Kilmer Homes – Rental Application

APPLICATIONS MUST BE RETURNED, BY MAIL ONLY, NO LATER THAN JANUARY 5, 2015 TO:

THE ALPERT GROUP, LLC

ONE PARKER PLAZA

FORT LEE, NJ 07024

Applicant Name: ______

LastFirstmiddle initial

Social Security #______Date of Birth: ______Full time student YES ____ or NO_____

Co-Applicant Name: ______

LastFirstmiddle initial

Social Security #______Date of Birth: ______Full time student YES ____ or NO_____

Other Occupants – Full Names / Date of Birth / Social Security # / Relationship to Applicant / Student Status
Full, Part or N/A

Do you anticipate any change in household composition within the next 12 months? ______

Current Address: ______street apt# city state zip

______

HomePhone #Work Phone #Cell Phone #

Date: from______to ______Monthly Rent $______Monthly Utilities $______

Does any member in your household have a disability that requires an accessible unit? ______Do they require a live-in Aide? ____

Has any member in your household served at least one day of active duty in the US Military? ______

Was your housing impacted by Superstorm Sandy? ______Have you registered with FEMA? ______

If not, do you have other evidence of displacement? ______

Present Landlord/Mortgage Co: ______

Name

______street city state zip

______Do you own or Rent? ______

Landlords phone #

Reason for moving?______

Previous Address: (Complete only if you have lived at your present address less than one year)

______street apt# city state zip

SECTION 8 APPLICANTS PLEASE COMPLETE THIS SECTION & PROVIDE A COPY OF YOUR VOUCHER

Housing Authority you receive assistance from: ______

Name & phone number of your caseworker: ______

Have you been released to move to a new apartment? ______Number of bedrooms your voucher is for ( 1 or 2) ______

INCOME INFORMATION: list all full time, part time, seasonal and self-employment of all household members and the anticipated income from each source of employment during the next 12-month period

Name of household member / Name & Address
Of employer / Position & Supervisors
Name & Phone # / Monthly Gross
Income / Date of hire

Do you anticipate a change in income within the next 12 months? ______If so what?______

ASSET INFORMATION:list all bank accounts including checking, savings, credit union, certificate of deposits, pension, annuities, 401(k), IRA stocks, bonds, money market, equity in real estate, life insurance policies etc for all household members.

Type of Account / Account Number / Bank Name / Address

Have you disposed of any Assets for less than fair market value in the last two years ? YES ______NO ______

TOTAL ANTICIPATED GROSS INCOME THROUGH THE NEXT 12 MONTHS

Applicant Annual Salary (including Tips, Fees, Bonuses & Commissions)$______

Co-Applicant Annual Salary (including Tips, Fees, Bonuses & Commissions)$______

Annual Anticipated Income from Assets $______

OTHER ADDITIONAL INCOME: (provide monthly amount for all items that apply)

$______Child Support$______Alimony$______Student Financial Aid

$______Social Security$______SSI/Disability$______Self Employment

$______Public Assistance$______AFDC

$______VA or RR$______Unemployment

$______Pension/Annuity$______Recurring Gift

$______Other______

Total Additional income$______

VEHICLE INFORMATION:

Year: ______Make: ______Model:______Color:______

License # and State: ______Registered to:______

Note: Management provides only 1 parking space per apartment. No commercial vehicles allowed

EMERGENCY CONTACT:Name:______

Address:______

Phone #:______Relationship: ______

HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES ______NO ______

If yes, please explain: ______

______

DO YOU OWN ANY PETS? YES ______NO ______

If yes, what kind?______

STATEMENTS BY ALL ADULT HOUSEHOLD MEMBERS

  1. We certify that all information given in this application and any addenda thereto is true, complete and accurate. We understand that if any of this information is false, misleading or incomplete, management may decline our application or, if move-in has occurred, terminate our rental agreement.
  2. We authorize Kilmer Homes to make any and all inquiries to verify this information, either directly or through information exchanged now or later with rental and credit screening services, and to contact previous and current landlords or other sources for credit and verification confirmation which may be released to appropriate Federal, State or local agencies.
  3. If our application is approved, and move-in occurs, we certify that only those persons listed in this application will occupy the apartment, that they will maintain no other place if residence, and that there are no other persons for whom we have, or expect to have, responsibility to provide housing.
  4. We have been notified that the Resident Selection Criteria is posted in the management office.
  5. We understand that if this application is place on a Waiting List, we may request sample copies of the rental agreement and house rules. If this application is approved, and move-in occurs, we certify that we will accept and comply with all conditions of occupancy as set forth therein, including specifically all conditions regarding pets, rent, damages and Security Deposits.
  6. We authorize management to obtain one or more “consumer reports” as defined in the Fair Credit Reporting Act, 15 U.S.C. Section 1681a(d), seeking information on our credit worthiness, credit standing, credit capacity, general reputation, personal characteristic, or mode of living.
  7. We hereby authorize verification of any and all information set forth on this application including release of information by any employer (present & former), any bank or savings and loan and any lender, and hereby waive all right of action for any consequence resulting from such information.

FAIR CREDIT REPORTING ACT

This is to inform you that as part of our procedure for processing your application, an investigative report may be made whereby information is obtained through personal interviews with third parties - such as family members, business associates, financial sources, friends, neighbors or other who are aquatinted with you. This inquiry includes information as to you character, general reputation, personal characteristics, mode of living, income and credit background and also police records. Please be advised all such information herein and released as authorized will be kept confidential. We do not discriminate on the basis of Race, Religion, National Origin, Color, Creed, Age, Sex, Handicap or Familial Status. I/WE HAVE READ AND UNDERTAND THE ABOVE

______

Applicant SignatureDate

______

Co-Applicant SignatureDate