CHOUTEAU HEIGHTS APTS/BLUE SPRINGS REALTY APPLICATION FOR OCCUPANCY

Application must be completely filled out.  Fee is $40/person, cash only.

Phone: 816.453.2414  E-mail: chouteauheights@gmail.com

Date:___________________                                        Desired date of occupancy:____________________

Do you have pets?_______ What kind?____________________________ Weight?______________________

Name:_______________________________________________________ SSN:________________________

        First                   Middle                Maiden                  Last

Date of Birth:_______________________ Check one:_____Married_____Single_____Divorced_____Separated

Spouse Name:_________________________________________________ SSN:________________________

                     First                   Middle                Maiden               Last

Spouse Date of Birth:_______________________

Number of people who will occupy:  Adults (over age 18):______Children (thru age 18):______

Child’s name:_______________________________________SSN:________________DOB:_______________

Child’s name:_______________________________________SSN:________________DOB:_______________

In case of emergency, notify:

_________________________________________________________________________________________

Name                                                Address                                        Phone number

PART I - RESIDENCE HISTORY

A. Present Address:_________________________________________________________________________

                        Address                                        City                        State                 Zip

Rent amount:___________From:__________To:__________Applicant Phone #:_________________________

Present Landlord:_____________________________Landlord Phone:_______________Fax:______________

B. Previous Address:________________________________________________________________________

                        Address                                        City                        State                 Zip

Rent amount:___________From:__________To:__________

Previous Landlord:____________________________Landlord Phone:_______________Fax:______________

C. Previous Address:________________________________________________________________________

                        Address                                        City                        State                 Zip

Rent amount:___________From:__________To:__________

Previous Landlord:_____________________________Landlord Phone:_______________Fax:______________

PART II - EMPLOYMENT

A. Employed by:______________________________________Phone #:______________Fax:_____________

Address:_______________________________________________Position or Dept:______________________

Dates of employment: From:______________To:_____________Income:_______________________________

B. Spouse Employed by:________________________________Phone #:______________Fax:_____________

Address:_______________________________________________Position or Dept:______________________

Dates of employment: From:______________To:_____________Income:_______________________________

C. Other Income/SSI/Disability:________________________________________________________________

Have you or your spouse ever been convicted, plead guilty to or been in jail for a crime?________Yes________No

Do you or your spouse have any pending criminal charges?__________Yes_________No

Number of cars:_____Driver’s Lic. No.:____________________Spouse DLN:_____________________State:___________

Make/Model:___________________________________________Color:_________Year:________Plate No.:___________

Make/Model:___________________________________________Color:_________Year:________Plate No.:___________

DISCLOSURE AND AUTHORIZATION (IMPORTANT - PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT) DISCLOSURE REGARDING BACKGROUND INVESTIGATION

CHOUTEAU HEIGHTS APARTMENTS/BLUE SPRINGS REALTY (Company) may obtain information about you from a consumer reporting agency for tenant screening purposes.  Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends or associates.  These references, credit history, professional licenses and credentials.  You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report.  Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for residency is an investigation into your education and/or employment history conducted by Datasource, Inc, 1200 NW South Outer Rd, Blue Springs, MO 64015, Phone: 816-228-5255, Fax: 816-224-9699, or another outside organization.  This Disclosure and Authorization allows the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if approved for residency, throughout the course of your tenancy to the extent permitted by law.  As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION (above) and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT (attached) and certify that I have read and understand both of those documents.  I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” at any time after receipt of this authorization and, if I am approved for residency throughout my tenancy.  To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Datasource, Inc, 1200 NW South Outer Rd, Blue Springs, MO 64015, Phone: 816-228-5255, Fax: 816-224-9699, another outside organization acting on behalf of the Company, and/or the Company itself.  I agree that a facsimile (fax), electronic or photographic copy of this Authorization shall be as valid as the original.  I understand that signing my name in the Name section below, and my Social Security Number in the SSN section above, that by doing so:

*I am authorizing Datasource, Inc to conduct the background check(s) described above.

*I am consenting to use of this completed form and have read and understand the above disclosure.

*I acknowledge I may request a hard copy of this Disclosure and Authorization form after agreeing to the background check.

A non-refundable processing charge of $40 cash per person will be retained by the Landlord.

___________________________________________________        _________________________________________________

Applicant Signature                                                Spouse Signature

CHOUTEAU HEIGHTS APARTMENTS

APPLICATION INFORMATION AND PROCESS

All applicants are thoroughly screened

Application fee: $40/person, CASH only

This includes:

*Credit

*Criminal

*Past rental history

*Must be on your job for at least 6 months

*Must make 2.5 times the rent

Applicants must have rental history that DOES NOT include family members.

We require a copy of:

*Your most recent paycheck stub

*Most recent bank statement

*Your driver's license

*Social security card

*Vehicle insurance card

*Paperwork from your veterinarian’s office stating your pets                                breed, weight, age, current on shots.

We will consider an application incomplete if I do not receive all the above.