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- 1 - R ESI D EN T I A L LEA SE AP P LI CA T I O N Lan d l o r d / Lesso r : Dat e o f Ap p l i cat i o n : Lo cat i o n o f Resi d en ce: Nam e o f Ten an t : Ot h er Nam es Ten an t h as u sed : Cu r r en t Ho me Ph o n e Nu m b er : Dr i v er s Li cen se No . St at e o f I ssu an ce: So ci al Secu r i t y Nu m b er : Dat e o f Bi r t h : Mar i t al St at u s: Sp o u se Nam e: Ch i l d r en Nam es: Nam e o f Ten an t # 2 : Cu r r en t Ph o n e No : SS# Ten an t # 2 : Wh o w i l l l i v e i n r esi d en ce ex cep t ap p l i can t an d ch i l d r en ? Pl ace o f Em p l o y m en t : Ad d r ess: Su p er v i so r : Ph o n e: Yo u r Jo b Ti t l e: Wo r k Ho u r s: Mo n t h l y Pay : Ho w l o n g at cu r r en t j o b ? Ot h er so u r ces o f i n co m e: Do y o u i n t en d t o r esi d e h er e i n d ef i n i t el y ? Yes No -I f n o , h o w l o n g ? Hav e y o u ev er f i l ed Ban k r u p t cy ? Yes No -I f y es, co u r t an d cau se n u m b er ? Ar e y o u a p ar t y t o an y l aw su i t ? Yes No -I f y es, p l ease d es cr i b e. Ar e t h er e an y j u d g m en t s ag ai n st y o u ? Yes No -I f y es, p l ease d escr i b e. Ban k Nam e: Ph o n e: Acco u n t No : Acco u nt No . Cr ed i t Ref er en ces: Nam e: Ph o n e: Nam e: Ph o n e: Nam e: Ph o n e: Co n d i t i o n s a n d I n f o r m a t i o n Al l p ag es o f t h i s l ease ap p l i cat i o n m u st b e si g n ed b y al l p er so n s w h o w i l l si g n t h e l ease ag r eem en t . Ad d i t i o n al t en an t i n f o r m at i o n i s o n p ag e 2 . Th e co m p l et i n g o f t h i s ap p l i cat i o n b y Ten an t an d t h e accep t an ce o f t h i s ap p l i cat i o n b y Lan d l o r d cr eat es n o o b l i g at i o n o f Lan d l o r d t o ap p r o v e t h e ap p l i cat i o n . Th i s ap p l i cat i o n w i l l b e ap p r o v ed o r r ej ect ed u su al l y w i t h i n f i v e ( 5 ) d ay s o f b ei n g su b m i t t ed t o l an d l o r d . Ho w ev er , t h er e i s n o o b l i g at i o n o f Lan d l o r d t o n o t i f y t en an t u n l ess t h e ap p l i cat i o n i s ap p r o v ed . I f t h i s ap p l i cat i o n i s ap p r o v ed , Ten an t m u st m ak e t h e secu r i t y d ep o si t an d si g n t h e l ease b ef o r e t h e t en an cy b eg i n s. Lan d l o r d co m p l i es w i t h al l Fed er al an d St at e l aw s r eg ar d i n g d i scr i m i n at i o n an d d o es n o t d i scr i m i n at e b ased u p o n ag e, sex , r ace, m ar i t al st at u s, r el i g i o n , n at i o n al o r i g i n , o r o t h er p r o h i b i t ed cl assi f i cat i o n s. Fo r La n d l o r d ’ s U se O n l y Ren t Am o u n t : Dep o si t : Dat e Lease t o b eg i n : En d o f Lease: Nu m b er o f Occu p an t s: ( Co n t i n u e d o n P a g e 2 ) By y o u r si g n at u r e h er eo n , y o u ag r ee t h at t h e i n f o r m at i o n d i sc l o sed b y y o u h er ei n i s t r u e, co m p l et e an d accu r at e t o t h e b est o f y o u r k n o w l ed g e, an d y o u ag r ee t h at t h e i n f o r m at i o n d i scl o sed b y y o u h er ei n i s m at er i al t o t h e p o t en t i al Lesso r ’s d eci si o n w i t h r esp ect t o g r an t i n g o r d en y i n g y o u r ap p l i cat i o n t o en t er i n t o a l ease. Si g n ed : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dat e: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Si g n ed : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dat e: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - 2 - Do y o u h av e an y p et s t h at y o u w o u l d l i k e t o o ccu p y t h e r esi d en ce? Yes No - I f y es, p l ease d escr i b e. No t e: Th i s p r o v i si o n d o es n o t i m p l y t h at p et s ar e al l o w ed . Hav e y o u ev er b een ev i ct ed f r o m a r en t al u n i t ? Yes No I f y es, p r o v i d e r easo n f o r ev i ct i o n . Mo t o r Veh i cl e I d en t i f i cat i o n : Year Mak e/ Mo d el Co l o r Tag Nu m b er Li st Cr ed i t Car d s Ty p e: Car d # Ty p e: Car d # Ty p e: Car d # Ty p e: Car d # Cr ed i t o r s Ty p e Of Deb t Am o u n t Ow ed Mo n t h l y Pay m en t Per so n t o n o t i f y i n case o f em er g en cy : Ph o n e: Pr esen t Ad d r ess: Z i p : Ho w l o n g ? Reaso n f o r l eav i n g : Nam e an d p h o n e # o f o w n er / m an ag er : Pr ev i o u s Ad d r ess: Wh en ? Reaso n f o r l eav i n g : Pr ev i o u s Ad d r ess: Wh en ? Reaso n f o r l eav i n g : D I SCLO SU R E O F M A N A GER : T h e M a n a g e r o f t h e P r e m i se s i s P h o n e : A d d r e ss: Ci t y : St a t e : Z i p : O W N ER D I SCLO SU R E: T h e o w n e r o f t h e p r e m i se s o r a p e r so n a u t h o r i z e d t o a ct f o r a n d o n b e h a l f o f t h e o w ne r f o r t h e p u r p o se o f se r v i ce o f p r o ce ss a n d r e ce i v i n g a n d r e c e i p t i n g f o r n o t i ce s a n d d e m a n d s i s d i scl o se d a s: N a m e: P h o n e : A d d r e ss: Ci t y : St a t e : Z i p : R A D O N GA S D I SCLO SU R E. R a d o n i s a n a t u r a l l y o ccu r r i n g r a d i o a ct i v e g a s t h a t , w h e n i t h a s a ccu m ul a t e d i n a b u i l d i n g i n su f f i ci e n t q u a n t i t i e s, m a y p r e se n t h e a l t h r i sk s t o p e r so n s w h o a r e e x p o se d t o i t o v e r t i m e . Le v e l s o f r a d o n t h a t e x ce e d f e d e r a l a n d st a t e g u i d e l i n e s h a v e b e e n f o u n d i n b u i l d i n g s i n e v e r y St a t e o f t h e U n i t e d St a t e s. A d d i ti o n a l i n f o rm a t i o n r e g a r d i n g r a d o n g a s m a y b e o b t a i n e d f r o m y o u r Co u n t y p u b l i c h e a l t h u n i t . Se e a l so h t t p : / / w w w . ep a. g o v / i aq / r ad o n / CO N SEN T T O CR ED I T CH ECK I / W e , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , t h e u n d e r si g n e d a p p l i ca n t ( s) a u t h o r i z e l a n d l o r d , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , o r h i s/ h e r / t h e i r a g e n t t o o r d e r a n d r e v i e w m y / o u r cr e d i t a n d cr i m i n a l h i st o r y a n d i n v e st i g a t e t h e a ccu r a cy o f t h e i n f o r m a t i o n co n t a i n e d i n t h e a p p l i ca t i o n . I / W e f u r t h e r a u t h o r i z e a l l b a n k s, e m p l o y e r s, cr e d i t o r s, cr e d i t ca r d co m p a n i e s, r e f e r e n ce s, a n d a n y a n d a l l o t h e r p e r so n s t o p r o v i d e t o La n d l o r d a n y a n d a l l i n f o r m a t i o n co n ce r n i n g m y / o u r cr e d i t . Si g n ed : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dat e: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Si g n ed : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dat e: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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