colchester property management, LLC

PO BOX 730 COLCHESTER VT. 05446

802.355.3571

PAULA@CCSINCVT.COM

This is an application for housing at:	________________________________________________

Requested lease signing date:	________________________________________________

GENERAL INFORMATION

Lease Signer Applicant:

Name____________________________	Contact#________________________

Name_____________________________	Contact#________________________

Current Address(es):

_____________________________________________________________________________________

Street	Apt.# City State ZIP

_____________________________________________________________________________________

Street	Apt.# City State ZIP

Number of bedrooms In current unit:	_______________

Amount of Current monthly rental payment:	$_______________

Check utilities paid by you: Heat Electricity Gas Others (specify)

_____________________________________________________________________________________

Approximate monthly cost of utilities paid by you	$_______________

(do not include wifi, cable or phone)

Dates of tenancy:	____________________	__________________

Reason for leaving

__________________________________________________________________________________________________________________________________________________________________________

Has your landlord received proper notice of your intentions to move: Yes	No

Landlord Contact Information:	Name:	_________________________

Contact #:	__________________________

Is it okay to contact current landlord for reference?	Yes	No

******If tenancy above was shorter than 3 YEARS, please fill out below******

Previous Address:	____________________________

____________________________

Lease dates:	_____________________________

Landlord:	Name:	____________________________

Contact#:	_____________________________

Is it okay to contact previous landlord?	Yes	No

HOUSEHOLD COMPOSITION

NAME___________________________________AGE________RELATIONSHIP________SELF______

HEAD OF HOUSEHOLD

NAME____________________________________AGE________RELATIONSHIP_________________

CO- HEAD OF HOUSEHOLD

NAME____________________________________AGE________RELATIONSHIP_________________

NAME____________________________________AGE________RELATIONSHIP_________________

NAME____________________________________AGE________RELATIONSHIP_________________

NAME____________________________________AGE________RELATIONSHIP_________________

Will all listed minors be living in the unit at least 50% of the time?

YES NO

Do you anticipate any changes in the household composition in the next 12 months?

YES NO

Is there someone not listed above, who would normally be living with the household? YES NO

If yes, Explain Why they were not listed? _____________________________________________________________________________

SOURCES OF income

Are you employed?	YESNO	Full Time? YES NO

Employer	________________________________________________________________

Contact Name	________________________________________________________________

Contact Number	________________________________________________________________

Length of Employment	_________________________________________________________

May we contact current employer?	YES NO

Gross Monthly Income	$_____________________________

**** If length of employment is less than 5 years please list all previous employments*****

Employer	__________________________________________

Contact Name	__________________________________________

Contact Number	__________________________________________

Dates of Employment	____________________________________________

May we contact previous employer?	YES NO

Employer	__________________________________________

Contact Name	__________________________________________

Contact Number	__________________________________________

Dates of Employment	____________________________________________

May we contact previous employer?	YES NO

Do you have a public housing voucher?	YES NO

If yes what public housing authority	________________________

Contact Name	_________________________

Contact Number	__________________________

Please list all sources of household income/employment

Household Member _________________ Monthly Income________________ Employer____________________________________________________________

Household Member _________________ Monthly Income________________ Employer____________________________________________________________

Please list any other sources of income:

___________________________________________________________________________________

MISCELLANEOUS

Question	Yes	No	Explanation
Do you own any real estate?	Where?
Do you own any pets
Have you ever been arrested or charged with a crime?
Have you ever received an Eviction Notice from a landlord?
Have you ever been evicted by a landlord?
Do you smoke?
Have you ever had a pest infestation?
Is anyone disabled?
Is anyone a registered sex offender
Have you ever been more than 5 days late with rent
Have you ever filed for bankruptcy?
Do you have 1st month and security deposit available?

PERSONAL REFERENCES:

Name:________________________________Address:______________________________________

Telephone #: (______)__________________Relationship: _________________________________

Name:________________________________Address:______________________________________

Telephone #: (______)__________________Relationship: _________________________________

Name:________________________________Address:______________________________________

Telephone #: (______)__________________Relationship: _________________________________

Certification

I/We hereby certify that I/We do/will not maintain a separate subsidized rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management’s selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge, and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All Adult applicants, 18 or older must sign application.

I hereby acknowledge that false information given in this Rental Application may constitute grounds for rejection of this application and termination of your lease.

I hereby acknowledge that incomplete Rental Applications will be rejected.

I authorize listed references, including employers and financial institutions, to release information to Lessor (Landlord).

I, the undersigned Applicant(s), have read and agree to all provisions of this Rental Application.

Signature:	__________________________________________

Printed Name:	__________________________________________

Date:	___________________________________________

Signature:	__________________________________________

Printed Name:	__________________________________________

Date:	___________________________________________

colchester property management, LLC