To Print Application Click Printer Icon On your Browser Desired Occupancy Date____________________________ SS#________________________________ Last______________________________ First_____________________ Middle Name_______________ Residence History (please provide three years of history - add pages if needed) Your Present Address__________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Your Phone#______________________________ Currently Own / Rent (please circle one) Current Monthly Mortgage / Rent Payment $_______________________________________________ Occupancy Dates - From______________________________ To______________________________ Reason For Leaving____________________________________________________________________ ____________________________________________________________________________________ Landlord's Name / Phone#_______________________________________________________________ Employment History (please provide theree years of history - add pages if needed) Current Employer______________________________________________________________________ Address______________________________________________________________________________ Supervisor's Name / Phone#_____________________________________________________________ Your Position____________________________ Hours Per Week__________Your Pay Rate__________ Date Started____________________________ Have You Ever: (please circle applicable responses) - Been sued for nonpayment of rent? YES / NO
- Filed for bankruptcy? YES/NO
- Had a judgement(s) filed against you? YES/NO
- Been sued for damage to rental property? YES / NO
- Been convicted of a crime or currently engage in criminal activity? YES / NO
- Pleaded guilty or no contest to a felony? YES / NO
- Pleaded guilty or no contest to a misdemeanor involving sexual misconduct? YES / NO
- Been served an eviction notice or asked to move out? YES / NO
Please answer Yes to above even though in your opinion the eviction was wrongful or illegal.
- Please explain any YES answers below:
________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Personal References (if submitted with a joint applicant, the same references shown here cannot appear on the joint applicant's form) Name / Relationship / Phone# 1___________________________________________________________________________________ 2___________________________________________________________________________________ 3___________________________________________________________________________________ Disclosures Radon Gas - Notice to Prospective Tenant: Radon is a naturally occurring radioactive gas that, when it has accumulated in a building in sufficient quantities, may present health risks to persons who are exposed to it over time. Levels of Radon that exceed Federal and State guidelines have been found in buildings in every state. Additional Information regarding Radon and Radon testing may be obtained from your County Public Health Unit. Lead Paint - Notice to Prospective Tenant: Every lessee of residential real property on which a residential dwelling was built prior to 1978 is notified that such property may present exposure to Lead from Lead-based paint that may place young children at risk of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage, including learning disabilities, reduced intelligence quotient, behavioral problems and impaired memory. Lead poisoning also poses a particular risk to pregnant women. The lessor of any interest in residential real estate is required to provide the lessee with any information on lead-based paint hazards from risk assessments or inspection in the lessor's possession and notify the lessee of any known Lead-based paint hazards. A risk assessment or inspection for possible Lead-based paint hazards is recommended prior to leasing. Acknowledgement I hereby make an application to rent the premises loacted at ____________________________________________________________________________________ for $____________________ per month and a security deposit of $____________________. I declare the foregoing information to be true and correct, and I hereby authorize you to conduct any employment, credit, reference and criminal background checks. I understand that if this application is accepted, and I lease the property, that you may periodically perform the same background checks listed above after I move in. These checks may also be run after I move out if I owe any money to you. I agree to update you with any information on this form promptly, if it changes, and if this application has been accepted by you. I certify that all the above information is true, complete, and accurate to the best of my knowledge, and understand that if I provide any false information on this form or subsequent updates, that you will be able to cancel the lease immediately upon discovering any such false information. I also agree to reimburse you for any and all costs which have accured to you because of any false disclosures made by me. I hereby give permission to employers, banks, rental and credit providers, and other agencies to provide all personal information concerning wages, income, employment, rental and bill paying histories, etc., which might influence the approval of this application. I authorize permission that a copy of this may be treated as an original.
Signed________________________________________ Date______________________________ Print Name_______________________________________________________________________ Mountain View Apartments | PO Box 400 | Brewster, NY 10509 | Voice 845.259.3591 | Fax 845.278.0931 |