WELCOME HOME Household Members by sae11431

VIEWS: 5 PAGES: 3

									                                                   Date:_____________Leasing Professional:__________________________________

 WELCOME HOME
Household Members
                                                       RELATION-    SOCIAL SECURITY/         STATE or GOVERNMENT ISSUED                        FULL TIME
                     NAME                    SEX         SHIP            ALIEN REG. #        PHOTO ID # & NAME OF ISSUER    BIRTH DATE         STUDENT
                                                        HEAD OF
                                                       HOUSEHOLD                                                                            Yes    No

                                                                                                                                            Yes    No


                                                                                                                                            Yes    No


                                                                                                                                            Yes    No


                                                                                                                                            Yes    No


                                                                                                                                            Yes    No


                                                                                                                                            Yes    No


                                                                                                                                            Yes    No

 List email addresses of all ADULT household members:
 ______________________________                 ______________________________                                   ______________________________
 ______________________________                 ______________________________                                   ______________________________


 Residency Information (Past Two Years)
 CURRENT FULL STREET ADDRESS:                                                                                                  OWN     RENT       OTHER


 CITY:                                                                                  STATE:                                     ZIP CODE:


 HOME PHONE NUMBER:                      CELL PHONE NUMBER:               EMAIL ADDRESS:                         MOVE IN DATE:       MOVE OUT DATE:
 (        )                              (         )
 APARTMENT/COMMUNITY NAME:               LANDLORD OR MORTGAGE CO. NAME:                 PROPERTY/LANDLORD PHONE:           MONTHLY RENT/MORTGAGE:
                                                                                        (        )                         $
 PAST FULL STREET ADDRESS:                                                                                                     OWN     RENT       OTHER


 CITY:                                                          STATE:                      ZIP CODE:                      Move In Date:
                                                                                                                           Move Out Date:

 APARTMENT/COMMUNITY NAME:                LANDLORD OR MORTGAGE CO. NAME:                PROPERTY/LANDLORD PHONE:           MONTHLY RENT/MORTGAGE:
                                                                                        (        )                         $

Household Information
      YES           NO
 1.                         Have any of the adults in the household used other names in the past?

                            List Name(s) used: ________________________________________________________________________________________
 2.                         Do you expect any additions to the household within the next twelve months?

                            Name & Relationship: ____________________________________________________________________________________
 3.                         Is there anyone living with you now who won’t be living with you at this community?
          If absent
         member is
         spouse use         Name: ________________________________________________________________________________________________
          USA19.40
          MI17.20
                            Explanation: ____________________________________________________________________________________________

 4.                         Do you have full custody of your child(ren)?
              No Children

 5.                         Are there any absent household members who under normal conditions would live with you (For example, a spouse
                            away in the military or living in another state or country)?
                            Name & Relationship:_____________________________________________________________________________________
                            Explanation: ____________________________________________________________________________________________
 6.                         Are you or any other ADULT household members claiming zero income? Name: _______________________________
          USA17.10


 7.                         Will you or any ADULT household member require a live-in caregiver or aide?
          USA19.50
          USA19.52          Name of Caregiver: _______________________________________________________________________________________
              And
                            Relationship (if any) :______________________________________________________________________________________
          USA20.10

 8.                         Will your household be receiving rental assistance from a federal, state or local government?
                            Contact Name & Telephone: _______________________________________________________________________________

         Page 1 of 3 Affordable Apartment Application – All States EXCEPT Ohio (05/28/09) On-Line Initials: _______ _______ ______ ______
Income Information:                 Do YOU or does ANYONE (including minor children) in your household receive OR expect to receive income from:

       YES          NO
                              Employment? (Include overtime, tips, bonuses, commissions and payments received in cash, full-time and part-
 9.
                              time employment, self-employment, military (active or reserve) employment for all household members)
       TX- Pay stubs (1st)    WHO RECEIVES:                        EMPLOYER:                                       AMOUNT RECEIVED:
        or USA16.70E or
         Work Number
                              _______________________________________________________________________________________________________
         For All Others         POSITION: __________________        START DATE:      __________________    END DATE: :        ____________________
             States
         Work Number
       Verification or EV
             Form:            WHO RECEIVES:                        EMPLOYER:                                       AMOUNT RECEIVED:
            FL16.70
          GA-Form 03          _______________________________________________________________________________________________________
          IL, NY & SC-
            USA16.70
                                POSITION: __________________        START DATE:      __________________    END DATE: :        ____________________
         MI-USA16.70E
        NC16.70G (Ver         WHO RECEIVES:                        EMPLOYER:                                       AMOUNT RECEIVED:
           1.2.07)
          TN-HO 0422          _______________________________________________________________________________________________________
                                POSITION: __________________        START DATE:      __________________    END DATE: :        ____________________

                              Benefits in lieu of earnings? (Include worker’s compensation, unemployment benefits or payments from a
 10.
                              severance package)
                              WHO RECEIVES:                        TYPE:                                           AMOUNT RECEIVED:
       Obtain PRINTOUT
         or letter from
                              _______________________________________________________________________________________________________
            Agency
                              _______________________________________________________________________________________________________

                              _______________________________________________________________________________________________________
                              Public Assistance, General Relief, Temporary Assistance for Needy Families (TANF) or Aid to Families with
 11.
                              Dependant Children (AFDC):?
                              WHO RECEIVES:                  TYPE:                     AMOUNT RECEIVED:              CASE WORKER:
       Obtain PRINTOUT
         or letter from
                              _______________________________________________________________________________________________________
            Agency
                              _______________________________________________________________________________________________________

                              _______________________________________________________________________________________________________
 12.                          Child support or Alimony, or have you been court ordered to receive Child Support or Alimony?
       GA Child Support
                              WHO RECEIVES:             CHILD’S NAME:                  WHO IS PAYING:                          AMOUNT RECEIVED:
        Affidavit-Rev         _______________________________________________________________________________________________________
            12.06
       Plus for all states,
       including GA, the
                              _______________________________________________________________________________________________________
           following
                              _______________________________________________________________________________________________________
        Obtain copy of        WHO RECEIVES:             CHILD’S NAME:                  WHO IS PAYING:                          AMOUNT RECEIVED:
          court order,
                              _______________________________________________________________________________________________________
        divorce decree,
           or custody         _______________________________________________________________________________________________________
         documents if
          applicable.         _______________________________________________________________________________________________________

                               How is the support received? (Check all that apply)
                                        Child Support Enforcement Agency                 Name of Agency:       _____________________________

                                        Court of Law                                     Name of Court:        _____________________________
        Obtain copy of
          court order,                  Directly from Individual                         Name of Person:      _____________________________
        divorce decree,
           or custody
                                        Other     Explain: ____________________________________________________________________
         documents if
          applicable.
                              If support/alimony is court-ordered but not received, what efforts have been made to collect the support?
                              _______________________________________________________________________________________________________

                              _______________________________________________________________________________________________________
                              ______________________________________________________________________________________________________
 13.                          Social Security, SSI or any other payments from the Social Security Administration?
                              WHO RECEIVES:                                SSA OFFICE:                             AMOUNT RECEIVED:
                              _______________________________________________________________________________________________________
       Obtain PRINTOUT

        or award letter       _______________________________________________________________________________________________________

                              _______________________________________________________________________________________________________
 14.                          Regular payments from a pension, retirement plan or annuities?
                              WHO RECEIVES:                                WHO IS PAYING:                          AMOUNT RECEIVED:
                              _______________________________________________________________________________________________________
       Obtain statement

        or award letter       _______________________________________________________________________________________________________

                              _______________________________________________________________________________________________________
 15.                          Student Financial Assistance (including scholarships, grants, loans, parental assistance and work study)?
                              WHO RECEIVES:                                WHO IS PAYING:                          AMOUNT RECEIVED:
           USA19.80
           USA19.85           _______________________________________________________________________________________________________
       FL ONLY: Gather
       above forms only       _______________________________________________________________________________________________________
        if Question 8 is
       answered “YES”         _______________________________________________________________________________________________________


       Page 2 of 3 Affordable Apartment Application – All States EXCEPT Ohio (05/28/09) On-Line Initials: _______ _______ ______ ______
         YES     NO
                          Regular gifts or payments from anyone outside of the household? (This includes anyone supplementing your
 16.
                          income or paying any of your bills.)
                          WHO RECEIVES:                              WHO IS PAYING:                           AMOUNT RECEIVED:
           USA19.65       _______________________________________________________________________________________________________

                          _______________________________________________________________________________________________________

 17.                      Any other income sources or types not listed?
                          WHO RECEIVES:                              WHO IS PAYING:                           AMOUNT RECEIVED:
                          _______________________________________________________________________________________________________

                          _______________________________________________________________________________________________________

                          _______________________________________________________________________________________________________
                          Do you or any other household member expect any significant changes to your income in the next 12
 18.
                          months? EXPLANATION:________________________________________________________________________________

Asset Information
   I understand that this application must be accompanied by an Asset Certification which lists all household assets,
   including those held by minor children. I further understand that my application will be considered incomplete and will
   not be processed until the Asset Affidavit is completed.
   Do you or any other household member, including minor children, have any of the following?
       Yes No                                                      Yes No
                 Checking or Savings Account?                               Stocks, Bonds or Trust Funds?
                 Certificates of Deposit or Money Market?                   Real Estate, Land Contracts or other capital investments?
                 Cash on hand or Safety Deposit Box?                        Whole or Universal Life Insurance Policies (not term life)?
                 IRA, 401(k) or other retirement accounts?                  Personal Property held as an investment
                 Within the past two years, have you or anyone else in your household given away any asset valued over $1,000.00 or have
                 you sold any asset for more than $1,000.00 below it’s fair market value?


Emergency Contact Information
       IN CASE OF ILLNESS, ACCIDENT, EMERGENCY, PLEASE CONTACT:
       NAME(S):_______________________________________________________________________________________________________

       ADDRESS(ES): CITY: __________________________________________________________STATE:_________ ZIP CODE:__________

       PHONE NUMBER(S): ________________________________________EMAIL ADDRESS: ______________________________________

 HAVE YOU EVER BEEN EVICTED FROM AN APARTMENT/HOME?                                                                       NO        YES
 HAVE YOU EVER HAD AN EVICTION PROCEEDING STARTED AGAINST YOU?                                                            NO        YES
 HAVE YOU EVER BEEN CHARGED WITH OR CONVICTED OF A CRIME THAT HAS NOT BEEN EXPUNGED OR                                    NO        YES
 SEALED BY A COURT? (A criminal charge or conviction will not necessarily exclude an applicant from residency.)
 If you answered YES to any of the questions above, please explain: ______________________________________________________
 _______________________________________________________________________________________________________________________


 APPLICANT REPRESENTS ALL OF THE ABOVE STATEMENTS ARE TRUE AND CORRECT. APPLICANT AUTHORIZES CONTINUING
 VERIFICATION OF THE ABOVE INFORMATION, REFERENCES, CRIMINAL HISTORY AND CREDIT RECORDS AT ANYTIME INCLUDING
 BEFORE, DURING AND AFTER THE EXPIRATION OF THE LEASE TERM AND RELEASES FROM LIABILITY ALL PERSONS AND ENTITIES
 REQUESTING OR SUPPLYING INFORMATION. APPLICANT ACKNOWLEDGES THAT FALSE, INCOMPLETE OR MISLEADING INFORMATION
 CONSTITUTES GROUNDS FOR REJECTION OF THIS APPLICATION; DISCOVERY OF FALSE, INCOMPLETE OR MISLEADING INFORMATION
 THAT OCCURS AFTER OCCUPANCY WILL RESULT IN TERMINATION OF THE RIGHT OF OCCUPANCY OF ALL OCCUPANTS UNDER LEASE
 AND/OR FORFEITURE OF DEPOSITS AND FEES. SECTION 1001 OF TITLE 18 OF THE U.S. CODE MAKES IT A CRIMINAL OFFENSE TO
 WILLFULLY FALSIFY A MATERIAL FACT OR MAKE FALSE STATEMENT IN ANY MATTER WITHIN THE JURISDICTION OF A FEDERAL AGENCY.


 THIS APPLICATION IS FOR INFORMATION ONLY AND DOES NOT OBLIGATE LANDLORD TO EXECUTE A LEASE OR DELIVER POSSESSION
 TO THE PROSPECTIVE RESIDENT. APPLICANT HAS PAID AT THE TIME OF APPLICATION AS A NON REFUNDABLE APPLICATION FEE
 $___________AND $_____________ AS A RESERVATION FEE. ADDITIONALLY, UPON APPROVAL OF THIS APPLICATION, APPLICANT
 SHALL PAY ANY ADDITIONAL DEPOSIT AS AGREED TO BETWEEN THE PARTIES. ALL DEPOSITS WILL BE APPLIED TOWARDS
 APPLICANT’S FULL SECURITY DEPOSIT ONCE APPLICANT HAS EXECUTED THE LEASE AGREEMENT. IN THE EVENT APPLICANT’S
 APPLICATION IS DENIED ONLY THE DEPOSIT AND RESERVATION FEE WILL BE REFUNDED BY MAIL IN ACCORDANCE WITH THE LAW.
 SHOULD THIS APPLICATION BE CANCELLED BY APPLICANT ALL MONIES, INCLUDING ALL RESERVATION FEES AND/OR DEPOSITS PAID UP
 TO $350 WILL BE FORFEITED.

 I, THE UNDERSIGNED APPLICANT(S), HAVE READ AND AGREE TO ALL OF THE PROVISIONS OF THIS APPLICATION AND
 REPRESENT AND PROMISE THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

 SIGNATURE                                       DATE                SIGNATURE:                                        DATE:

 SIGNATURE                                       DATE                SIGNATURE:                                        DATE:


 FOR LEASING PROFESSIONAL ONLY:
 APARTMENT SIZE:                               PREFERRED LOCATION:                             MOVE-IN DATE DESIRED:
 WASHER/DRYER                        CABLE                      PREMIUMS
 OTHER:                                                          CONCESSION OFFERED:
 MARKET SOURCE:           LOCATOR      BILLBOARD        SIGNS       FLYER      WORD OF MOUTH            NEWSPAPER    MAILING
  APT. GUIDE          INTERNET SOURCE ____________     PROPERTY REFERRAL ________________________________________
                                                                                          (COMMUNITY)

  OTHER ______________________           RESIDENT REFERRAL _______________________________________________________




        Page 3 of 3 Affordable Apartment Application – All States EXCEPT Ohio (05/28/09) On-Line Initials: _______ _______ ______ ______

								
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