RENTAL APPLICATION

Landlord:
Eugene H. Utt
8120 SE Waterway Drive
Hobe Sound, FL 33455

This Application is made to rent:

Mobile Home ___
Route 8, Box 384-__ ___(Milton St/Hopewell Rd) 
Fairmont, WV 26554

for a term of one year.

Desired date of occupancy:_______________________________________
Desired length of occupancy:______________________________________
Reason for moving:_____________________________________________

The annual rent shall be $4,800 payable $400.00 monthly in advance.
A security deposit of $400.00 shall be payable in advance.
First month, and security deposit in separate Cashier checks or Money Orders.

The Applicant authorizes and understands that the Landlord may perform reference checks, criminal conviction inquiries and a credit check to verify the Applicant's credit references and credit history in connection with the processing of this Rental Application.

A nonrefundable credit report fee of $15.00 will be due with this application. (Cashier’s Check or Money Order.
A copy of this report will be provided to the applicant. 

IF A SECOND ADULT WILL ALSO BE RENTING THE PREMISES (that is, they will be signing on the lease and their income, credit, etc. should be considered for application purposes), THEN THEY WILL NEED TO COMPLETE A SEPARATE RENTAL APPLICATION FORM.

PLEASE PRINT ALL REQUESTED INFORMATION

APPLICANT INFORMATION

Full Legal Name (First, Middle, Last):________________________________________

No. of occupants:	Adults(18 & older): _____	Children (17 & under): _____ 
Water bed:	Yes _____	No _____
Smokers:	Yes _____	No _____
Pets:	Yes _____	No _____  If yes, how many, kind (e.g. dog, cat, bird, fish, reptile, exotic, etc.) and weight: _________________________________________________________________

PRESENT ADDRESS: ________________________________________________

How long at present address: __________________________
Home Phone No.: (____)_______________

Landlord's Name: ___________________________________________________
Phone No.:  (____)____________
Current rent payment: ____________

PRIOR ADDRESS: ____________________________________________________

How long at prior address: ____________________________
Landlord's Name: ____________________________________________________
Phone No.: (____)______________________
Rent payment: ____________

Reason for moving: ___________________________________________________

Social Security No.: _______-______-_______
Driver's License No. :_____________________
Copy (Xerox,etc.) of Driver’s License___on a separate page, must be legible.
Vehicle Model: _____________________Year: __________
License No.: ________________________
Vehicle Model: _____________________Year: __________
License No.: ________________________

MONTHLY SOURCES OF INCOME:
Wages/Salary	$__________
Commissions	$__________
Tips	$__________
Gov't assistance	$__________
Child support/Alimony	$__________
Other________________	$__________
	TOTAL	           $__________

CURRENT EMPLOYER:

Employer Name:  _____________________________________________________
Employer Address:____________________________________________________
Position: ____________________	How long: __________________
Supervisor: __________________	Business Phone: (____)________
Annual Income: _________________________________________________

PRIOR EMPLOYER:

Employer Name:  _____________________________________________________
Employer Address:____________________________________________________
Position: ____________________	How long: __________________
Supervisor: __________________	Business Phone: (____)________
Annual Income: _________________________________________________

NEAREST RELATIVE NOT LIVING WITH YOU:

Name: ___________________________________________________________
Address: __________________________________________________________
Home Phone No.: (____)____________
Relationship: _____________________

PERSONAL REFERENCES:

Name: __________________________________________________________
Address: _________________________________________________________
Phone No.: (____)________________
Relationship: ____________________

Name: ___________________________________________________________
Address: _________________________________________________________
Address: __________________________________________________________
Phone No.: (____)________________
Relationship: ____________________

BANK & BROKERAGE ACCOUNT REFERENCES:

Bank/Brokerage Name:_________________________________________________ 
Branch Address: ______________________________
Telephone Number:_____________________________
Account No.: __________________________

Bank/Brokerage Name: __________________________________________________ 
Branch Address: ______________________________
Telephone Number:
Account No.: __________________________

CREDIT REFERENCES (Auto loans, installment debt, credit cards, etc.):

Credit Card: __________________________________________
Issuing Bank: _______________________________________________________
Account No.: ______________________	Credit limit: _______________
Balance owed: _____________________	Monthly payment: __________
Expiration date: ____________________	Year Issued: ______________

Credit Card Name: _________________________________________________
Issuing Bank: _______________________________________________________
Account No.: ______________________	Credit limit :_______________
Balance owed: _____________________ 	Monthly payment: __________
Expiration date: ____________________ 	Year Issued: ______________

Credit Purchases (e.g. Car loan or other installment debt)
Bank/Lender Name:__________________________________________________
Account No.: ______________________	Credit limit: _______________
Balance owed: _____________________	Monthly payment: __________

Credit Purchases (e.g. Car loan or other installment debt)
Bank/Lender Name:__________________________________________________
Account No.: ______________________	Credit limit: _______________
Balance owed: _____________________	Monthly payment: __________

Do you own real estate?  
Yes ____  No ____  If yes, please explain where:
__________________________________________________________________
__________________________________________________________________

Have you ever been evicted from any rental premises?
Yes ____  No ____  If yes, please explain:
___________________________________________________________________
___________________________________________________________________

Have you ever not paid rent when due?
Yes ____  No ____  If yes, please explain:
___________________________________________________________________
___________________________________________________________________

Are there any circumstances which may interrupt your income or ability to pay rent?
Yes ____  No ____  If yes, please explain:
___________________________________________________________________
___________________________________________________________________

Have you ever been convicted of a felony?  
Yes ____  No ____  If yes, please explain:
____________________________________________________________________
____________________________________________________________________

Please provide the names of other tenants, including children and anyone who will live with you, even if on a temporary basis.

(1)Name: _______________________________________________________________
Present Address:________ __________________________________________________
How long at present address: ___________ Home Phone No.: (____)________________

If Adult (18 or older), Age: _____ Relationship: ____________________
Occupation: ___________________________ 
If Child, Age: _____ School: _____________________

(2)Name: _______________________________________________________________
Present Address: _________________________________________________________
How long at present address: ___________ Home Phone No.: (____)________________

If Adult (18 or older), Age: _____ Relationship: ____________________
Occupation: ___________________________ 
If Child, Age: _____ School: _____________________

(3)Name: _______________________________________________________________
Present Address: _________________________________________________________
How long at present address: ___________ Home Phone No.: (____)________________

If Adult (18 or older), Age: _____ Relationship: ____________________
Occupation: ___________________________ 
If Child, Age: _____ School: _____________________

(4)Name: _____________________________________________________________
Present Address: __________________________________________________
How long at present address: ___________ Home Phone No.: (____)________________

If Adult (18 or older), Age: _____ Relationship: ____________________
Occupation: ___________________________ 
If Child, Age: _____ School: _____________________
After completing this application, please present two forms of identification (one with a photo) so that your identity as the applicant can be confirmed.  If any of this identification information does not match the information presented in this application (such as your current address, driver’s license number, social security number, etc.), please provide an explanation below: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I represent that the information provided in this Application is true and correct to the best of my knowledge.  Eugene H. Utt or his agent(s) is authorized to verify the references, employment, and other information given in this Application including, but not limited to,  requesting a credit report.  The information provided by the prospective tenant(s) and the information provided by the parties referenced herein may be used by Eugene H. Utt or his agent(s) to determine whether to accept this Rental Application.

_____________________________________________	_______________
Individual Applicant's Signature	Date

Co-Applicant's, excluding a husband or a wife, must complete a separate rental application form.	

IT IS AGAINST THE LAW TO DISCRIMINATE AGAINST PROSPECTIVE TENANTS ON THE BASIS OF RACE, RELIGION, NATIONAL ORIGIN, AGE, DISABILITY OR FAMILY STATUS.  LOCAL OR STATE LAWS MAY INCLUDE ADDITIONAL CLASSES WHICH ARE PROTECTED FROM DISCRIMINATION IN HOUSING.

Eugene H. Utt
8120 SE Waterway Drive
Hobe Sound, FL 33455  

________________

______________________________________
______________________________________
______________________________________
______________________________________

Dear Employer:

We are in the process of confirming information provided by a prospective tenant who has provided your name as employer in connection with a rental application.   Please verify the information provided by the tenant by telephone or return the form to me at the above address.  

Thank you for your cooperation.

________________________________________________
Eugene H. Utt

TENANT SUPPLIED INFORMATION

Prospective Tenant's Name: _______________________________________ 
Position: ___________________________________________________ 
Wage/Salary: ___________________  Per: ____________ 
Length of time with above Employer: _________________________

I have completed the above information in connection with a rental application.  The addressee of this letter is authorized to verify this information and supply the above named landlord with the information requested in the following items.  Your response is solely a matter of courtesy for which no responsibility is attached to your institution or any of your officers.

Prospective Tenant's Signature: ____________________________________

VERIFICATION TO BE COMPLETED BY EMPLOYER

Is the employment information correct:  Yes ____ No ____
Is this employment:
Part-time ______  Full-time ______  Temporary ______  Permanent ______

Information provided by: __________________________________________
Title: _____________________________________ Date: ________________

Eugene H. Utt
8120 SE Waterway Drive
Hobe Sound, FL 33455  

_________________

______________________________________
______________________________________
______________________________________
______________________________________

Dear Sir or Madam:

Please verify the bank account information provided in connection with a rental application by the prospective tenant named on the following page. You may return the form to me at the above address.

Thank you for your cooperation.

________________________________________________
Eugene H. Utt

TENANT SUPPLIED INFORMATION

Name of Prospective Tenant(s):
___________________________________________________
___________________________________________________
Address __________________________________________________________
_________________________________________________________________

Type of Account:  Checking ______ Savings ______ Other: ______________
Account Number:___________________________ Balance: $____________

Type of Account:  Checking ______ Savings ______ Other:  ______________
Account Number: __________________________ Balance: $____________

I have completed the above information in connection with a rental application.  The addressee of this letter is authorized to verify this information and supply the above named landlord with the information requested in the following items.  Your response is solely a matter of courtesy for which no responsibility is attached to your institution or any of your officers.

_______________________________	______________________________
Signature of Account Holder	Signature of Account Holder

VERIFICATION TO BE COMPLETED BY BANK

Type of Account:  Checking _____ Savings _____ Other: ____________
Account Number: __________________________ Balance $____________ 
Average Balance for previous two months:  $____________
Date Account opened: ________________

Type of Account:  Checking _____ Savings _____ Other: ____________ 
Account Number: __________________________ Balance $____________ 
Average Balance for previous two months:  $____________
Date Account opened: ________________

Signature: ______________________________________ Date: ___________
Title: ____________________________________

PLEASE RETURN THIS FORM TO THE LANDLORD.

Final Checklist for Rental Application
For: Mobile Home "  "
Route 8, Box 384-  (Milton St/Hopewell Rd), WV Fairmont

Make It Legal

_____	The Rental Application should be signed by the Applicant(s) 
	By signing the Application, the Applicant:  
(i) verifies that the information provided is true and correct to the best of his or her knowledge,
(ii) authorizes the Landlord to verify the references and employment information provided in the Application, and
(iii) acknowledges receipt of a copy of the Application. 

_____	If the optional Employment Verification Letter is to be used, it should be signed by the Applicant(s) at the time that the Application is submitted to the Landlord.

_____	If the optional Request for Account Verification is to be used, it should be signed by the Applicant(s) at the time that the Application is submitted to the Landlord.

Original/Copies

_____	Eugene H. Utt should retain the original application.  It is not necessary to provide the applicant with a copy.

Other Information

*	After completing the application, ask the applicant for some form of identification such as a driver's license, credit card, passport, or military ID so that you can confirm the identity of the Applicant.  Also verify the identification with information given on the Application - social security number, driver's license number, current address.  Ask for an explanation of anything that does not match.  Make a note of the explanation, and then decide for yourself if you believe the explanation.

*	If an Application is deemed acceptable and the Landlord decides to lease the the property to the Applicant, execute a written lease agreement between the parties.  .

*	If an Applicant does not meet your criteria, be sure to document the basis of your decision.  The best approach with the Applicant is to be honest, direct, and polite.  Further, don't budge from your predetermined criteria despite an appeal from the Applicant.

*	You are not required to rent to the first person who expresses an interest in the rental unit.  The purpose of the application process is to gather relevant information about perspective tenants to determine whether or not the potential tenant would be a quality renter.  If an Applicant fails to meet your objective rental criteria, it is permissible to decline to rent the unit to him or her if such decision is made in good faith and for a legitimate, legal purpose.

*	Do not discriminate against an applicant on the basis of an illegal purpose: race, color, religion, sex, national origin, age, disability or family status.  Such discrimination AS THE SOLE BASIS OF REFUSAL TO RENT is illegal throughout the United States.  You may call the U.S. Department of Housing and Urban Development (HUD) at 1-800-424-8590 to ask questions about discrimination.

*	It is a good idea to check with your local housing commission and/or landlord associations for additional information.