FAX TO: 206-333-0502 ATTN: MELISSA
Location:             XXXXX NE 148th Lane, Bothell WA 98011            Date:

Name of Tenant:                                                        Do you intend to reside       Yes   No
Home Phone:                             Work Phone                     here indefinitely?

Drivers License No.                                     State:         -If no, how long?

Social Security Number:                      Date of Birth:            Have you or your              Yes   No
                                                                       roommates ever filed
Place of Employment:                                                   Bankruptcy?
Address:                                                               Are you a party to any        Yes   No
Supervisor:                                 Phone:                     lawsuit?

Job Title:                                  Work Hours:                -If yes, please describe.

Gross Mo Pay:                     How long at current job?             Are there any judgments       Yes   No
                                                                       against you?
Marital Status:
                                                                       -If yes, please describe.
Roommate or Spouse:
                                                                       Do you have any pets that     Yes   No
Home Phone:                             Work Phone                     you would like to occupy
Drivers License No.                                     State:         the residence? (This does
                                                                       not imply that pets are
Social Security Number:                      Date of Birth:            allowed.)
Place of Employment:                                                   -If yes, please describe.
Address:                                                               Have you ever been            Yes   No
Supervisor:                                 Phone:                     evicted from a rental unit?

Job Title:                                  Work Hours:                If yes, provide reason:

Gross Mo Pay:                     How long at current job?             Person to notify in case of emergency:

Children Names:
Who will live in residence except applicant and children?              Phone:

Other sources of income:

Present Address:
How long?                  Reason for leaving:
owner/manager:                                                     Phone
Previous Address:
How long?                  Reason for leaving:
owner/manager:                                                     Phone
By your signature hereon, you agree the information disclosed by you herein is true, complete and accurate
to the best of your knowledge, and you agree that the information is material to Limerick Properties
decision with respect to granting or denying your application to enter into a lease.
                                          CONSENT TO CREDIT CHECK
I/We, the undersigned applicant(s) authorize Limerick Properties or their agent to order and review
my/our credit and criminal history and investigate the accuracy of the information contained in the
application. I/We further authorize all banks, employers, creditors, credit card companies, references,
and any and all other persons to provide to Landlord any and all information concerning my/our credit.

Signed: _____          ______________________________                  Date: ____          ________________

Signed: _____          ______________________________                  Date: ____          ________________

                                               Conditions and Information

All pages of this lease application must be signed by all persons who will sign the lease agreement.

The completing of this application by Tenant and the acceptance of this application by Landlord creates no obligation
of Landlord to approve the application.

This application will be approved or rejected usually within five (5) days of being submitted to landlord. However,
there is no obligation of Landlord to notify tenant unless the application is approved.

If this application is approved, Tenant must make the security deposit and sign the lease before the tenancy begins.

Landlord complies with all Federal and State laws regarding discrimination and does not discriminate based upon age,
sex, race, marital status, religion, national origin, or other prohibited classifications.



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