North Dakota Tenant Rental Application

SE
C
TION
B •
INFORMATION
REGARDING
JOINT
APPLICA
NT
(SPOUSE
AND/OR
PA
RENT/GUARDIAN
ONL
Y )
Full Name:
---,,--
-.-
--
-
---
--:-::
::--,.,----
-
--
-
--
....,...,,...,-::-:---- Birthdate:
(last)
(First) (Middle)
Present Street Address
:-
--------
-
--
-
--
-
----
---------------
City:
_________
State:
__
_ Zip:
______
Telephone:
--
---
-
------
Reason for Leaving: Rent per month:$ Years There: _
_______
_ _
Soci
al
Security Number:
Dr
ivers License Number:
--
--------
-
Previous Street Address:
__
_
___
__
_ _
______
_ _ _ _ _ _ _ Years There :
______
_
City:
__
____
_
__
State:
__
_ Zip: Telephone:
--
----
------
Reason for Leaving: Rent per month:$
__
Landlord &
Telephone:-
-
----
---
Present Empl
oyer"""
:
___
____
______
_ Years
There"'":
___
____
Tele
ph
one.
"'":----
--
-
Position
or Title: Name
of
SupeNi
so
r:
___
_ _
____
______
_
Employer's Address:
__
_
__
_ _ _
______
_
________
_ _ _
____
____
_
Previous Employer:
__
_
_____
_
_____
_..;.
_______
___
Years There:.
___
_
__
_
Previous E
mp
loyer's Address:
___
_
________
_____
_ _
__
_ _ _
__
____
_ _ _
Present Net Income/Month: $
__
_
___
_ Number
of
H
ou
rs worked: - -
--
-'
' Week
__
____
,/
Month
Number
of
occupants that will be occupying the unit:
_____
__
_
NOTE
: Alimony, child support, or separate
ma
intenance income need not be revealed
if
you do not wish to have it considered
as a basis for paying this obligation.
Other income: $ per . Sources of other income:
-:-:---=:--:-:---:-
::-:-:-
-
--,.---
..,.-,-
-
Is any income listed
in
this section likely to
be
reduced
in
the next two years? 0 Yes 0 No If Yes, please explain:
Name of nearest relative not living with you:
____
______
_ _ _ _ Telephone:
__________
_
Relationshi
p:
_ _
__
_ _
____
__
_ .Address:
___
____
_
____
__
_____
__
_ _
Presen
t
Land
l
ord
1.
Pre
v
iou
s
Land
lord
2.
3.
4.
5.
Automobile Make, Model & Year:
Li
cense#:
________
State:
__
_
Are
you
the co-maker and/or guarantor
of
any loan or contract? 0 Yes 0 No If Yes, to whom
_________
_
Are there any unsatisfied judgments
or
liens against you? 0 Yes 0 No
If
Yes, to whom.
___
_
__
___
__
_
Other obligations- (i.e. liability to pay alimony, child support, separate maintenance) Use separate sheet if necessary:
ACKNOWLEGEMENT
AND
AGREEMENT
For purposes of renting, the undersigned acknowledges that they were informed of the rental criter
ia
which was established per
the addendum provided.
The undersigned represents that
all
of
the above statements are true and complete and hereby authorizes management, its
employees and agents to contact and obtain
in
formation from any individua ls
or
entities that may have information regarding
credit history, emp loyment and past residential arrangements
of
the undersigned . The undersigned hereby indemn ify a
nd
hold
management, its employees and agents and
all other individual
or
entities contracted
by
management harmless from all causes
of action, expenses, losses, damages
of
any ki
nd
arisi
ng
from
or
related to infor
ma
tion obtained regarding credit history, em-
ployment or pri
or
residential arrangements
of
the undersigned.
All persons will be treated
fai
rl
y and equally without regard to race, color, religion, sex, familial statu
s,
handicap, marital status,
status with respect
to
public assistance or national origin in compliance with the Fair Housi
ng
Act.
A
ppli
ca nt:
__
_
________
__
___
__
_
___
_
Date:
__
_
____
____
_
Co-Ap
pli
ca
nt
: _
____
______
_______
__
_
Date: _
______
__
___
_
NOAA
Re
nt
al
Application
Revised
11n00
1
Page 2/2
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North Dakota Tenant Rental Application PDF

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