Supplemental Real Estate Application

SUPPLEMENTAL REAL ESTATE APPLICATION

Property Identification

Parcel / APN Number:

Applicant Information

Date of Birth:    Phone:

Date moved in:    Monthly Rent:

Additional Occupants

Occupant 1 Name:    Age:    Relationship:

Occupant 2 Name:    Age:    Relationship:

Employment & Income

Position:    Supervisor:

Employer Phone:    Gross Monthly Income:

I authorize the verification of the above employment and income information and consent to contact my employer and other sources for confirmation.

Vehicles & Pets

Year:    License Plate:

Applicant has pets

References

Prior Rental History

Previous Landlord:    Phone:

Monthly Rent:    Lease End Date:

Disclosures

Have you ever been convicted of a felony?   Yes   No

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

Is the subject property built before 1978?   Yes   No

Attachments / Additional Documents

Authorization, Certifications and Notices

By signing below, Applicant certifies that all information provided in this Supplemental Real Estate Application is true, complete and correct. Applicant authorizes verification of any information contained herein, including but not limited to credit, criminal background, rental history, employment, income and references. Applicant acknowledges that false statements or omissions are grounds for application denial or, if discovered after occupancy, termination of tenancy and recovery of damages.

Applicant understands that this Supplemental Real Estate Application supplements and is incorporated into the original application for the referenced property and may be relied upon by management, owner, or designated agents in evaluating the overall application. Applicant releases all persons and entities from liability for information provided in good faith in response to inquiries made in the verification process.

Applicant further acknowledges receipt of any statutorily required disclosures and understands that approval is conditioned on satisfactory verification. Applicant agrees to provide additional documentation upon request to substantiate income, identity, or other material facts.

Certification Statement

I certify under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge. I acknowledge that management may keep this application whether or not it is approved.

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