Residential Occupancy Application

RESIDENTIAL OCCUPANCY APPLICATION

Property Identification

Property Address:   Unit #:

Applicant Information

Other Names Used:   Date of Birth:

Current Residence

Owner/Manager:   Phone:

Monthly Rent/Mortgage:   Move-in Date:   Reason for Leaving:

Employment & Income

Position:   Supervisor:

Employer Phone:   Monthly Gross Income:   Date Employed:

Previous Residence (if less than 5 years at current)

Previous Landlord:   Phone:

Occupants, Vehicles & Pets

Do you have pets? Yes No

References & Emergency Contact

Disclosures

Is the dwelling known to contain lead-based paint? Yes No

Are you a party to any pending eviction or have you been evicted in the last 7 years? Yes No

Have you ever filed bankruptcy within the last 7 years? Yes No

Authorization and Consent

I certify that the information provided in this application is true and complete. I authorize the landlord, agent, and their agents to verify the information provided, to obtain credit reports, criminal background checks, tenancy history, employment verification, and other consumer reports as permitted by law. I expressly authorize any current or former employer, landlord, credit bureaus, public agencies and personal references to release information relevant to this application.

I acknowledge that false statements, material omissions or misrepresentations may constitute grounds for denial of this application or for immediate termination of occupancy if discovered after move-in. I release all persons from liability for damages that may result from furnishing such information to the landlord or agent, provided they act in good faith.

I understand screening fees, if any, may be charged to process this application and are non-refundable unless otherwise required by law. I understand submission of this application does not create a lease or tenancy until a written lease is signed by the landlord and applicant and any required deposits are paid.

Applicant consents to verification, screening, and the terms described above.

Additional Acknowledgements

Occupancy is limited to the persons listed on this application. Tenant(s) are responsible for property damage caused by occupants or guests. Applicant agrees to comply with property rules, utilities responsibilities, and insurance requirements as set forth in any resulting lease.

By signing below, I certify under penalty of perjury that the information provided is true and complete, and I authorize the checks and verifications described above.

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