Industrial/Stevens Apartments
1410 Washington Boulevard
DETROIT, MI 48226
(313) 961-3195
RENTAL APPLICATION
UNIT SIZE: (circle one) 1 bedroom 2 bedroom
Do you require a unit equipped with handicapped accessible features? YES NO
Do you need any special accommodations related to a disability or impairment? YES NO
If yes, list accommodation or special needs ______
Are you a Full-Time Student enrolled at an institution of higher education? YES NO
If you answered YES you will need to fill out a questionnaire to determine if you are eligible to receive Section 8 Assistance.
HOUSEHOLD INFORMATION
Applicant’ Name ______Co-Applicant______
Address (street, city, state, zip) ______
Phone # ______Work # ______Msg. # ______
Other names used ______
(Maiden name, nicknames, etc)
Soc. Sec # ______Date of Birth ______
Driver’s License # ______or Michigan I.D. # ______
Name & Address of current landlord ______
Monthly Rent Amount $______How Long Have You Lived Here? ______
Are You Related To Landlord? YES NO Reason for Moving ______
List all people including yourself who will occupy the unit:
NAME DATE OF BIRTH AGE SEX SOC SEC # RELATIONSHIP
______
______
______
______
Do you have custody (at least 51% of the time) of all of the children that you have listed to reside with you? YES NO
INCOME INFORMATION
What is your projected annual gross income (before taxes) for your household?
Employment income $ ______Child Support $ ______
Unemployment $ ______Social Security$______
Worker’s Compensation $ ______SSI $ ______
FIA Grant $ ______VA Benefits $ ______
Any other income $ ______What Kind? ______
TOTAL INCOME $ ______ (add all spaces together)
Employer Name & Address ______
Current Bank(s) Name & Address ______
Page 1 of 4
RENTAL HISTORY
LIST ALL PRIOR ADDRESSES & LANDLORDS (If at current address less than 3 years):
If you need additional space, please attach a separate sheet.
1. PREVIOUS ADDRESS (street, city, state, zip)______
______
Choose one: Was this a rental? ______Did you own it? ______
Were you living with a friend? ______Were you living with a relative? ______
Dates of Occupancy: from ______to______Rental Amount $______
Name & Address of Landlord______
______
Telephone Number ______
2. PREVIOUS ADDRESS (street, city, state, zip)______
______
Choose one: Was this a rental? ______Did you own it? ______
Were you living with a friend? ______Were you living with a relative? ______
Dates of Occupancy: from ______to______Rental Amount $______
Name & Address of Landlord______
______
Telephone Number ______
3. PREVIOUS ADDRESS (street, city, state, zip)______
______
Choose one: Was this a rental? ______Did you own it? ______
Were you living with a friend? ______Were you living with a relative? ______
Dates of Occupancy: from ______to______Rental Amount $______
Name & Address of Landlord______
______
Telephone Number ______
List all counties & states you have ever lived in & the dates in which you resided there.
1.______3.______
2.______4.______
Have you or a member of your household ever lived in subsidized housing? YES NO
If yes, where & when ______
Have you ever committed fraud in an assisted housing program? YES NO
Have you ever been requested to repay money for knowingly misrepresenting
information to such housing programs? YES NO
Have you ever been evicted from any dwelling? YES NO
If yes, please explain on back
Page 2 of 4
Are you a former resident of Industrial/Stevens Apartments? YES NO
If yes, where & when ______
Have you or a member of your household ever filed an application with Industrial/Stevens Apartments or any properties that are managed by Wingate Management? YES NO
Have you ever filed a petition for bankruptcy? YES NO
______
Federal law requires us to get drug and criminal background and sex offender registration information about all adult household members applying for assisted housing. To enable us to do this all household members age 18 or older must answer the questions below, then sign below to consent to a background check. The questions ask about drug-related and other criminal activity that could adversely affect the health, safety, or welfare of other residents.
Industrial/Stevens Apartments will deny the application of any applicant who does not provide complete and accurate information on this form or does not consent to a background check.
Do you currently use illegal drugs or abuse alcohol? YES NO
Are you currently subject to a lifetime registration requirement under a state
Sex offender registration program? YES NO
Have you been convicted of any drug-related crime? YES NO
Have you been convicted of any crime involving violence? YES NO
Are you currently charged with any of the above criminal activities? YES NO
Have you or an adult member of your household ever been
convicted of a misdemeanor or a felony? YES NO
If yes, what was the nature of the offense, what county/state did it happen in,
& what year were you convicted? ______
______
I understand that the above information is required to determine my eligibility for residency. I certify that my answers to the above questions are true and complete to the best of my knowledge. I understand that making false statements on this form is grounds for rejection or termination of my lease. I authorize Industrial/Stevens Apartments to verify the above information, and I consent to the release of the necessary information to determine my eligibility.
I hereby authorize law enforcement agencies to release criminal records and/or sex offender registration information to Industrial/Stevens Apartments, to a public housing authority, or to an agency contracted by Industrial/Stevens Apartments to conduct criminal background checks.
Applicant’s Signature______Date______
Co-Applicant’s Signature ______Date______
Page 3 of 4
I FULLY UNDERSTAND THAT TITLE 18 SECTION 1001 OF THE UNITED STATES CODE STATES THAT A PERSON IS GUILTY OF A FELONY FOR KNOWINGLY AND WILLINGLY MAKING FALSE OR FRAUDULENT STATEMENTS TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES. I, THEREFORE CERTIFY THAT THE FOREGOING INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE INQUIRIES TO BE MADE TO VERIFY THE STATEMENTS ABOVE. FALSIFIED STATEMENTS SHALL BE GROUNDS FOR TERMINATION.
______
Applicant Date
______
Co-Applicant Date
I authorize Industrial/Stevens Apartments to obtain information on my rental/credit/criminal/ employment/source of income history by contacting any references necessary to evaluate renting risks. I hereby release all references to give Industrial/Stevens Apartments all requested information.
______
Applicant Date
______
Co-Applicant Date
______
Number of vehicles in your household ______
Year______Make______Model______License #______
Year______Make______Model______License #______
______
How did you hear of Industrial/Stevens Apts? ______
Page 4 of 4