Application Form – Country Valley Manufactured Home Community

COUNTRY VALLEY MOBILE HOME PARK RENTAL APPLICATION

FIRST NAMEyour full name

LAST NAMEyour full name

M.I.

SOCIAL SECURITY NUMBER

PREVIOUS NAME(S)

Emaila valid email

PHONE NUMBERa valid phone number

DATE OF BIRTHof appointment

DRIVER'S LICENSE NO.a valid license no.

STATE & EXPIRATION

ALT. PHONE NUMBER

PRESENT ADDRESSPRESENT ADDRESS

CITYcity

STATE

ZIP CODEZIP CODE

FROMFROM

TOTO

LANDLORD/MANAGER'S NAME

PHONE NUMBERPHONE NUMBER

RENT AMOUNTRENT AMOUNT

REASON FOR MOVING

PREVIOUS ADDRESSPREVIOUS ADDRESS

CITY

STATE

ZIP CODEZIP CODE

FROMFROM

TOTO

LANDLORD/MANAGER'S NAME

PHONE NUMBERPHONE NUMBER

RENT AMOUNTRENT AMOUNT

REASON FOR MOVINGREASON FOR MOVING

PREVIOUS ADDRESSPREVIOUS ADDRESS

CITYCITY

STATESTATE

ZIP CODEZIP CODE

FROMFROM

TOTO

LANDLORD/MANAGER'S NAMELANDLORD/MANAGER'S NAME

PHONE NUMBERPHONE NUMBER

RENT AMOUNTRENT AMOUNT

REASON FOR MOVING

NAME(S) OF CO-APPLICANT(S)your full name

NAME(S) OF DEPENDENT(S)

DO YOU HAVE PETS? IF YES, PLEASE DESCRIBE.more details

0 / 50

PRESENT EMPLOYERPRESENT EMPLOYER

POSTION

SUPERVISOR NAME & POSITION

PHONE NUMBERPHONE NUMBER

LENGTH OF EMPLOYMENTLENGTH OF EMPLOYMENTfull name

RATE OF PAY

FULL TIME/PART TIME

OTHER SOURCE(S) OF INCOMEmore details

0 / 50

BANK NAMEBANK NAME

TYPE(S) OF ACCOUNT(S) HELD

BANK NAMEBANK NAME

TYPE(S) OF ACCOUNT(S) HELD

AUTOMOBILE MAKE

MODEL

YEARYEAR

COLORCOLOR

LICENSE PLATE NO.LICENSE PLATE NO.

AUTOMOBILE MAKEyour full name

MODELMODEL

YEARYEAR

COLORCOLOR

LICENSE PLATE NO.LICENSE PLATE NO.

STATES AND COUNTIES YOU HAVE LIVED IN THE LAST 5 YEARS

	Yes	No
ARE YOU 18 OR OLDER?

	Yes	No
HAVE YOU EVER FILED FOR BANKRUPTCY?

	Yes	No
HAVE YOU EVER NOT FULFILLED A RENTAL AGREEMENT?

	Yes	No
HAVE YOU EVER WILLFULLY OR INTENTIONALLY REFUSED TO PAY RENT?

	Yes	No
HAVE YOU HAD ONE OR MORE LATE RENT PAYMENTS IN THE LAST YEAR?

	Yes	No
ARE YOU BEING OR HAVE YOU EVER BEEN EVICTED FROM A RENTAL UNIT?

	Yes	No
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR CRIME?

	Yes	No
ARE THERE ANY CLAIMS, SUITS OR JUDGEMENTS AGAINST YOU?

	Yes	No
DO YOU OR ANY HOUSEHOLD MEMBERS REQUIRE SPECIAL HOUSING NEEDS?

IF YOU ANSWERED YES TO ANY OF THESE QUESTIONS, PLEASE EXPLAIN HEREmore details

0 / 100

PERSONAL REFERENCEPERSONAL REFERENCE

RELATIONSHIPRELATIONSHIP

PHONE NUMBERPHONE NUMBER

PERSONAL REFERENCEPERSONAL REFERENCE

RELATIONSHIPRELATIONSHIP

PHONE NUMBERPHONE NUMBER

I,________________ , declare that the statements above are true and correct. I hereby authorize

the verification of references, previous tenancy and computerized credit checks. I understand that you will retain this application whether or not it is approved. This application is a legally binding agreement between the applicant and CVMHP LLC, pending approval. Both parties agree to the terms as stated above. A non-refundable application fee of $30.00 is required at the time this form is submitted.

Signature of ApplicantSignature of Applicant

DateDate

Rental Application Form