Residential Lease Questionnaire

RESIDENTIAL LEASE QUESTIONNAIRE

Property Identification

Parties

Proposed Lease Terms

Lease Term Start Date:    Lease Term End Date:

Rent Due Day Each Month (day of month):    Late Fee Terms:

Occupancy and Use

Intended Use:

Pets, Service Animals, and Smoking

Pets Allowed: Yes    No

Smoking Allowed Inside Unit: Yes    No

Parking and Storage

Assigned Parking Spaces:    Parking Location / Permit Required:

Alterations, Accessibility, and Accommodations

Tenant May Make Non-Structural Alterations with Written Approval: Yes    No

Request for Reasonable Accommodation for Disability: Yes    No

Utilities, Appliances, and Maintenance

Disclosures — Indicate Yes or No and Provide Details Where Requested

Property Built Before 1978 (Lead-Based Paint Warning): Yes    No

Known Mold or Water Damage: Yes    No

Prior Structural or Significant Repairs (foundation, roof, major systems): Yes    No

Pest Infestation History (rodents, termites, etc.): Yes    No

Safety and Security

Smoke Detectors Present and Functional: Yes    No

Carbon Monoxide Detectors Present: Yes    No

Security Alarm or Access Control on Premises: Yes    No

HOA / Condominium Rules (if applicable)

Subject to HOA or Condominium Rules: Yes    No

Subletting, Assignment, and Insurance

Subletting / Assignment Allowed with Approval: Yes    No

Tenant Renter's Insurance Required: Yes    No

Background, Screening, and Authorizations

Applicant Consents to Employment, Rental, Credit, and Criminal Background Checks: Yes    No

Additional Requests / Notes

Certifications and Authorizations

By signing below, Tenant certifies that all information provided in this questionnaire is true, accurate and complete to the best of Tenant's knowledge. Tenant authorizes Landlord or Landlord's agent to verify information provided, to obtain credit and background checks, and to make inquiries of current or prior landlords, employers, and references. Tenant acknowledges that providing false or materially misleading information is grounds for denial of tenancy or, if a lease has been executed, termination of tenancy and recovery of damages.

Landlord certifies that the information provided herein reflects Landlord's current knowledge of the property's condition and applicable rules or restrictions. Landlord will disclose in the lease any specific material facts known to Landlord that would affect Tenant's use or occupancy.

This questionnaire is for informational purposes and, unless incorporated by reference into a written lease signed by both parties, does not itself create a leasehold interest. Any representations made in this questionnaire that conflict with a subsequently executed lease shall be superseded by the terms of that lease.

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