Today's Date: {field:today_s_date_1552358007117}

PERSONAL INFORMATION:

Address: {field:address_1553779227577} Monthly Rent: {field:monthly_rent_usd_1554221907098}

{field:how_long_have_you_known_them_1553719305019}{field:name_1553115263922}- By which date would you like to move in, if approved: {field:by_which_date_would_you_like_to_move_in_if_approved_1671632736733} Applicant Name: {field:applicant_name_1552399561196} Phone: {field:phone_1552399422097} Date of Birth: {field:dob_date_1554829322440} Social Security#: {field:social_security_1552444093338} DL/ID#: {field:dl_id_1552444160455} States: {field:states_1562159960678} Email Address: {field:email_1553723920610} Present Address: {field:present_address_1552444471495} Employer: {field:employer_1552444565539} Position Held: {field:position_held_1552444602447} Date of Hire: {field:date_of_hire_1552491964463} Income:$ {field:income_usd_1552492027101} Pay Frequency: {field:tenant1_pay_frequency_1552492516839} Supervisor: {field:supervisor_1552492783187} Phone#: {field:phone_1552492844074} Have you ever been evicted? {field:tenant1_been_evicted_1552493780727} If yes, when?: {field:if_yes_when_1552493862380} Have you ever filed bankruptcy?: {field:have_you_ever_filed_bankruptcy_1552496067777} Have you been convicted of or plead guilty to anything other than a traffic violation in the last 5 years?: {field:listselect_1552496184225} If yes, please briefly explain when and why: {field:if_yes_please_briefly_explain_when_and_why_1552496334717} Tenant#2: Name: {field:tenant_2_name_1552496767412} Phone: {field:phone_1552496821564} Date of Birth: {field:tenant2_date_1552496900353} Social Security#: {field:social_security_1552496981725} DL/ID#: {field:dl_id_1552497096177} States: {field:us_states_1552497166564} E-mail Address: {field:tenant2_date_1552496900353} Present Address: {field:employer_1552598724337} Employer: {field:employer_1552598724337} Position Held: {field:listselect_1552599000649} Date of Hire: {field:date_of_hire_1552598984329} Income:$ {field:income_usd_1552598975881} Pay Frequency: {field:listselect_1552599000649} Supervisor: {field:supervisor_1552599179356} Phone#: {field:phone_1552599483095} Have you ever been evicted? {field:tenant1_been_evicted_1552493780727} If yes, when?: {field:if_yes_when_1552493862380} Have you ever filed bankruptcy?: {field:have_you_ever_filed_bankruptcy_1552496067777} Have you been convicted of or plead guilty to anything other than a traffic violation in the last 5 years?: {field:listselect_1552496184225} If yes, please briefly explain when and why: {field:rental_history_1553782880951} Have you ever been evicted? {field:tenant2_evicted} If yes, when?: {field:tenant2_datewhen_1552599850757} Have you ever filed bankruptcy?: {field:tenant2listselect_1552599853169} Have you been convicted of or plead guilty to anything other than a traffic violation in the last 5 years?: {field:tenant2listselect_1552600186265} If yes, please briefly explain when and why: {field:tenant2textbox_1552600247626} * An eviction and/or criminal background does NOT automatically disqualify you from being approved* RENTAL HISTORY: Present: Landlords Name: {field:landlord_s_name_1552600544636} Phone#: {field:phone_1552600871513} Is this landlord a friend or relative?: {field:is_this_landlord_a_friend_or_relative_1552600902287} If yes, please list relationship: {field:if_yes_please_list_relationship_1552601000953} Rent Amount?:$ {field:rent_amount_usd_1552601032956} Length at Address: {field:length_at_address_1552601056380} Did you sign a lease? {field:did_you_sign_a_lease_1555009061020} Previous: Landlords Name: {field:landlord_s_name_1552601164821} Phone#: {field:phone_1552601172875} Is this landlord a friend or relative?: {field:is_this_landlord_a_friend_or_relative_1552601211682} If yes, please list relationship: {field:if_yes_please_list_relationship_1552601255583} Rent Amount?:$ {field:rent_amount_usd_1552601032956} Length at Address: {field:length_at_address_1561579820531} Did you sign a lease? {field:did_you_sign_a_lease_1561579878698} ADDITIONAL OCCUPANTS: Occupant #1: Name: {field:occupant_2_name_1552601627132} Phone#: {field:phone_1552601493357} Date of Birth: {field:date_of_birth_1552601531348} Relationship to Tenant: {field:relationship_to_tenant_1552601562975} Occupant #2: Name: {field:name_1552601469535} Phone#: {field:name_1552601469535} Date of Birth: {field:date_of_birth_1552601688653} Relationship to Tenant: {field:relationship_to_tenant_1552601724027} Occupant #3: Name: {field:name_1552601786215} Phone#: {field:phone_1552601812580} Date of Birth: {field:date_of_birth_1552601857155} Relationship to Tenant: {field:relationship_to_tenant_1552601887115} EMERGENCY CONTACT: Person #1 to notify in case of emergency: Name: {field:name_1552752131926} Phone#: {field:phone_1561580826183} Address: {field:address_1552752155771} Relationship to Tenant: {field:relationship_to_tenant_1561647022574} E-mail: {field:e-mail_1552752179609} Person #2 to notify in case of emergency: Name: {field:name_1552752284016} Phone#: {field:phone_1561581075407} Address: {field:address_1552752301560} Relationship to Tenant: {field:relationship_to_tenant_1561647204047} E-mail: {field:e-mail_1552752318927} PETS: (There is a $75.00, NON-REFUNDABLE fee for pets) Pet #1 Type of animal?: {field:type_of_animal_1552752725300} Is it an inside or outside pet?: {field:is_it_an_inside_or_outside_pet_1554146515338} Are pets? shots/healthcare up to date?: {field:are_pet_s_shots_healthcare_up_to_date_1552752821304} Do pet bite?: {field:does_pet_bite_1552752868810} Is pet caged/chained up?: {field:is_pet_caged_chained_up_1552752923648} Pet #2 Type of animal?: {field:type_of_animal_1552752725300} Is it an inside or outside pet?: {field:is_it_an_inside_or_outside_pet_1554146515338} Are pets? shots/healthcare up to date?: {field:are_pet_s_shots_healthcare_up_to_date_1552752821304} Do pet bite?: {field:does_pet_bite_1552752868810} Is pet caged/chained up?: {field:is_pet_caged_chained_up_1552752923648} REFERENCES: Reference #1 (Relative): Name: {field:name_1553115263922} Phone#: {field:phone_1553115316213} E-mail: {field:email_1553115513536} Relationship to Tenant: {field:listselect_1553783821022} How long have you known them?: {field:how_long_have_you_known_them_1553719305019} Reference #2 (Relative): Name: {field:name2_1553719468528} Phone#: {field:phone_1561645822264} E-mail: {field:e-mail2_1553719891826} Relationship to Tenant: {field:listselect_1553794040033} How long have you known them?: {field:how_long_have_you_known_them2_1553719924622} Reference #3 (Co-Worker): Name: {field:firstname_1553723975236} Phone#: {field:phone_1553724010011} E-mail: {field:email_1553723920610} Relationship to Tenant: {field:listselect_1553793991669} How long have you known them?: {field:textbox_1553720019314} Reference #4 (friend): Name: {field:firstname_1553794637803} Phone#: {field:phone_1553794649039} E-mail: {field:email_1553794730994} Relationship to Tenant: {field:listselect_1553810369225} How long have you known them?: {field:textbox_1553794761330} MISCELLANEOUS INFORMATION: How did you hear about Emmit Moss Trust?: {field:textbox_1553794761330} If referred by one of our residents, please tell us who: {field:if_referred_by_one_of_our_residents_please_tell_us_who_1553795052190} Does anyone have additional income that is verifiable, such as social security, child support, or alimony?: {field:child_support_1553795090799} If yes, from which source?: {field:if_yes_from_which_source_1553795158782} Amount$: {field:amountusd_1553795225583} *Any additional income listed will have to be proved as well, award letters ARE an acceptable form of proof* I hereby certify that the information I have provided above is truthful and complete. I understand that any false or inaccurate information on my application could result in the denial of my application. Tenant 1 Signature {field:tenant_1_signature_1553810721780} Date: {field:date_1553810734946} Tenant 2 Signature {field:tenant_2_signature_1671743788957} Date: {field:date_1553810776238} DO NOT WRITE BELOW THIS LINE FOR OFFICE USE ONLY Application Taken By: ____ Date: ____ Status: ____ Move in Fee Required is $800.00 Move in Amount Received?: ____ Notified of status?: ____ Date Received: ____ Pet Fee Required is $75.00 Pet fee Amount Received?: ____ Date Received: ____ Application Fee Required is $25.00 Application fee Amount Received?: ____ Date Received: ____

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