Futrell-Sievert Limited Partnership

FUTRELL-SIEVERT LIMITED PARTNERSHIP

RESIDENTIAL RENTAL APPLICATION

Applicant’s Information Apartment or residence applied for:

Full Name Complex name Downtown Apartments

Social Security Number Property address 431 Beaver Street

Driver’s License Number State City, State, Zip Code Santa Rosa, California 95404

Date of birth No. of bedrooms baths Apartment

Home Telephone No.

Work Telephone No. Resident Manager or Leasing Agent

E-mail Address ______

Do you have any pets? Yes / No Name Mercy Linares

Do you have any water filled furniture: Yes / No Telephone No. 707-527-4006

Does any member of the household smoke? Yes / No Fax No. 707-568-3457

Why are you vacating your present residence?

PLEASE NOTE: All persons over the age of 17 listed in the next

section below as a household member or co-applicant must

On what date would you prefer to move in? complete a separate rental application.

Additional Household Members or Co-Applicants

Full Name Date of Birth Social Security Number Relationship to the Primary Applicant

/ / / / ‘

/ / / / ‘

/ / / / ‘

/ / / / ‘

/ / / / ‘

Applicant Information Verification of Information (for office use only)

Present Address Present Address Verification (for office use only)

Street Apt # Was the rent paid on time? Yes / No

City / State / Zip Was a majority of the security deposit refunded? Yes / No

Owner / Manager’s Name Was 30-day notice given? Yes / No

Telephone No. Was the apartment left in good condition? Yes / No

Monthly Rent $ Would this landlord rent to this applicant again? Yes / No

Occupancy Dates: In Out Did landlord have any problems or complaints? Yes / No

Does the landlord listed above own the property? Yes / No Verified by

Does the landlord listed above reside with you? Yes / No Comments

What is your relationship to the landlord above (circle one)

None Parent Relative Friend Room-Mate

First Prior Address First Prior Address Verification (for office use only)

Street Apt # Was the rent paid on time? Yes / No

City / State / Zip Was a majority of the security deposit refunded? Yes / No

Owner / Manager’s Name Was 30-day notice given? Yes / No

Telephone No. Was the apartment left in good condition? Yes / No

Monthly Rent $ Would this landlord rent to this applicant again? Yes / No

Occupancy Dates: In Out Did landlord have any problems or complaints? Yes / No

Does the landlord listed above own the property? Yes / No Verified by

Does the landlord listed above reside with you? Yes / No Comments

What is your relationship to the landlord above (circle one)

None Parent Relative Friend Room-Mate

Second Prior Address Second Prior Address Verification (for office use only)

Street Apt # Was the rent paid on time? Yes / No

City / State / Zip Was a majority of the security deposit refunded? Yes / No

Owner / Manager’s Name Was 30-day notice given? Yes / No

Telephone No. Was the apartment left in good condition? Yes / No

Monthly Rent $ Would this landlord rent to this applicant again? Yes / No

Occupancy Dates: In Out Did landlord have any problems or complaints? Yes / No

Does the landlord listed above own the property? Yes / No Verified by

Does the landlord listed above reside with you? Yes / No Comments

What is your relationship to the landlord above (circle one)

None Parent Relative Friend Room-Mate

Equal Housing Opportunity: We encourage and support the affirmative action housing program barring housing discrimination due to race, ethnic heritage, national origin, religion, sex or sexual orientation, handicap or familial status.

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Applicant Information Verification of Information (for office use only)

Current Occupation Current Occupation Verification (for office use only)

Company Name Length of employment verified as yrs months

Address Suite No. Applicant’s work hours are (circle one) full-time / part-time

City / State / Zip Income verified as

Telephone No. Is the applicant still in a probationary period? Yes / No

Fax No. Is the applicant’s job performance satisfactory? Yes / No

Job Title Will the applicant’s job position continue next year? Yes / No

Job Description Verified by

Supervisor’s Name Comments

Length of employment: years months

Estimated gross monthly income before taxes $

Are you self employed? Yes / No

Previous Occupation Previous Occupation Verification (for office use only)

Company Name length of employment verified as yrs months

Address Suite No. Applicant’s work hours are (circle one) full-time / part-time

City / State / Zip Income verified as

Telephone No. Verified by

Fax No. Comments

Length of employment: years months

Estimated gross monthly income before taxes $

Additional Sources of Income Additional Income Sources Verification (for office use only)

Description Verified by

Paid by Comments

Address Suite No.

City / State / Zip

Telephone No.

Fax No.

Estimated gross monthly income before taxes $

Bank Information

Name of Bank Telephone Fax

Address Account No.

City / State / Zip Type of Account (circle one) checking savings other

Name of Bank Telephone Fax

Address Account No.

City / State / Zip Type of Account (circle one) checking savings other

Credit References

Name of lender Account No.

Approximate balance Paid / mo. $ Account Type (circle one) credit card mortgage other

Name of lender Account No.

Approximate balance Paid / mo. $ Account Type (circle one) credit card mortgage other

Personal References

Name Telephone Fax

Address Length of acquaintance yrs months

Name Telephone Fax

Address Length of acquaintance yrs months

In Case of Emergency Notify

Name Telephone Fax

Address Relationship to applicant

Motor Vehicles

Make Model Yr License No. Make Model Yr License No.

Have you ever been evicted for any reason? Yes / No Have you ever filed bankruptcy? Yes / No

Have you ever withheld rent when due? Yes / No Have you ever been convicted of a felony Yes / No

I the undersigned applicant represent that all of the above information is true and correct to the best of my knowledge. I hereby authorize Futrell-Sievert Limited Partnership or it’s Agents to investigate and verify the above information by any reasonable means, including but not limited to, obtaining a consumer and / or investigative credit report.

Applicant’s Signature Date

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