Tenant Information:

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					                                                   Joseph Bogart
                                                   PO Box 14373
                                                Gainesville, FL 32604
                                                    352-278-9347

Tenant Information:
Everything on this sheet is kept completely confidential and the information is solely used in emergency
situations and collection purposes. The information is however required to live (continue living) here.

Full Name ________________________________________ Date of Birth _______________
Your Social Security # _______________________________ Driver’s License # _______________________________
Home Telephone Number ________________________ Work Phone ____________________________
              Cell Number _______________________________ E-Mail _______________________
Who lives with you? (Include ages of children, please)
     ___________________________________________________________________________________
Permanent/Previous Address:
_________________________________________________________________________Phone (____) ____________
     Name                      Address                       City           State   Zip

Present Address:
__________________________________________________________________________Phone (____)_________
     Name                      Address                       City           State   Zip

Landlord ______________________________ How long have you lived there? _______ From ________to_________

Employment

Place of employment _____________________________________ Position/Title ______________________
     Rate of pay $________ Number of hours/wk ______ Supervisor _______________________________________
                                                                  Name                      Phone
     Length of employment _____ years _____ months

Where does your co-tenant work? (Company name) ______________________________
References (2) ____________________________________________________________________________
               Name                                Phone            Name                          Phone

Banking & Credit

Primary Bank _________________________ Account # _________________________
Type of account: ___ checking ___ savings ___ other _________________________

Other

Vehicle _______________________________________________________________________________________
              Color                      Make                       Model                 Tag#

Emergency Contact: ___________________________________________________________________(___)________
                       Name                        Address                  City          State   Zip     Phone

Friend (non-relative): __________________________________________________________________(___)________
                       Name                        Address                  City          State   Zip     Phone

Have you ever been evicted? Yes ___ No ___
If yes, why and from where? _________________________________________________________________________
Have you ever been convicted of a felony? Yes ___ No ___
If yes, why and when? ______________________________________________________________________________

By signing, you agree that I have permission to contact references, conduct a background check, and run a credit check.
     You also agree that the information that you have provided is accurate and correct.

Signature _________________________________________ Date _______________________

				
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