Application for Occupancy s2

WALL STREET TOWER

555 Canal St., Manchester, NH 03101

APPLICATION FOR OCCUPANCY

This information is to be filled out by the Head of Household. Please complete all sections and sign the bottom of same where indicated.

NAME: ______

STREET ADDRESS: ______

CITY: ______STATE: ______ZIP CODE: ______

HOME PHONE: ( ) ______WORK PHONE: ( ) ______

I would like to be contacted at: ______Work ______Home ______Either

PRESENT LANDLORD: ______PHONE #: ( )______

LANDLORD’S ADDRESS: ______

Monthly Rent: $______Apt. Size: ____ How long have you lived here? ____ yrs. ____ mos.

Reason for Moving: ______

If you have lived at your current address less than 3 years, please fill in the following:

Previous Address: ______

Name of Previous Landlord: ______

Phone No: ( ) ______

Address of Previous Landlord: ______

Reason for Moving: ______

List all persons, including yourself, who will occupy the apartment:

Full Name Relationship Soc. Sec.# Birth Date Sex

1. ______(Head)______

2. ______

3. ______

4. ______

5. ______

Names of those attending school: ______

______

List all full and/or part-time employment for all household members:

Occupation Name & Address Length of Gross Earnings

Name and/or Title of Employer Employment Before Taxes

1. ______$______per___

______

2. ______$______per___

______

3. ______$______per___

______

Other sources of Income, for example: Social Security, SSI, Interest, Alimony, Child Support, Annuities, Dividends, Income from Rental Property, Armed Forces, Reserves, Scholarships, and/or Grants.

Name Type of Income Amount

1. ______$______per____

2. ______$______per____

3. ______$______per____

4. ______$______per____

ASSETS – Complete each category as applicable:

Checking Acct. Bank Account # Balance

1. ______$______

2. ______$______

PASSBOOK SAVINGS/MONEY MARKET ACCOUNT:

1. ______$______

2. ______$______

STOCKS AND BONDS – VALUE: SAVINGS BONDS – VALUE:

$ ______$ ______

Do you NOW own real estate? _____ YES _____ NO

If “YES”, what is the value? ______

Have you EVER owned real estate? _____ YES _____ NO

If “YES”, when? ______

I AUTHORIZE THE MANAGEMENT COMPANY TO CONDUCT A CREDIT, LANDLORD AND ANY OTHER VERIFICATION NECESSARY IN ORDER TO QUALIFY ME FOR TENANCY AT ______.

I UNDERSTAND THAT MY DEPOST OF $______CONSISTS OF THE FOLLOWING:

$______IS A NON-REFUNDABLE CREDIT CHECK AND $______WILL BE USED TOWARD THE FIRST MONTH’S RENT, IF APPROVED, AND WILL BE REFUNDED IF REJECTED. I UNDERSTAND THAT THE $______WILL BE FORFEITED IF I CANCEL AFTER THREE (3) DAYS OF THE DATE OF THIS APPLICATION.

I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

The heating system at Wall Street Tower is a gas heat pump system. It is a forced hot water system. Wall Street Tower is responsible for the gas required to heat the hot water and for the water itself. The heat and air conditioner require an electric compressor to operate the fan. The fan and compressor must operate when using the heat or air conditioning. The usage of the compressor will appear on your electric bill. To determine average monthly electricity rates for your apartment, contact Public Service of New Hampshire. ______( initial this paragraph)

The following information is required for STATISTICAL PURPOSES ONLY: Please check the one group which identifies the HEAD OF HOUSEHOLD: White (Non-Hispanic Origin) _____,

Black (Non-Hispanic Origin) ______, Hispanic ______, American Indian ______, Alaskan Native ______, Asian or Pacific Islander ______.

Make Year/Color License Plate #

Automobile: 1. ______

2. ______

I would like to move in by: ______

This date must be approved and confirmed by the Site Manager.

This office will not accept cash for any reason.

______(Signature of Applicant) Date: ______

______

Management’s Signature Date

In case of an Emergency contact: Name: ______

Address: ______

Phone No.: ______

#IR-197 (07/09)

AN EQUAL HOUSING OPPORTUNITY