Application For Luther House Apartment Template Page 6
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14Lutheran Senior Services of Southern Chester County (PA),
Inc.
Luther House II, Inc.
Luther House III, Inc.
Luther House IV, Inc.
APPLICATION FOR LUTHER HOUSE APARTMENT…Page 4 of 4
Will you have a pet? Yes_______ No______ If “Yes”, what type? ________________
Does your current dwelling have bedbugs? Yes_______ No______
**PLEASE NOTE: ONLY ONE (1) PET IS PERMITTED PER APARTMENT**
Person to Contact in Case of Emergency:
Name:____________________________________________________________
Address:__________________________________________________________
Telephone: ________________________________________________________
Present Landlord:
Name:__________________________________________________________
Address:________________________________________________________
Telephone:______________________________________________________
Previous Landlord:
Name:__________________________________________________________
Address:________________________________________________________
Telephone:______________________________________________________
------------------------------------------------------------------------------------------------------------
Two Character References (Not Relatives) and Addresses:
1._________________________________________________________________
2._________________________________________________________________
SIGNATURE:_______________________________________ DATE:____________
(Head of Household)
________________________________________ DATE:____________
(Second Occupant)
Revised 1/2013
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Parent category: Legal