PERSONAL INFORMATION - Amazon S3



MEGUNTICOOK MANAGEMENT100 Washington StreetP.O. Box 618Camden, Maine 04843-0618207/236-2736/236-9557 faxRESIDENTIAL RENTAL APPLICATIONTo the Applicant:We sincerely thank you for your application. Please help us promptly process this application by clearly completing all the information.Date of Application:_____________________ Type and Size of Unit:____________Desired Move-In Date: __________________PERSONAL INFORMATIONApplicant’s Full Name:__________________________________________________Date of Birth:_______________________ Marital Status: _____________________Social Security Number:_________________________________________________Spouse’s/Co-Applicant’s Name: ___________________________________________Date of Birth:___________________ Social Security Number:___________________Names, Relationships, and Ages of others who will be living in the unit:____________________________________________________________________________________________________________________________________________________________________________________________________________Do you own pets?_______________ Do you own furniture?____________________Is anyone who will be living in the unit handicapped?_________________________Driver’s license number:____________________ Number of Vehicles:___________Make/Model_________ Year ______ Color______ Plate #______ State __________Make/Model_________ Year ______ Color______ Plate #______ State __________RESIDENCE HISTORYPresent Address:_______________________________________________________Present Mailing Address:________________________________________________Present Phone Number:_________________________________________________Length of Residency:_______________________ Amount of Rent:______________Reason for Moving: ____________________________________________________Present Landlord or Mortgage Holder:______________________________________Address:_______________________________ Phone #: ______________________Previous Address and Phone #:____________________________________________Length of Residency: ______________________ Amount of Rent:_______________Reason for Moving:_____________________________________________________Previous Landlord or Mortgage Holder:_____________________________________Address:_______________________________ Phone #: ______________________EMPLOYMENT INFORMATIONEmployed: Full time_____ Part time______ Unemployed_______ Retired__________Employer’s name:_______________________________________________________Employer’s Address:_____________________________________________________Telephone #:_______________ Position held: _________________________________Department:______________________ Supervisor:_____________________________Present Income: $___________________ per __________________________________Spouse’s/Co-Tenant’s Employment:Employed: Full time_____ Part time______ Unemployed ________ Retired__________Employer’s name:________________________________________________________Employer’s Address: ______________________________________________________Telephone #:________________ Position held:_________________________________Department:________________________ Supervisor:____________________________Present income: $____________________ per __________________________________OTHER INCOMEChild Support: $_______________________Interest Income: $_____________________ Source: ____________________Public Assistance: $___________________ Type: _____________________Pension/Retirement: $__________________ Source: ____________________Social Security: $_____________________ Type: _____________________Other: $_________________________ ___ Type/Source: _______________REFERENCESBank: __________________________________________________________________Address: _______________________________________________________________Account #:________________________ Checking ______ Savings______ Loan______Credit Reference:__________________________ Account#: ______________________Address: ________________________________________________________________Please be advised that in checking references, we do Credit Report checks on all applicants.Personal references (non-family):Name:Address:Phone:____________________________________________________________________________________________________________________________________In case of personal emergency, notify:______________________________________Relationship:_______ Address:____________________________________________Phone#, day:______________________evening:___________________________How did you learn about this housing?_______________________________________Please tell us any other information about yourself that might help us in evaluating your application:______________________________________________________________________________________________________________________________________________________________________________________________________________The following information is requested by the apartment’s owner in order to assure the Federal Government that, acting through it’s Farmer’s Home Administration, that Federal laws prohibiting discrimination against tenants/applicants on the basis of race, national origin, and sex are complied with. YOU ARE NOT REQUIRED to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of individual applicants on the basis of visual observation or surname.Race/National Origin: _____ White, non Hispanic _____ Asian or Pacific Islander_____ Black, non Hispanic _____ Hispanic _______ American Indian or Alaskan NativeSex of Tenant: ______ Male _______ FemaleAUTHORIZATIONPLEASE READ CAREFULLY BEFORE SIGNINGIn considering this application, management will rely heavily on the information you have supplied. It is important that the information is accurate and complete.By signing this application, I/we represent and warrant that the information is accurate. I/we authorize management to verify any information and references listed.Applicant’s signature:___________________________________ Date:_____________Co-Applicant’s signature:________________________________ Date:_____________Please return the completed application to:Megunticook Management100 Washington StreetP.O. Box 618Camden, Maine 04843-0618 ................
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