Rental Application Form And Applicant/resident Release And Consent Form printable pdf download

Coastal Properties of Va. Inc.

RENTAL APPLICATION

NOTE: Co-applicants must complete a separate application form. PLEASE PRINT

Marital Status:

___Single

___Married

___Divorced ___Widowed ___Separated

Email address:

Part time student

Applicant:

___________________________________

______________________

________________

____________________

Full time student

Full Name

Social Security

Birth Date

Phone #

Not a student

Co-Applicant:

___________________________________

______________________

________________

____________________

Part time student

Full Name

Social Security

Birth Date

Phone #

Full time student

Not a student

Other Occupants:

Part time student

Full time student

(1)____________________________________

_____________________

__________________________

Not a student

Name

Birth Date

Social Security

Relationship

Part time student

Full time student

(1)____________________________________

_____________________

__________________________

Not a student

Name

Birth Date

Social Security

Relationship

Part time student

Full time student

(1)____________________________________

_____________________

__________________________

Not a student

Name

Birth Date

Social Security

Relationship

Part time student

Full time student

(1)____________________________________

_____________________

__________________________

Not a student

Name

Birth Date

Social Security

Relationship

Are any changes in household composition anticipated in the next 12 months?

( ) Yes

( ) No

If yes, please explain:______________________________________________________________________________________________________

STUDENT STATUS:

Are all of the residents full-time students?

( ) Yes

( ) No

IF YES:

is the household comprised of a single parent and child, neither of whom is dependent on a third party?

( ) Yes

( ) No

IF YES: are Applicant & Co-Applicant married and file a joint tax return?

( ) Yes

( ) No

IF YES:

does the household receive AFDC or TANF?

( ) Yes

( ) No

IF YES:

is head of household in federal or state job training program?

( ) Yes

( ) No

HOUSING HISTORY:

Current

Address:

Street Name

Apt. #

Payment

Date From

Date To

Amount

Landlord's Name/Phone #:

City

State

Zip Code(required)

County

Landlord's Address:

Reason for Moving:

Address:

Street Name

Apt. #

Payment

Date From

Date To

Amount

Landlord's Name/Phone #:

City

State

Zip Code(required)

County

Landlord's Address:

Reason for Moving:

OTHER INFORMATION

Driver's License #:

State:

Expires:

Vehicle Model:

Year:

Color:

License Plate #:

HAVE YOU EVER:

Filed for Bankruptcy? - - - - - - - - - - - - - - - -

( ) Yes ( )No

Been evicted from Tenancy? - - - - - - - - - -

( ) Yes ( )No

Been convicted of a Felony? - - - - - - - - - -

( ) Yes ( )No

WILL YOU BE BRINGING A PET? ( )Yes

( )No

If Yes, what type?

HOW DID YOU HEAR ABOUT US?

Nearest Living Relative:

Name

Phone

Relationship

Address

CPOVA 2012 Revised

Tax Credit Form #10

Rental Application Form And Applicant/resident Release And Consent Form

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