CAMBRIDGE PREMIER REALTY RENTAL APPLICATION Date: 14, Property Address_ X32 e_ Wi VA Applicant Full Name_(Wawelle Pare Co-Applicant Full Name Nophuo Pave Current Address_QB_ Cold Sorina Lae Current Address, a vifidd CT 06074 Svéffeld CT 06678 Phone Numbers (al) M13 S7S_9a%4 Phone Numbers (all)_ BGO 61 _3\35 Email tnichel\e, pere® & copn.com emai; Sbhrole45 @ amat\.com Sociat See. 373-15 -HN8F pow 8 /8O/N961 — sociat Soo.#OUS-41-7208 008.6 /aa /1aas Driv. Licenso Stato and # Cl_ 086333733 Rent or own? Rent Howtong?, Current monthly vent:_ IRonting, Name/Phone # of Landlord, ct Rent or owne Rent How tong?, Driv. License State and # Current monthly rent; If Renting, Namo/Phone # of Landlord If At Current Location Less than 3 Yr, Please list all Within Last 3 years and Include landlord contact info: N/A IFAt Current Location Less than 3 Yrs, Please list all Within Last 3 years Include landlord contact info: N/A Part Time Student Unemployed Retired Present or Most Recent Employer SCAPA Nats Ayadien ‘Address and Phone Number. Great Pond fr Whdroe, CT 06045 360 96a 8238 supervisor Matt Kevsseay Pay Rate Position Serr Royer Dato of tie | ACOH ‘Any other Income (alimony, child support, dieabilty, ete, Husband, If Student, List School:_M/A_ Bank Used For checking Bank & A prec! con Employment Status (cirele ono): Full Time Unemployed Retired Present or Most Recent Employer__S)x Fla. Aatdross and Phone Number [2% Klela_ Sheet Aojauam MA OlOOL 412-786-9300 Supervisor Arista @eveno pay rate $4.50 /he Position Performer pate ot ire Sune QOVD ‘Any othor Income (alimony, child support, dlsabity, oe Ervelonce Audio Enaineer, Work Studia W student, st Senoot: Shenandooln University, Bank Used For Checking_Webster Rote. Applicant{s) Initials se StHave you hiad any judgments, foreclosures, collections, Bankruptcies Or Othor Credit Issues ip the Last § years? 1 So, Ploase List Any Info You Ca Have you had any judgments, foreclosures, collections, Bankruptcies Or Other Credit Issues in the Last yaars? If S0, Please List Any Info You Can: Please List Name, Birthdate and Relation to Applicant for Al Other Occupants of Home: Sosnua fase - 6/22/45- Sen Ploase List Name, Birthdate and Relation to Applicant for All Other Occupants of Home: Galen Claris - | [\1 AS = Friend [Cot\eagve Galen Clack — LIN/AS= Sona Colteane Tyrer Aitstatt- 5/4/45 - Frerd [olleagre Tylee_Attstatt - 5/41/95 ~ Sons Galleagve, Have you ever been convicted of any crime? Include any misdemeanors ineluding DUI, Have you ever boon convicted af any crimo? Include any misdemeanors including DUI: Typo, Brood and Size of Any Pots:_N /A CNot_0 covpant) Nama/Phone# of Closet Relative Not Living With You NVA (Not 0 eeu pant’ Year, take and Model of ail Vohictos: AJ /A Not Cceopant ‘Tho Undersigned Party Hereby Warranties That All Information Listed Above Is True and Correet To the Best of His/Her Knowedge. Any Atlompt To Hide, Cover Up or Falsify Any Information Shall Result in the Permanent Disqualification of This Applicant For Any Property Owned or Managed by Cambridge Premior Realty. Al information wil be verified, and in signing below you uundorstand and agree to verification ofthis information through the use of background, credit, eriminal and ‘employment checks. A credit check will appear on your ‘consumer credit report as an inquiry. This information vill be used to determine your suitability as a tonant and othe used or shared for any other purpose. This information search shall gonorate a charge of $38.00 per applicant, and shall be payable in cash oF cortfieg funds. This application will be made a permanent part of any lease agreement executed on a Cambridge property. Wihs Applicant Date. do hereby authorize ‘Type, Breed and Size of Any Pots:_N/A NameiPhone # of Closest Relative Not Living With You: MMone\\e Sarg 413-575-0394 ‘Year, Make and Model of Al Vehicles: 200% Ford Explorer ‘The Undersigned Party Hereby Warranties That All Information Listed Above is True and Correct To the Best of HisiHer Knowledge. Any Attompt To Hide, Cover Up oF Falsify Any Information Shall Result in the Permanent Disqualification of This Applicant For Any Property ‘Owned or Managed by Cambridge Premier Realty, Al information will be verified, and In signing below you understand and agree to verification of this information through the use of background, credit, criminal and ‘employment checks. A credit check will appoar on your ‘consumer credit report as an inquiry. This information Will be used to detormine your suitability asa tenant and will not be used or shared for any other purpose. This information search shall generate a charge of $36.00 per applicant, and shall be payable in cash or certified funds. ‘This application will be made a permanont part of any lease agreement executed on a Cambridge property. THs == Date 1 Soshva Por’ do hereby authorize‘Cambridge Premier Realty to conduct a thorough background check including rental and employment history. In signing befow I do hereby authorize my employers and landlords, including past and present, to disclose any and all information that may assist Cambridge Premier Realty in making a decision ‘bout my suitability as a tenant. ‘Additionally, | do/clo not (circle one) wish for this info to be shared with the owner of the property If necessary. Wis : Rppiicant ate In signing below I do recognize and understand that Cambridge Premier Realty Is representing the over of the property and NOT the applicant or potential tenant. Cambridge will assist and guice you in the application and tenancy period, but shall not at any time act a3 an agent or ropresontative for you without the written consont of all partlos to any lease agreement. Cambridge will at all times conduct themselves in a fair and ethical manner and endeavor to assure you of safe and oquital This pplicant Bate Cambridge Premior Realty to conduct a thorough background check including rental and employment history. In signing below I do hereby authorize my employers and landlords, including past and present, o disclose any and all information that may assist Cambridge Premier Realty in making a decision ‘about my suitability as a tonant. Additionally, | do/do not (circle one) wish for this info to bo shared with the owner of the property f necessary. ze In signing belove | do recognize and understand that Cambridge Premier Really Is represonting tho owner of the property and NOT the applicant or potential tenant. Cambridge will assist and guide you in the application and tenancy period, but shall not at any time act as an agent or representative for you without the writen consent ofall parties fo any lease agreement. Cambridge will at all ‘times conduct themselves in a fair and ethical manner and endeavor to assure you of safe and equitable housing, THAS Date Ou Ge-Applicant Date *35.00 application fee due for ALL APPLICANTS at time of submission. Funds must be paid in cash or by certified funds. Application will NOT be considered without this fee (No Checks). “Application MUST be complete - any incomplete answers could disqualify this application. If you have any questions, please contact our office at (540) 662-2300. CAMBRIDGE PREMIER REALTY 2509 Valley Ave Winchester, VA 22601 (540) 662-2300 FAX (540) 722-2225CAMBRIDGE PREMIER REALTY COLLECTION NOTICE By signing below, I/We the undersigned hereby agree that in the event that payment is not received (as defined by the terms of any Cambridge Premier Realty Landlord/Tenant lease contract entered into), I/We the undersigned shall be responsible for any costs incurred by Cambridge Premier Realty in their effort to collect any amount past duc incurred in the services rendered by Cambridge Premier Realty including but not limited to; court costs, attomey fees, and any fees generated by subcontracting our right to collection to a collection company. AND FURTHER, by signing below, /We understand this notice becomes a part of my/our contract with Cambridge Premier Realty and thereby agree to its provisions. Date 7/1/15 Michelle Rare. Customer Name (printed) Customer Signature Deshwo Rye Customer Name (printed) Ciistomer Signature