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Nebraska Residential Rental Application

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                             This Residential Rental Application is used by landlords to provide to prospective tenants in
                             order to obtain their pertinent information. The application elicits applicants' personal
                             information, income information and residential and credit history allowing the landlord to
                             make an informed decision on which applicant to select. It is important that the landlord
                             has this information to evaluate which potential tenant will be able to make the rent
                             payments and take care of the property. This document should be utilized by landlords
                             located in Nebraska when listing a property for rent.
             ®




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                           RESIDENTIAL RENTAL APPLICATION

The undersigned hereby makes an application to rent the following property:
______________________________________________________________________________
____________________________________ [Instruction: Insert the address of the property].

PERSONAL INFORMATION

1. Full Name                           :       _________________________________________

2. Social security number (SSN)        :       _________________________________________

3. Date of Birth                       :       _________________________________________

4. Number of Dependents                :       _________________________________________

5. Name of the dependent with SSN:             _________________________________________

   a. _________________________________________

   b. _________________________________________

   c. _________________________________________

   d. _________________________________________

INCOME INFORMATION

Employment Status:       [___] Employed        [___] Self Employed        [___] Unemployed

Job Occupation and Title               : _________________________________________

Average Monthly Income                 : _________________________________________

Duration of Employment                 : _________________________________________

Company Name                           : _________________________________________

Company Number                         : _________________________________________

Company Address                        : _________________________________________

RESIDENTIAL HISTORY (LAST 2 YEARS)

1. Current Address of rental apartment/home            : __________________________________

                                                        __________________________________

                                                        __________________________________.


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   Name of the Owner/Agent                             : __________________________________

   Phone of the Owner/Agent                            : __________________________________

   Moved in date                                       : __________________________________

   Rent                                                : $ ______________

   Reasons for Leaving                    :
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

2. Previous Address of rental apartment/home           : __________________________________

                                                        __________________________________

                                                        __________________________________.

   Name of the Owner/Agent                             : __________________________________

   Phone of the Owner/Agent                            : __________________________________

   Moved in date                                       : __________________________________

   Rent                                                : $ ______________

   Reasons for Leaving                    :
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

3. Previous Address of rental apartment/home           : __________________________________

                                                        __________________________________

                                                        __________________________________.

   Name of the Owner/Agent                             : __________________________________

   Phone of the Owner/Agent                            : __________________________________

   Moved in date                                       : __________________________________

   Rent                                                : $ ______________


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   Reasons for Leaving                    :
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________
   ___________________________________________________________________________

DESCRIBE CREDIT HISTORY

1. Have you declared bankruptcy in the past seven (7) years?

   Yes ___________

   No ____________.




© Copyright 2011 Docstoc Inc. registered document proprietary, copy not   4
                                 PERSONAL DECLARATION

I declare that the information that I have provided here are true and updated to the best of my
knowledge.

I hereby authorize the prospective landlord (Landlord's Name: ______________________) to
carry out any background and credit checks necessary to verify my particulars and standing.

I also authorize the prospective landlord to contact my current landlord, employer, next of kin
and other related person for references.

Important Note: Providing false information to a landlord in order to obtain a tenancy is legal
grounds for terminating that tenancy with immediate effect.

_________________________

   Applicant’s Signature

Applicant's Name: ______________________

Date: ____ [Month] ____ [Date], 20____.




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Description: This Residential Rental Application is used by landlords to provide to prospective tenants in order to obtain their pertinent information. The application elicits applicants' personal information, income information and residential and credit history allowing the landlord to make an informed decision on which applicant to select. It is important that the landlord has this information to evaluate which potential tenant will be able to make the rent payments and take care of the property. This document should be utilized by landlords located in Nebraska when listing a property for rent.
This document is also part of a package Essential Nebraska Legal Documents 145 Documents Included