Application for residency

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Please Give Us the Following Information

APPLICATION FOR RESIDENCY

PLEASE FILL OUT COMPLETELY - THANK YOU

Please tell us about yourself

^{Last First Middle Maiden} Applicant			^{Date of Birth}			^{Social Security # Driver’s License #}
Marital Status	Present Phone No. ( )	9:00 to 5:00 CONTACT PHONE NO.: ( ) Ext.
Have you ever had an eviction Yes No filed against you?				^{PETS (Keeping of pets requires a pet deposit and owner’s consent)} Breed Age Weight
Present ^{Street # Name Apt. # City State Zip Rent/Mortgage Pymt} Address							Own  Rent 	Since / /
Landlord ^{Name Address City State Zip} Mtg. Co.							Phone No. ( )
Previous ^{Street # Name Apt. # City State Zip Rent/Mortgage Pymt} Address							Own  Rent 	Since / /
Have you or any occupants ever been arrested for, convicted of, put on probation for, or had adjudication withheld or deferred for a felony offense? Yes No					If yes, please explain

Please Tell Us about Your Job

Present ^{Name Business Address City State Phone No.} Employer ( )
^{Position Supervisor Monthly Income}From / / to / /
Previous ^{Name Business Address City State Phone No.} Employer ( )
^{Position Supervisor Monthly Income}From / / to / /

Please Give Us the Following Information
Emergency ^{Name Full Address Phone No.} Contact ( )
Automobile ^{Year Make Model Color Tag #} 1^st Car		Automobile ^{Year Make Model Color Tag #} 2^nd Car
Children ^{Name Age} Occupying	^{Name Age}		^{Name Age}
Bank ^{Name Location City State} Ref

Spouse/Co-applicant: Please Tell Us about Yourself

^{Last First Middle Maiden} Applicant			^{Date of Birth}			^{Social Security # Driver’s License #}
Marital Status	Present Phone No. ( )	9:00 to 5:00 CONTACT PHONE NO.: ( ) Ext.
Have you ever had an eviction Yes No filed against you?				^{PETS (Keeping of pets requires a pet deposit and owner’s consent)} Breed Age Weight
Present ^{Street # Name Apt. # City State Zip Rent/Mortgage Pymt} Address							Own  Rent 	Since / /
Landlord ^{Name Address City State Zip} Mtg. Co.							Phone No. ( )
Previous ^{Street # Name Apt. # City State Zip Rent/Mortgage Pymt} Address							Own  Rent 	Since / /
Have you or any occupants ever been arrested for, convicted of, put on probation for, or had adjudication withheld or deferred for a felony offense? Yes No					If yes, please explain

Please Tell Us about Your Job

Present ^{Name Business Address City State Phone No.} Employer ( )
^{Position Supervisor Monthly Income}From / / to / /
Previous ^{Name Business Address City State Phone No.} Employer ( )
^{Position Supervisor Monthly Income}From / / to / /

Please Give Us the Following Information
Emergency ^{Name Full Address Phone No.} Contact ( )
Automobile ^{Year Make Model Color Tag #} 1^st Car		Automobile ^{Year Make Model Color Tag #} 2^nd Car
Children ^{Name Age} Occupying	^{Name Age}		^{Name Age}
Bank ^{Name Location City State} Ref

Applicant represents that all of the statements and representations are true and complete, and hereby, authorizes verification of the above information, references and credit records. Applicant understands that an investigative consumer report including information about character, credit history, general reputation, personal characteristics, mode of living, and all public record information including criminal records may be made. Applicant agrees that false, misleading or misrepresented information may result in the application being rejected, will void a lease/rental agreement if any and/or be grounds for immediate eviction with loss of all deposits and any other penalties as provided by the lease and/or application terms. Applicant authorizes verification of all information by the Landlord and or Management Company. APPLICATION FEE IS NON REFUNDABLE --Applicant(s) has paid to Landlord and/or Management company herewith the sum of $____________ as a FEE for costs, expenses and fees in processing the application. SECURITY DEPOSIT AGREEMENT --Applicant has deposited a “RENTAL DEPOSIT” of $______________in consideration for taking the dwelling off the market while the application is being processed. Once applicant(s) has been notified of approval by Landlord and/or Management you, applicant(s) have 24 hours to change your mind and “RENTAL DEPOSIT” shall be forfeited as liquidated damages as this home was no longer available to other prospective applicant(s) once initial applicant(s) approval. The “RENTAL DEPOSIT” shall be refunded only if applicant is not approved. Keys will be furnished only after lease and other rental documents have been properly executed by all parties and only after applicable rentals and security deposits have been paid. This application is preliminary only, in no way implies that a particular rental unit shall be available and in no way obligates Landlord or Management to execute a lease or deliver possession of the proposed premises.

_______________________________________________________________ Applicants Name _______________________________________________________________ Applicants Signature Date _______________________________________________________________ Co-Applicants Name _______________________________________________________________ Co-Applicants Signature Date		Area Reserved For Office Use Only: Application received by __________________________________ Date

CHAPPELL PROPERTIES

904-485-2635

AFFIDAVIT

(Addendum to Application)
I, _____________________________, the undersigned applicant freely and voluntarily authorize verification of any and all information set forth on documentation relating to this application or release of any other information relating to this application. Including, release of information by any creditor or employer.

In addition, I voluntarily consent to a criminal background investigation and release of any information pertaining to arrest or conviction and herby authorize Chappell Properties to obtain my consumer credit file from any source.

The applicant understands and herby acknowledges the information referred to above, or certain portions thereof, may be protected from disclosure without this signed authorization by federal and state laws.
Applicant represents that the information set forth on this document or any other document related to this application is true and complete. The applicant understands that this is an official document governed by state and federal laws.

_____________________________

Applicants Signature
_____________________________

Date
_____________________________

Witness Signature

YOU MUST ALSO COMPLETE THE BELOW PORTION OF THIS AFFADIVIT, PLEASE WRITE CLEARLY

_________________________

Social Security Number
_________________________

Date of Birth

_________________________

Maiden Name (if applicable)

__________________________
__________________________

Present Address

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Application for residency

APPLICATION FOR RESIDENCY

Please Give Us the Following Information

Please Give Us the Following Information