Meadowood Apartments
Rental Application
Landlord: Meadowood Apartments
Address: 1387 30th Ave, Kenosha, WI 53144
Phone: (262) 552-9080 Fax: (262) 552-5336
OFFICE USEDate Received : / Time Received : / AM / PM
Address : / Unit : / Beds :
Monthly Rent : / Monthly Pet Rent :
Earnest Money : / Security Deposit : / Pet Deposit :
Move-In Date : / Agent :
Applicant and Family
List all household members who will live in the apartment. Be sure to include any temporarily absent family (such as military/student family members who will be returning to the household) and any unborn children.
Number of foster children or adults (If applicable): / *Will a live-in attendant be a household member? (Yes/No) / *
* Do not include in chart below.
Will any adult household members be moving in during the next 12 months? (Yes/No)
Household Members:
Full Name / Relationship / Date of Birth / Social Security No.Last, First MI / (mm/dd/yyyy) / 123-45-6789
1
2
3
4
5
6
7
8
9
10
**IMPORTANT: EACH ADULT APPLICANT MUCT COMPLETE A SEPARATE APPLICATION FORM STARTING ON PAGE 2.
**EACH MINOR APPLICANT MUST COMPLETE A CHILD ASSET VERIFICATION ATTACHMENT FORM STARTING ON PAGE 6.
APPLICANT: / SSN :STUDENT STATUS / Form #RAA-150 / YES / NO
Is this applicant a full-time student?
Or, will this applicant become a full-time student within the next 12months?
Or, has this applicant been a full-time student during the current calendar year?
MARITAL STATUS / Form #MVF-130 / Please check one.
Single / Married / Divorced / Separated / Widowed
Other (Please explain):
INCOME
Please indicate each source of income that you receive or anticipate receiving in the next 12 months as specified:
Description / Form No. / Yes / No / Check the number of income sources.
Employment / IVF-110 / 1 / 2 / 3
Employment (If less than 6 months) / IVF-120 / 1 / 2 / 3
Severance Pay / IVF-120 / 1 / 2 / 3
Unemployment / IVF-130 / 1 / 2 / 3
Non-Employment / IVF-140 / 1 / 2 / 3
Workers Compensation / IVF-150 / 1 / 2 / 3
Disability / IVF-160 / 1 / 2 / 3
Social Security / IVF-170 / 1 / 2 / 3
SSI / IVF-170 / 1 / 2 / 3
VA Benefits / IVF-190 / 1 / 2 / 3
Military Benefits / IVF-210 / 1 / 2 / 3
Pension/Annuities / IVF-220 / 1 / 2 / 3
Child Support/Alimony/Family Maintenance / IVF-230 / 1 / 2 / 3
Non-Receipt of Child Support/Alimony/Family Maintenance / IVF-240 / 1 / 2 / 3
Public Assistance/ AFDC / IVF-250 / 1 / 2 / 3
Trust Account / IVF-260 / 1 / 2 / 3
Net Business Income/Self-Employment Income / IVF-270 / 1 / 2 / 3
Net Rental Income / IVF-280 / 1 / 2 / 3
Recurring Gifts/Contributions / IVF-310 / 1 / 2 / 3
Lottery Payments (Periodic) / IVF-320 / 1 / 2 / 3
Adoption Assistance Payments / IVF-330 / 1 / 2 / 3
Income from Temporarily Absent Family Members / 1 / 2 / 3
Income from Persons Permanently Confined to a hospital or nursing home / 1 / 2 / 3
APPLICANT: / SSN :
DAY PHONE: / EVENING PHONE:
ASSETS
Do you have any of the following types of assets or do you expect to establish any in the next 12 months?
Description / Form No. / Yes / No / Check the number of income sources.
Checking Account / AVF-110 / 1 / 2 / 3
Savings Account / AVF-120 / 1 / 2 / 3
Cash Kept at Home / AVF-130 / 1 / 2 / 3
Safety Deposit Box / AVF-135 / 1 / 2 / 3
CD / Money Market Accounts / AVF-140 / 1 / 2 / 3
Stocks / Bonds / AVF-150 / 1 / 2 / 3
Trust Account / AVF-160 / 1 / 2 / 3
Treasury Bills / AVF-170 / 1 / 2 / 3
IRA / AVF-180 / 1 / 2 / 3
Keogh / AVF-190 / 1 / 2 / 3
401K / AVF-210 / 1 / 2 / 3
Pension / Annuities / AVF-220 / 1 / 2 / 3
Whole Life / Universal Life Insurance / AVF-230 / 1 / 2 / 3
Land Contract / Purchase Money Mortgage / AVF-240 / 1 / 2 / 3
Real Estate Property and Mortgage Assets / AVF-250(a/b) AVF-260 / 1 / 2 / 3
Lottery Winnings (Lump Sum) / AVF-270 / 1 / 2 / 3
Personal Property Held as an Investment (Such as Gems, Jewelry, Antique Cars, Stamp Collection, Etc.) / AVF-280 / 1 / 2 / 3
Have You Sold Any Assets in the Past 2 Years for More Than $1,000 Less Than Fair Market Value? / AVF-290 / 1 / 2 / 3
Did You Receive Any Insurance Claim Settlements, Inheritance, Lottery Winnings, or Capital Gains in the Next 12 Months? / AVF-310(a/b) / 1 / 2 / 3
Are Total Household Assets At or Below $5,000? / AVF-320 / 1 / 2 / 3
APPLICANT : / SSN :
RESIDENCE HISTORY
A minimum of 3 years of housing history is required.
CURRENT ADDRESS
Street :
City : / State : / Zip :
Since (MM/YYYY) : / Rent / Own / Monthly Rent/Mortgage :
Reason for leaving :
Landlord :
Street : / City :
State : / Zip : / Phone :
PREVIOUS ADDRESS
(If within the last 3 years)
Street :
City : / State : / Zip :
Since (MM/YYYY) : / Rent / Own / Monthly Rent/Mortgage :
Reason for leaving :
Landlord :
Street : / City :
State : / Zip : / Phone :
OTHER INFORMATION
Emergency Contact Information
(Closest relative, not living with you)
Name: / Relationship:
Street : / City :
State : / Zip : / Phone :
VEHICLE INFORMATION
Applicants Driver's License No. : / State:
Make / Model / Color / Year / License Plate No.
1
2
PET INFORMATION
Name / Breed/Type / Age / Sex / Color
1
2
Are you currently receiving Rent Assistance? Yes No
Voucher ______Certificate ______
Has your Rent Assistance ever been terminated? Yes No
If yes, please explain: ______
Will this unit be your only place of residence? Yes No
If no, please explain: ______
Will a business be run out of your home? Yes No
If yes, please explain: ______
Have you ever been convicted of a felony? Yes No
If yes, please explain: ______
Have you ever filed for bankruptcy? Yes No
If yes, when: ______
Have you ever been evicted from tenancy? Yes No
If yes, please explain: ______
Have you ever willfully or intentionally refused to pay rent when due? Yes No
If yes, please explain: ______
I hereby apply to lease the above-described premises for the term of and upon the conditions set forth above. I understand and agree that inquires may include information related to credit, employer, rental and criminal records. I further agree that verification of all information and references, including all sources of income and assets, may be conducted and I release all parties for any liability for disclosing factual information obtained by the landlord.
I warrant that all statements set forth above are true and correct to the best of my knowledge. I understand that deliberately submitting false information or withholding information constitutes fraud for which federal law specifies fines up to $10,000 and prison terms of up to five years. Should any statement made above in any way misrepresent or be an untrue statement of facts, the entire deposit will be retained by the landlord to offset the agent’s cost, rent and additional fees prior to taking possession of the apartment.
I understand that this form is an application for residence only and that submission of this application in no way reserves or guarantees an apartment. I deposit $100 as Earnest Money and $25as a nonrefundable application processing fee for each applicant over the age of 18. When this application is approved, I agree to execute a lease and to pay any security deposit, rent and additional fees prior to taking possession of the apartment.
If, once approved, I do not take possession of the apartment, I understand that any Earnest Money paid will be forfeited as liquidated damages to offset the agent’s cost, time, and effort in processing my application.
If this application is not approved, I understand that any Earnest Money deposit and/or any refundable application processing fee will be refunded to me and I waive any claim for additional damages by reason of non-acceptance.
Applicant SignatureDate
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APPLICANT EMPLOYMENT HISTORYCurrent Employer
Current Employer :
Street : / City :
State : / Zip : / Phone :
Start Date (MM/YYYY) : / Wages : / Hours per Week :
Previous Employer
Previous Employer :
Street : / City :
State : / Zip : / Phone :
Start & End Date (MM/YYYY) : / Wages : / Hours per Week :
As an inducement to the owner of the property and to the agent to accept this application, I warrant that all statement above set forth to the best of my knowledge are true and correct. I understand that deliberately submitting false information or withholding information constitutes fraud. Federal Law specifies fines up to $10,000 and prison terms up to five years for fraud.
This is preliminary application and gives you no lease or rental rights. Additional information may be required at a later date to complete processing of this application. I have paid the Earnest Money deposit and credit report fee indicated on this application. The Earnest Money deposit will be applied to my first month’s rent or security deposit if the Landlord enters into a lease or rental agreement with me. If this application is approved, and I fail to enter into a lease or rental agreement, the earnest money and any subsequent payments may be retained to compensate the Landlord’s cost and damages, subject to the Landlord’s duty to mitigate, or per state statues. The Earnest Money and subsequent payments will be refunded to me by the end of the next business day if: (1) this application is rejected, or withdrawn before approval, or (2) if the Landlord takes no action on this application by the end of the 21st day following the Landlord’s receipt of the Earnest Money. Any application fee is non-refundable.
I hereby authorize the Landlord and Manager to investigate my credit and financial responsibility, income, rental and eviction history, and the statements made in this application and to obtain consumer credit report on me from a consumer-reporting agency that complies and maintains files on consumers on a nationwide basis. My performance under any lease or rental agreement that I may enter into with the Landlord may be reported to such reporting agency.
I acknowledge that the Manager and the agents and employees thereof represent the interests of the Landlord, but they also have a duty to treat all parties fairly and in accordance with Fair Housing Law, and to disclose material adverse facts about the property. I understand that deliberately submitting false information or withholding information constitutes fraud and is grounds for eviction, or non-acceptance of application.
Wisconsin applicants only: Applicant hereby acknowledge receipt of a copy of the lease, the policies and procedures addendum, the NONSTANDARD RENTAL PROVISIONS addendum, and any other addenda that applicant has expressed interest in which will require the applicant’s signature upon entering into a lease.
InitialThe undersigned applicant(s) agree(s) that the Landlord shall have up to twenty-one (21) calendar days from acceptance of the Earnest Money deposit to approve or deny the rental application.
Applicant Signature / Date______
On-Site Property ManagerDate
Development: / APT NO. :By my signature below, I hereby indicate my desire to lease an apartment from Meadowood Apartments. I do also hereby consent to and authorize any representative of Legacy Varin Property Management Services, LLC or the above-mentioned development to obtain, verify, and exchange information or any reports concerning me as are maintained by, but not limited to: City, County, State, Federal Law Enforcement Agencies, Credit Reporting Agencies, present and/or past residences. I understand that any information obtained may be considered to Towne Investments or the above-mentioned development at their sole discretion they make with respect to the apartment for which I am making application.
Furthermore, I hereby release and hold harmless any agents, owners, or affiliates of Legacy Varin Property Management Services, LLC or the above-mentioned development, including but not limited to their officers, directors, employees, present and/or past residences, it officers and employers that shall provide information to Legacy Varin Property Management Services, LLC or the above-mentioned development upon request, from and against any and all claims, demands, suits, or expenses arising from or related to the content, validity or handling of said reports.
Print Name / Social Security NumberApplicant Signature / Date
E-Mail Address
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