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Applicant Information |
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Rental History: |
| First: |
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MI: |
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Last: |
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| E-Mail: |
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Home Phone: |
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Cell: |
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| DRV#: |
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Soc Sec: |
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Date of Birth: |
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Present Landlord: |
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Your Address (city-State): |
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Phone: |
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Yrs
Rented & Rent $ |
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Prior Landlord: |
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Address: |
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Phone: |
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Yrs
Rented & Rent $ |
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Employment: |
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Current Employer: |
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Gross Pay/Month: |
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Years Employed: |
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Position: |
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Address of Employer: |
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City / State: |
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Phone: |
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Supervisor: |
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Prior Employer: |
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Gross Pay/Month: |
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Years Employed: |
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Position: |
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Address of Employer: |
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City / State: |
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Phone: |
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Supervisor: |
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| Co-Applicant
Information |
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Rental History: |
| First: |
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MI: |
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Last: |
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| DRV#: |
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Soc Sec: |
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Date of Birth: |
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Present Landlord: |
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Address: |
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Phone: |
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Yrs
Rented & Rent $ |
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Prior Landlord: |
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Address: |
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Phone: |
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Yrs
Rented & Rent $ |
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Employment: |
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Current Employer: |
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Gross Pay/Month: |
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Years Employed: |
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Position: |
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Address of Employer: |
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City / State: |
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Phone: |
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Supervisor: |
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Prior Employer: |
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Gross Pay/Month: |
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Years Employed: |
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Position: |
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Address of Employer: |
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City / State: |
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Phone: |
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Supervisor: |
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| Other Adults
or Minor Occupants of Home: |
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Name: |
Relationship to Applicant: |
Date of Birth: |
Soc. Sec#: |
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1:
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| 2:
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| 3:
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| 4:
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| 5:
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| Additional
Information: |
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Vehicles - Make / Model
License Plate #: |
Persons to Contact in Case
of Emergency - Name / Phone: |
Pets - Name: |
Pet Breed: |
| Make: |
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Name: |
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1:
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| Model: |
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Phone: |
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2:
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| Plate#: |
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3:
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Name: |
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| Make: |
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Phone: |
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| Model: |
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| Plate#: |
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Disclosures: |
| 1.
Have you or any other proposed occupant of the site ever
been known by any other name (s)? If so list below: |
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| 2.
Have you or any other proposed occupant of the site, ever
been convicted for the illegal manufacture or distribution
of a controlled substance? -If Yes, who, what, when and
where |
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| 3.
Are You or any other proposed occupant of the site, a
current illegal user or addict of a controlled substance?
If yes which person: |
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| 4.
Have you or any other proposed occupant of the site, been
served with a notice of a breach of your lease or been
evicted? If yes
which person: |
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| 5.
Have you or any other proposed occupant of the site been
arrested or convicted of a crime? (A "yes" answer does not
automatically disqualify you for tenancy. If yes who,
what, when and where (make sure to list state it took
place) |
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Certification and Agreement
- Please read carefully
I represent that the information provided herein is true
and correct to the best of my knowledge. I understand that
if my application is accepted any false statements on, or
omissions from, this application may result in eviction.
You are hereby authorized to make any investigation of my
personal history, financial and credit record through any
investigation agency or bureaus of your choosing. I
understand landlord may also consult CCAP (state court
records) and the sexual predator list. I understand that a
security deposit, earnest money deposit, if any, will be
returned if my application is not accepted; however, a
credit check fee, if any, is not refundable. |
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Applicant: |
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Co-Applicant: |
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