RESIDENCY APPLICATION
Today’s Date
*
/
Month
/
Day
Year
Date
Desired Occupancy Date
*
/
Month
/
Day
Year
Date
Preferred Apartment Size
*
How did you hear about us?
*
Name
*
First Name
Middle Name
Last Name
Currently Rent or Own?
*
Rent
Own
Current Address
*
Apartment Number
*
City
*
State
*
Zip
*
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
/
Month
/
Day
Year
Date
Social Security Number
*
Driver’s License or State ID Number
*
Do you own a vehicle?
*
Yes
No
If so, make and model
*
Emergency Contact:
Name
*
First Name
Middle Name
Last Name
Address
*
Apartment Number
*
City
*
State
*
Zip
*
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Relationship to Applicant
*
MONTHLY INCOME
Rows
Monthly Income
Social Security
Pension(s)
Annuities
Wages
Interest
Dividends
Rent
IRA Distribution
Other
Total
ASSETS (List Value)
Rows
Assets (List Value)
Checking Account
Savings Account
Stocks/Bonds
Annuities
IRAs
Life Insurance (Cash Value)
Personal Residence
Other Residence
Certificate of Deposit
Other
Total
Power of Attorney for Health Care
Do you have a Power of Attorney for Health Care?
*
Yes
No
Name
First Name
Middle Name
Last Name
Address
Apartment Number
City
State
Zip
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Power of Attorney for Finances
Do you have a Power of Attorney for Finances?
*
Yes
No
Name
First Name
Middle Name
Last Name
Address
Apartment Number
City
State
Zip
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Guardian
Do you have a Guardian?
*
Yes
No
Name
First Name
Middle Name
Last Name
Address
Apartment Number
City
Zip
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Have you...
*
Rows
Yes
No
Ever been evicted?
Ever been convicted of a misdemeanor?
Ever been convicted of a felony?
Ever had a judgement filed against you?
Ever declared bankruptcy?
Ever had an account assigned to a collection agency?
Ever been subject to a lifetime sex offender
registration program in any state?
If yes to being subject to a lifetime sex offender registration program in any state, which states?
*
Rows
Yes
No
Do you have a bed bug or other pest
issue in your current residence?
Has your residence been treated for
bed bugs or other pests in the last 12 months?
If you have had a pest treatment in the last 12 months, please explain:
Upload Driver's License or other ID
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Upload Social Security Card
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Upload all income/asset images
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Signature
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
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