Rental Application Form

Rental Application Form

Apply for housing at your preferred property.
Rental Application #102522 KS36810
This is an application for housing at:
Project*
Address*
Please complete this application and return to:
Name*
Address*
Applications are placed in order of date and time received. An applicant may be interviewed only after the receipt of this tenant application. Every question must be answered. Do NOT leave blanks. Use N/A when not applicable.
Section A. GENERAL INFORMATION
Applicant Name*
Current Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Daytime Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Evening Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Number of bedrooms in current unit*
RentOwn
Amount of current monthly rental or mortgage payment*
YesNo
HeatElectricityGasOther
Approximate monthly cost of utilities paid by you*
StudioOne BRTwo BRThree BRHandicap BR
B. HOUSEHOLD COMPOSITION
Explain custody agreement (proof of custody may be required)*

Rows	Name	Relationship to head	Birth Date	Age (Optional)	SS# (last 4 digits)	Student (Y/N)
Head
C0-H
3.
4.
5.
6.
7.
8.

YesNo
YesNo
Explain:*
YesNo
Explain:*
YesNo
Explain:*
YesNo
Explain:*
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
C. INCOME
List ALL sources of income as requested below. If a section doesn’t apply, cross out or write NA
Household Member Name Social Security Gross Monthly Amount
1. *Social Security$*
12. *Social Security$*
13.*SSI Benefits $*
14.*SSI Benefits $*
15.*Pension (list source)$*
16.* Pension (list source)$*
17.* Veteran’s Benefits (list claim #)$*
18.* Veteran’s Benefits (list claim #)$*
19.* Unemployment Compensation$*
20.* Unemployment Compensation$*
21.* Public Assistance (Title IV/TANF etc.)$*
22.* Contributions to the Household (monetary or not)$*
23.* Full-Time Student Income (18 & Over Only)$*
24.* Financial Aid (excluding loans)$*
25.* Annuities (list sources)$*
26.* Long Term Medical Care Insurance Payments in excess of $180/day$*
27.* Scheduled Payments from Investments:$*
28.* Retirement Account Payments (including RMDs):$*
29.* Income From Rental Property:$*
Household Member Name Source of Income Monthly Amount
30.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
31.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
32.* Employment amount:$*
Employer*
Position Held*
How Long Employed*
33.* Previous Employment amount (last 60 days):$*
Employer*
Position Held*
How Long Employed*
34. Alimoney:$*
YesNo
List amount you receive:*
$
35. $* Child Support:$
YesNo
List amount you receive:*
36. Other Income:$*
37. Other Income:$*
38. Other Income:$*
39. TOTAL GROSS ANNUAL INCOME (Based on the monthly amounts listed above x 12)*
40. TOTAL GROSS ANNUAL INCOME FROM PREVIOUS YEAR*
YesNo
YesNo
YesNo
44. If yes to any of the above, explain:
YesNo
D. ASSETS (even if jointly held)

If your assets are too numerous to list here, please request an additional form. If a section doesn’t apply, cross out or write NA.
46. Checking Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
47. Savings Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
48. Trust Account
#. Bank: Balance:$
49. Debit cards not associated with a checking account
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
50. Certificates of Deposit (CDs)
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
51. Money Market Accounts
#. Bank: Balance:$
#. Bank: Balance:$
#. Bank: Balance:$
52. Savings Bonds
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
#. Maturity Date:Date Value:$
53. Life Insurance Policy # Cash Value:$
54. Life Insurance Policy # Cash Value:$
55. Mutual Funds
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
56. Stocks
Name #Shares:Dividend Paid$
Values:$
Name #Shares:Dividend Paid$
Values:$
Name #Shares:Dividend Paid$
Values:$
57. Bonds
Name #Shares:Interest or Dividend$
Values:$
Name #Shares:Interest or Dividend$
Values:$
YesNO
Type of property:*
59. Location of property:*
60. Appraised Market Value: $*
61. Mortgage or outstanding loans balance due: $*
62. Amount of annual insurance premium: $*
63. Amount of most recent tax bill: $*
YesNo
Describe*
YesNo
Type of Property:*
66. Market value when sold/disposed: $*
67. Amount sold/disposed for: $*
68. Date of transaction:*
YesNo
Describe the asset:*
70. Date of disposition:

MonthDayYear
Date
71. Amount disposed: $*
YesNo
Describe*
E. ADDITIONAL INFORMATION
YesNo
YesNo
Describe*
YesNo
Describe*
YesNo
Describe*
YesNo
Briefly describe your reasons for applying:*
F. REFERENCE INFORMATION
78. Current Landlord
Name*

First NameLast Name
Address*
Cell Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
How Long?:
79. Prior Landlord
Name*

First NameLast Name
Address:*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
How Long?*
80. Credit Reference #1:*
Address:*
Account #*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
81. Credit Reference #2:*
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
82. Personal Reference #1: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
83. Personal Reference #2: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
84. Personal Reference #3: *
Address:*
Relationship*
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
G. VEHICLE AND PET INFORMATION (if applicable)

List any cars, trucks, or other vehicles owned. Parking will be provided for one vehicle. Arrangements with Management will be necessary for more than one vehicle.
86. Type of Vehicle:*
License Plate #: *
Year/Make:*
Color:*
87. Type of Vehicle:*
License Plate #: *
Year/Make:*
Color:*
YesNo
Describe:*
H. APPLICATION ASSISTANCE
YesNo
Who assisted and what was the reason for the assistance:*
CERTIFICATION

I/We hereby certify that I/We Do/Will Not maintain a separate subsidized rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge, and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult applicants, 18 or older, must sign and date the application.
SIGNATURE(S) (Must be dated):
(Signature of Tenant) *

Clear
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *

Clear
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *

Clear
Date*

MonthDayYear
Date
(Signature of Co-Tenant) *

Clear
Date*

MonthDayYear
Date
Should be Empty:

Rental Application Form

Rental Application #102522 KS36810

This is an application for housing at:

Please complete this application and return to:

Section A. GENERAL INFORMATION

B. HOUSEHOLD COMPOSITION

C. INCOME

D. ASSETS (even if jointly held)

46. Checking Accounts

47. Savings Accounts

48. Trust Account

49. Debit cards not associated with a checking account

50. Certificates of Deposit (CDs)

51. Money Market Accounts

52. Savings Bonds

55. Mutual Funds

56. Stocks

57. Bonds

E. ADDITIONAL INFORMATION

F. REFERENCE INFORMATION

78. Current Landlord

79. Prior Landlord

G. VEHICLE AND PET INFORMATION (if applicable)

H. APPLICATION ASSISTANCE

CERTIFICATION

SIGNATURE(S) (Must be dated):