01/20/11

I, David G. Doe am renting a room to Carl Wiglus. Rent for remainder of January is
$92.00. Monthly rent thereafter is $275.00 per month. Due on the 1 st of each month
beginning 02/01/11. Due at signing is $92.00 and security deposit of $275.00
Monthly rent for 6 months, $275.00 per month. Includes utilities, basic cable and
internet services.
Name: _______________________________________________
Social Security _________________________________________
Contact#: _____________________________________________
Relative name & contact# for emergency purposes:

Date: ______________________
Signature: _____________________________________
Signature of home owner:
______________________________________________