Applicant's name:          App. #2's Name:

Marital Status:    Married       Single     Divorced     Separated  Other:

Soc. Sec. Number:   Date of Birth:    Soc. Sec. Number:   Date of Birth:

Driver's License:    Driver's License appl 2:

Phone Number:            E-Mail Address:

Present Address:   City:    State:     Zip Code:

Landlord/Owner:   Telephone Number:

Current Rent Amount:    Rent From:   To:

Reason for leaving:

.............................................................................................................................................................................................

Current Employment:   Telephone number:

Supervisor:   Position:

Length Employed: to Full time Part Time  Salary: Per (Hr/Yr):

App. #2's Current Employment:   Telephone number:

Supervisor:   Position:

Length Employed: to Full time Part Time  Salary: Per (Hr/Yr):

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Vehicle Information: List Make & Model & Year:    Plate:

                                                                         Plate:

Do you have any RV, boats, trailers? If so, please list:

Please answer the following questions:

Will you have pets: yes  No  If so, How many?   What Type:

Will you have any water filled furniture: yes   No        If so, please specify:

Have you ever declared Bankruptcy:     yes   No       If so, when:              

Have you ever had an eviction filed against you?: yesNo  If so, please specify:

Have you ever been convicted of a felony? yes   No   If so, please specify:

Have you ever been convicted of a misdemeanor? yes   No If so, please specify:

Have you ever refused to pay rent? yes   No              If so, please specify:

Applicant's Signature:   Co-Applicant Signature:     Date:

By printing my name under signature I authorize Landmarket Realty LLC and its affiliates to verify all information contained in this application including but not limited to credit history, work/Employment history, criminal background and references.