APPLICATION :YEAR 2017
Name:_____________________________________________
Present
Address:_____________________________________________________
How
long:_________________________________
Home phone
No.:____________________________
Landlord’s
Name:_______________________________________
Phone
No.:_____________________________________________
Current rent
payment:____________________________________
No. of occupants (adult and
children):_________________
Any smokers: ______________
Pets:________________
List on back any prior
addresses if not at current address for more than 2 years.
Social Security
number:__________________________
Driver’s
License No:_________________________
Employer:_______________________________________________________________
Address:________________________________________________________________
Position_____________________________________
How
long:_______________________________________________________________
Supervisor:_______________________________
Contact phone:___________________
Annual___________________________________
Please include a copy of
your most recent pay stub demonstrating above income.
Include all above
information on back for a prior employer if at position less than 2 years.
List any other loans,
including auto loans below. Include monthly payments & date of maturity for
all loans. Also, list any credit card debts that require a monthly payment, the
amount of such_________________________________________________________
______________________________________________________________________________
Have you ever refused to
pay rent when due? _________________________________________
Have you ever been evicted
from any rental premises? __________________________________
Are there any circumstances
that may interrupt your ability to pay rent? ____________________
Under the penalty of
perjury, I attest that the above answers are true to the best of my knowledge.
____________________________________
Sign
____________________________________
Print Name
State of New York )
) ss.:
Country of _________ )
On
the ____day of ___________, 20 before me, the undersigned, a notary in and for
said state,
personally
appeared _____________________________, personally known to me or proved to me
on the basis
of satisfactory evidence to be the individual whose name is subscribed in the
within instrument and acknowledged
to me that he executed the same in his capacity and that by his signature on
the instrument, the
individual, or the person upon behalf of which the individual acted, executed
the instrument.
________________________
NOTARY PUBLIC
