APARTMENT RENTAL APPLICATION-FILL IT OUT AND E-MAIL IT BACK

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