Stat. § 504B.173.

Full Legal Name (as appears on ID): [[Applicant Full Legal Name]]
SSN: [[Full SSN, will be handled securely and redacted after screening]]
Date of Birth: [[Date of Birth]]
Current Address for Reports: [[Current Address]]

Applicant Signature / Electronic Consent

By signing below (or checking the electronic consent box and typing my name), I certify that all information provided is true, complete, and accurate to the best of my knowledge, and I authorize the procurement and use of consumer reports and verifications as described.

Applicant Signature: _______________________________ Date: [[Application Date]]

Printed Name: [[Applicant Full Legal Name]]

Co-Applicant / Additional Adult (if applicable)

Signature: _______________________________ Date: [[Application Date]]
Printed Name: [[Co-Applicant Full Name]]

5. Vehicle and Pet Information (if applicable)

Vehicles to be parked on premises:
[[Year/Make/Model/License for each or "None"]]

Pets:
[[Type, breed, weight, number or "None, no pets will be kept without written consent"]]

Assistance / Service / Emotional Support Animals:
[[Describe and attach documentation if requesting accommodation under fair housing law]]

6. Additional Disclosures and Questions

Have you or any proposed occupant ever been convicted of a felony? [[Yes, explain dates, nature, jurisdiction / No]]

Have you or any proposed occupant ever been evicted or had an unlawful detainer filed? [[Yes, explain / No]]

Have you or any proposed occupant ever filed for bankruptcy? [[Yes, date and chapter / No]]

Are you or any proposed occupant a current or former service member entitled to SCRA protections? [[Yes / No]]

Do you or any proposed occupant require any reasonable accommodation under the Fair Housing Act or Minnesota Human Rights Act (e.g., disability-related modification)? [[Yes, describe / No]]

Lawful Source of Income (Minneapolis/St. Paul and other protected jurisdictions):
I certify that my income includes lawful sources such as employment, Social Security, disability, child support, or other legal sources. Landlord may not deny solely on the basis of lawful source of income where protected.

7. Receipt for Screening Fee (to be completed by Landlord upon receipt)

Receipt

Date Received: [[Date]]

Received from: [[Applicant Full Name]]

Amount: [[Application Fee Amount]]

Method: [[Cash / Check # / Credit Card / Other]]

Landlord / Agent Signature: _______________________________

Printed Name: [[Landlord or Agent Name]]

This receipt confirms payment. The fee will be used only for actual screening costs. Refund or accounting will be provided as required by Minn. Stat. § 504B.173 upon request or if applicant is rejected for non-disclosed reasons.

8. Landlord Use Only, Screening Decision Record

Date Application Received: [[Date]]

Fee Received and Receipted: [[Yes, Receipt # or attached / No fee charged]]

Screening Performed: [[Credit report date / Background check date / References verified / Other]]

Decision: [[Approved / Conditionally Approved / Denied]]

If Denied or Conditional, Specific Criteria Not Met (must identify from pre-disclosed list and notify applicant within 14 days per § 504B.173 Subd. 3):
[[List specific criteria failed, e.g. "Credit score below disclosed threshold", "Prior eviction resulting in writ within 5 years", "Income below 2.5× rent threshold"]]

Adverse Action Notice Provided (if applicable): [[Date and method, copy of report + FCRA summary of rights provided]]

Notes: [[Any other relevant notes]]

9. Minnesota Human Rights Act and Protected Classes

Landlord complies with the Minnesota Human Rights Act (Minn. Stat. § 363A) and federal Fair Housing Act. Protected classes include race, color, creed, religion, national origin, sex, marital status, familial status, disability, public assistance status, sexual orientation, gender identity, and (in certain jurisdictions) lawful source of income and other expansions. Landlord will not discriminate in the acceptance or processing of applications.

10. Professional Advice Disclaimer and References

Disclaimer

This is a template application and disclosure form only. It does not constitute legal advice. Screening practices, fees, and decision criteria must comply with current Minnesota Statutes § 504B.173, § 363A, FCRA, and any applicable local ordinances (e.g., Minneapolis, St. Paul). Landlords should consult a licensed Minnesota attorney or qualified compliance professional to ensure forms and procedures are current and jurisdiction-specific. Applicants have rights to receipts, criteria disclosure, return of fees, and notice of adverse action.

Key References (as of 2026)
- Minn. Stat. § 504B.173, Applicant screening fee limitations, disclosures, receipts, return, and remedies.
- Minn. Stat. § 504B.173 Subd. 3a, Limitations on denial based on pending/eviction records.
- Minn. Stat. § 363A, Minnesota Human Rights Act (protected classes, source of income in certain cities).
- 15 U.S.C. § 1681 et seq., Fair Credit Reporting Act.
- Minnesota Attorney General Landlord-Tenant resources.

> ⚠️ Template only, not legal or professional advice. Complete all `[[Token Name]]` fields. Landlord must disclose screening criteria and service information in writing before accepting any fee. Verify current law before use.