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<br />. ' APPLI~N ~'ION / AGREEII~~~ 1' ~ ',
<br />aRF~1IJdFST
<br />' i ~ ~ ~ To be completed by each unmarried adult
<br />OUSING ASSOCIATION ,TN MBE 9DD SSP ~ P~u. ~~~~ $ENT~ /1 :-
<br />PROftE~iT.Y NAME / NUMBER ,, , ~' ~ ~ ~ ~ ~ ~ ~ ~
<br />) ( ~~ -~
<br />DATE UNIT WAN D (BA O AVA ILI '`~ ~ R00 ATE'S U3T NAME ASPP~ATION FEE
<br />DATE - y~ C~ PER TERM8 ~ CONDtTION8, N72) ~-
<br />~ PHONE
<br />~. EETAODRES8 ~ ~ ~ ~
<br />OWNEqb OENT • " '.`. ~~ ~ ' ~
<br />~~ ._~ , , /
<br />NA E NAME ~ --._„~, .
<br />~~ ~~ ~•~ ~ ~~ r ~C~ ~ II ~ ~ ~~DATE 0 . . OR. LIC. M / STATE -..
<br />DATEQF IRTH S~.~ EC. ~_~' DFi. L N TATE ,
<br />~~ ~.,~ . ~ g ~: a ~i~ ~'3
<br />erecQ~DDRESS CITY STATE ZIP
<br />PRESE TSTREE7ADDR S J '` ~ CITY • STA 21P P~~~r
<br />Q I , ~l,/f~ ~' ~ ~ O ~ ~ PHONE ..
<br />T~ PHONE q F
<br />FROM ~ .~ Sa I ` .' .. .. .
<br />PHQNFr., r • f'I/y LANDlOR4lIPIlL..~..
<br />UNOLORD NAME ~ ,
<br />~,L ~ ~ . C`• 7E~ ~` CIN STATE ZIP
<br />t~p R T~ ET ADD~SiS,~,l ,_ ~~~~~ v~ ~~~~ /in ~ y ZIP LANDLORD STREETADDRESS
<br />i~ N h.~
<br />~" FOHMERSTREETADDRESS cirr STATE ziP
<br />_ _. . . . _ . ... . _ ...__.91IY.....'^.+...
<br />FORMEHSTREETADORESS . ~ gTA~~~~'nP "
<br />„~w..
<br />FROM ~ TO ORD PHONE
<br />_ FROM . --..~._ 7 09btE8.L6t9RI.QBR.-.-.._~........PH4LIE_
<br />" cir. STATE z~P
<br />FORMER UNOLORD STREET ADDRESS " ""~ ~~T~''~°" -" ~ ~ ~ STATE ~ :21P . ~ FOFMER U~NDIOHD BTREETADDRESS , ` J
<br />~ - - ° ' PRESENT EM
<br />~ PPESEN EMPLOYER ( ' . ~ - i~ ~~
<br />ai~F ~!'» • v.. C.~ cirr srnTe z~a
<br />STREETADOR S / ! ^ ' C STe TE ~ Z1P STREETADDRESS _~_ `
<br />r ( C ~ % % / ~1 ~. ,V ~ i+/~~ Q~C ~' ~`_ -
<br />PHONE POS~TION HOW LONG?
<br />PMONE, POSITON HOW ON04
<br />-~ .. L 'J, ~ A. ~J ! M p ' ~ ~ SOUR -.
<br />OU E - aROS3PAY OTHERINCOME
<br />aROS~ (MONTHLV)~ STHERINCOME /~ ~,' An S• .'~.
<br />. ...~.__....
<br />PREVIOUS MPL VER ,/ ~ f PREVIOUS EMPLOYER
<br />~ - v ~ ~ vv . .~ .^ STaTE ZiP --
<br />CITV STATE ~ 21P 8TREETADDRHSS` ~~------°• •- ~°°
<br />$TREETADDRESS_ -~--~-•••-~-- •~- ~~•- - .
<br />. .. _.._ .....__..........._.._ ._..._ _..~.__......_ .. HOW LONG9
<br />HOW 1ON04 PMONE POSITION 4
<br />.._. ..._
<br />PHONE . .......POSITI. _'-..._.....-...._.~~_...._....... ..............,......
<br />BRA M PHONE ` ACCOUNTNUMBER ^ ~, % ~
<br />~ gANK (Chttkinp/ ` / _ M
<br />Ih / U ~~ ACCOUNTNUMBER~~
<br />BR H PHONE ~~ /\ O~ v O O'~~
<br />B/~NK (Savinqe / ^ ~ ~ `, ~~ ' ~ { r G O 0 0
<br />C~. • ~ t . vL
<br />SMOKE DETECTORS: Resident acknowledges and the manager certifies that the Premises is equipped with a smoke detector as required by ORS
<br />Chapter 479 and that the smoke detector has been tested and Is opera6le at this time: It is the residenYs responsibility to test the smoke detector at least
<br />every six months, replace dead batteries as requfred, and notify Landlord in wrf,ting of any operating deficiencies. Resident shall not remove or tamper
<br />with a functioning smoke detector, including working batteries. l have received'In tructfons on the proper use of the smoke detector. TYPE OF SMOKE
<br />-.,r-- ~l . .
<br />DETECTOR _~BATTERY'' ^ELECTRI€ ` INITIALS -..... ., ~. 1~~,,./•:.,.~..: . „_._......, .. . ; _ .. . ,
<br />OTHER OCCUPANTS VEHICLES PETS
<br />AGE OR uCENSE o. ~Number end type - subject to approval by managemenq
<br />DATE OF BIRTH o oei s
<br />NAME e
<br />-• "'-~ ~ • -~°°' '"- ~ Do You Intend to Use:
<br />----- ory~. p WATERBED ^ AQUARIUM
<br />•--' -`--" ^ MUSICAL INSTRUMENT
<br />----•- "' ~ Do you have Renters Insurance?
<br />PARKINO SPACES NEEDED .. ~ ^ Y85 ~ NO
<br />_ _ ~---•--^.._ _ Yes No ~ ~
<br />Why are you vacating your present plece of residence? `:'/ • Y Have you qiven legal notice where you now Iive7
<br />I certify that the above information is correct and complete and hereby authorize you to do a credit check and make any inqulrles you feel necessary to evaluate my tenancy and
<br />credit standing. I• we understand that gfving i~complete or false informatlon is grounds for rejectlon of thls application. If any information supplied on this application is later found
<br />to be false this is grounds for terminatlon of tenancy. of this
<br />Owner - Agent has charged e screening fee as set forth above. Applicant acreeninp enteil the checking of the applicent's credit, income and other criterl cant rs copy cy. The
<br />applicant has the right to dispute the accuracy of any intormatfon provlded to the owner • agent by the screening aervice or credit reporting agency. App'
<br />~ application shall be the receipt for the screeni~roved tenants wlll haye : e8 ot hourorform the timecof notiflcattion o eithegexecute aeental agrleemenSand make~ IBdepos~s or
<br />Vancouver, WA 98666. If the application is app
<br />ap S'cantsrta I~t ~ mely ake PgY s ep 1feeq~unda t o~etl they wil be ee ed to havePet aed hiel unit end the next applicant foethe un t wilabel~p ooessel~to occupy the unit. I~
<br />- /. % G. C DATE ,
<br />~x" '.. _ ~. ATE. ' SPOUSE
<br />•' APPLIC NT - '- RENT DUE DATE ,
<br />..._.._ ._. .~. ..__ _ AND ENDINO -~~'`, n_ . f ,, -,! i _
<br />^ LEASE TEFM BEGINNING
<br />^ CHECK IF EARLY TERMINATION PROVISION A~~IE~ Fumished? ^ Yes ~ No
<br />MONTH TO MONTH TENANCY BEGINNING pIR3 C~~' RENT. ~./ r` ~ '1 ~ '$ ~,
<br />MONTHLY STATED RENT $~ ~ From ~1 Tv I'~ v Dus /
<br />SECOM2M~fUi'S RENT: ~ . ~ ~ ~ / / $ C ~ t -
<br />OTHER MONTHLY CHP.RGES $ ` From v ~ T° J
<br />~•-• APPLICATION FEE (Non•refundable) ~, " ; •~ , / $ '
<br />IDENTIFY r "~ '
<br />TOTAI. MONTHLY CHARGES $ APPLICANT SCREENWf3 PEE (Nornrefundable) ~ '-~
<br />$ ~, C~ ~ SECURITY DEPOSIT (Refundable) $ ~-
<br />LATE CHARGE AFTER 4TH // ~ ~,L $ C~) t' ~~.
<br />OTHER CHARGE - 4~,~!-~C(.tiZ~ .X , I'" ~ 1. ~"
<br />_ Late Charge calculated by: ' ' ~
<br />~.. ~ `"""' Management will provide tho following: TOTAL $
<br />~ ~1 Flat4eE"D~~'~'='"-"'~- ~ r day ~ $ $g~e~ (~Wale~ [~'derbape ~ Basic ceble p Othe~ - _~
<br />^ 5% OF STATED RENT I=VERY 5 DAYS Resident must arrange torsf~~i' {~ `~"~' ~'`~ ~~~~~ 1- ~' •, /`
<br />Utillty D~sciosure J 3 ~ - •
<br />RETURN CHECK CHARGE `
<br />SPECIAL LEASE PRO ISIONS: ~ .,~,~ ~ ~._..~-_...._-_~...._...
<br />~ ~ ~
<br />I(WE) HAVE EAD A AG TO T TERMS A ONOITIONS ~ISTED `N TH~DES OF THIS CONTRA . ,,,._ _.,r _
<br />~r ~ yONE,~ ; ~ : ..
<br />/ E ,~ ~ /~~ ,., r , ~ ~'1~J ; c ~ ~ ; ~ ~
<br />IN CA92 F EMERGENCY NQT1FY ~ .t ~ ~ h G~~ ~~
<br />~C`. h Y~ r1..! (. ' "~ f ~ . PHONE
<br />STREETADDRES8
<br />NEXT OF KIN
<br />NE A NT 7 DATE ~ :~.~r '~ ~ ~~/' • ~ -
<br />IF APPlICABLE, REAL ESTATE BROKER APPROVAL / DATE ~ ~,.1,•L,L.,,.~.. 7~J' ,~ J,,. ••
<br />WHITE - Office YELLOW • Reside File PINK - sident
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