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<br />NOUSING RSSOCIRTION
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<br />APPLIC`~TION A REE ~~ ~
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<br />To be completed by each unmarried adult ~
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<br />I PROf~ERT.Y NAME / NUMBER ~ _
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<br />DATE . L._/ ,~'~
<br />~ DATE UNIT WAN D (BA O AVA ILI
<br />PER TERMS & COND(TION3, M22) ~ ..~ .. G' ~ ROO ATE'S LAST NAME ' APP~ATION FEE
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<br />OWNEq{~ GENT• ~ ~~ EETADD
<br />, RE3S ~ PHONE
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<br />II NAME ~ ~^'
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<br />OATE OF IRTH
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<br />~ D~L ~. N T~TE ~DATE 0 , . DR. LIC. k / STATE ~ ~ ~ ~
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<br />PRESE TSTREETADDR S ,~ I` CI7Y ~~ S7AT ZIP
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<br />~ PAE3ENISIBEEZADDRESS Ci7Y STnTE ~ ZiP
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<br />S~ ~~ PHONE q F ~
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<br />L4NDLORD NAME / PHQD{F~..,. ~ ~^
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<br />I~ LANDLORD NAMF~,
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<br />ORD TREETADD S. ~ ~ .' ~,qY Sy1T~21P
<br />`~ ~- ~ ~_~-~ ~~r~-~~ ~ ~ ~ <i,G-n, v UINDLOflDSTREETADDRESS CITV STATE ZIP
<br />FORMERSTREETADDRESS __. ....,__..,....~..G1TY ~
<br />STATE~ -.ZIP
<br />. . FORMERSTREETADDRESS CITY STATE ZIP
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<br />FROM ~ TO ....
<br />LORD PHONE
<br />FORMERLANDLORDSTREETADDRESS '~ ~"-' CIN-~•~- ~•- ~ STATE 21P ~ FORMERLANDIORDSTREETADDRESS CIN S7nTE ZIP
<br />- PRESENj EMPLOYER ~ , PRESENT EM ^~
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<br />STREETADDR S /' `1 ' n ' C 3T/JATE ~ ZIP
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<br />c STREETADDRESS CI7Y STATE ZiP
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<br />PHONE
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<br />- PO51T ON
<br />I' HOW ONG4 PHONE POSITION HOW LONG? ~~
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<br />GROSS PAY (MONTHLY)
<br />'~' OTHER INCOME r..- OU E~ OROSS PAY OTHER INCOME SOUR ---.__._,
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<br />D $ S r•f ., H S _.. "_.,,,----._..__
<br />PREVIOUS MP~ YER
<br />/ ~ PREVIOUS EMPLOYER
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<br />STREETADDRESS ,,,, __.__ .,__,,,____,_._ CI7Y STATE ZIP STREETADDRH33"--~-' S7r,7E Zia
<br />PHONE ,.. ...~~~• ~POSITiON---•--~---~~__.___,_._...._„_,,,.,. HOW,LONG7 PHONE POSITION 4 ~-
<br />~ HOWLONG7
<br />_ BANK (Ch~cking/
<br />. BqA H PHONE ~~ "~ ACCOUNT NUMBER ~
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<br />~ 1 4,-,., t~ ~' -~ - 7 r
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<br />B NK (Savings / 1.
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<br />~ BR H
<br />~ PHONE ~ ACCOUNT NUMBER
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<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 operable at this time. It is the resident's responsibility to test the smoke detector at least
<br />every six months, replace dead batteries as required, and notify Landlord in writing of any operating deficiencies. Resident shatl not remove or tamper
<br />with a functioning smoke detector, including working batteries. l have received'fn tructions on the proper use of the smoke detector. TYPE OF SMOKE ~
<br />DETECTOR J~BATTERY~ ' ~ ELECTRIE INITIALS -._ , I~C~
<br />-~ -~ _ . . ,. . . .. .. . .
<br />OTHER OCCUPANTS
<br />AGE OR
<br />NAME DATE OF BIRTH
<br />VEHICLES
<br />PETS
<br />(Number and type - subject to approval by management)
<br />I Do You Intend to Use:
<br />^ WATERBED ^ A~UARIUM
<br />^ MUSICAL INSTRUMENT
<br />I PARKINO SPACES NEEDED
<br />Do you have Renters Insurance?
<br />^Yes~No
<br />Why are you vacating your present p~ace of residence7l`~ ~:'/ ~ fY [.{ Have you given legal notice where you now live7 Yes No ~~~'
<br />I certiy that the above information is correct and complete and hereby suthorize you to do a credit check and make any inquiries you feel necessary to evaluate my tenancy and
<br />credit standing. I- we understand that giving incomplete or false information is grounds for rejectfon of this application. Ii any information supplied on this application is later found
<br />to be false this is grounds for termination of tenancy.
<br />Owner ~ Agenl has charged a screening fee as set forth above. Applicant acreeninp enteil the checking of the applicanYs credit, income and other criteria for residency. The
<br />applicant has the right to dispute the accuracy of any information provided to the owner • agent by the screening service or credit reporting agency. Applicant's copy of this
<br />application shall be the receipt for the screening fee. The name and ad es of the screening service or credit reporting agency is: Tenant Evaluation System, P.O. Box 684,
<br />Vancouver, WA 98666. If the application Is approved, tenants will have ~ hours form the time of notlfication to efther execute a rental agreement and make all deposits or
<br />fees required th9reunder or pay requlred funds tQ hold the unit~and exeGute receipt which will provide for the forfelture of the monies if applicants fail lo occupy the unit. If
<br />applicants fail to timely)ake tge step~,requlj8'q.Qbove, they will be~deepfed to have refused the unit and the next applicant for the unit will be processed.
<br />APPI.ICANT .____,
<br />^ LEASE TERM BEGINNING_ _
<br />. ...._~ - --- AND ENDING AeNr ou~ onTe
<br />~tiA. ~ rt.,. ~,. ~ ~ ..y ~
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<br />^ CHECK IF EARLY TERMINATION PROVISION APPLIE~~~I~QQU~ $
<br />MONTH TO MONTH TENANCY BEGINNING l~~ ~ Furnished? ^ Yes ~1 No
<br />
<br />MONTHLY STATED RENT $ S ~ FIRS RENT. ~ ~ r, ,
<br />From ~ Toy V Due / C~~ ) ~, $ . ~
<br />~ ~ / ~
<br />$
<br />OTHER MONTHLY CHARGES " SECO M SRENT.r
<br />From ~ ~ 7o J • ~~ Due /~
<br />$ ~ ~ r '~"
<br />IDENTIFY r~r APPUCATION FEE (Non-refundable) ~,. ' , •.j , ~ / $ ~~•
<br />TOTAL MONTHLY CHARGES $ APPLICANT SCREENING FEE (Non-refundaWe) $ ?, .-.~
<br />$ ~'• C~ ~ SECURITY DEPOSIT (Refundable) $ `~'~'r-
<br />LATE CHARGE AFTER 4TH
<br /> OTHER CHARGE • ,~--; ;,4
<br />!_.-y~.~t,Z;~ ~/
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<br />;, $ C ' ~ ~ -~-
<br />_ Late Charge calculated by:
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<br />~ ~J Flatfe2'ot'~j'~-~----- ~ r day ~ $
<br />Management will provide tho following:
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<br />TOTAL $
<br /> Garbage Basic cab
<br />e O Othe~
<br />~jSewer [~~Wa{er [~
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<br />^ 5%, OF STATED RENT f=VERY 5 OAYS ~ ~'~~~~
<br />Resident must arrange for ~~ i~ •.~
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<br />RETURN CHECK CHARGE Utility Disclosure ~ <. •
<br />SPECIAL LEASE PRO ISIONS:
<br />I(WE) HAVE EAD A AG TO T TERMS A ONDITIONS USTED ON TH IDES OF THIS CONTFACT. •...
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<br />IN CA92 F EMERGENCY N FY
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<br />NEXT OF KIN STREETADDRESS ~ PHONE
<br />IF APPLICABIE, FEAI ESTATE BROKER APPROVAL I DA7E , NE AQ~N~T ;/ DATE ~ ~ , ~ %
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<br />WHITE - Office YEILOW - Reside File PINK - sident ~~
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