{field:header_1554306210013}

Today's Date:__{field:today_s_date_1552358007117}

PERSONAL INFORMATION:

Address:{field:address_1553779227577}________________________________MonthlyRent:__field:monthly_rent_usd_1554221907098}

By which date would you like to move in, if approved:_{field:by_which_date_would_you_like_to_move_in_if_approved_1671632736733}______________________________________________________________________________

:__{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} if_yes_please_briefly_explain_when_and_why_1552496334717}____________________________________________________________________________________

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?:$____________________ 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: __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 #1 (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 $75.00 _________Move in Amount Received?:____________________________________________Notified of status?: Date Received:________________________

Pet Fee Required is $750.00 _____________Pet fee Amount Received?:______________________________________________________________________________Date Received:________________________

Application Fee Required is $25.00 _______Application fee Amount Received?:_______________________________________________________________________Date Received:________________________

Request Information...