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Us Citizenship Questionnaire


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                                                                                                        P.O. Box 1372
                                                                                                        Easton PA18044-1372
              .                                                                                         610.253.3219
              Eyesore Investment                                                                                ve rge
                                                                                                              Ne rFo t9/11

              April 2, 2008                                    U.S. Citizenship Questionnaire

              Prospective Tenant Name
              City, State, Zip

              As a condition of your lease, and In order to comply with the Patriot Act, and
              Immigration Laws that may subject EI to fines of a $1000.00 per day if housing
              illegal Immigrants, the following questions are necessary.
              Are you a U.S. Citizen? __________________________________________________________________

              Place of birth______________________________________________________________________

              Date of Birth______________________________________________________________________

              Social Security Number_____________________________________________________________

              If not a U.S. Citizen, what country were you born in? ____________________________________

              Are you in the U.S on a work or student Visa? (If yes must provide documentation which must
              then be attached to the lease)________________________________________________________

              Work/Student Visa Expiration Date__________________________________________________

              Attached Documents: Drivers License________ SS #_______

              By signing this document I hereby state that all information provided above is accurate and true, and I
              agree that any discovery of false statements substantiating that I am an Illegal Immigrant or Terrorist
              will result in termination of any existing lease(s) signed with Eyesore Investment regardless of lease
              term. Tenant understands that Eyesore Investment will cooperate fully with all government

              Print Name                                 Sign Name                                             Date

For God so loved the world that he gave his
one and only son, so that all who believe in
 Him shall not perish, but have eternal life.    ............................
                  John 3:16

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