RAFAEL TOWN CENTER
APARTMENTS
1050 COURT STREET
SAN RAFAEL, CA 94901
(415) 482-9998
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APPLICATION
FOR OCCUPANCY
To the applicant:: Please fill out this form completely. All references will be checked and if any
information found to be false or incomplete, the application may be rejected. Use additional pages if more space is needed. There is a non-refundable $30.00 PER
APPLICANT (PERSONS OVER 18) application fee.
Application fee is required at the time of turning application in.
1.
PART 1 APPLICANT INFORMATION
APPLICANT (1)
Social Security Number
______-_____-______
______________________ __________ _____________________
First Name M.I. Last Name
APPLICANT (2)
Social Security Number
______-_____-______
______________________ __________ _____________________
First Name M.I. Last Name
2.
Present Address and Telephone Number :
APPLICANT (1)
________________________________________________
Address
________________________________________________
City State Zip Code
________________________________________________
Telephone No. (work) Telephone No. (home)
How long have you lived at your present address:
________________________
Mailing address, if
different:___________________________________________
Present
Address and Telephone Number :
APPLICANT (2)
________________________________________________
Address
________________________________________________
City State Zip Code
________________________________________________
Telephone No. (work) Telephone No. (home)
How long have you lived at your present address:
________________________
Mailing address, if
different:___________________________________________
3.
Household Members
List below all the persons who are applying to live in the unit. If any household member has a handicap,
please indicate in the last column.
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Name
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Relationship to Applicant
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Sex
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Date of Birth *
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Age
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Handicap
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1.
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2.
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3.
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4.
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* OPTIONAL
4.
Special Needs, If Any:
[ ] Elderly (Over
60)
[ ] Handicap
(specify): ________________________________________________
Part 2 HOUSEHOLD INCOME, ASSETS, AND SUBSIDIES EXHIBIT ‘A’ MUST BE
COMPLETED BY AFFORDABLE APPLICANT
5.
INCOME: List below income received from all sources
by all members of the household, except minors (a member of the household other
than the family head or spouse, who is under 18 or is a full-time students and
lives at home.) Sources may include
employment, social security, aid to families with dependent children, alimony
and child support, pensions, interest and dividends, and unemployment
benefits. Show amount on an annual
basis. Use additional paper if
necessary.
INCOME SOURCES:
Applicant (1)
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Employers
Name & Address:
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Annual
Amount
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Phone Number
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Contact
Person(s)
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Employers
Name & Address:
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Annual
Amount
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Phone Number
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Contact
Person(s)
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INCOME SOURCES:
Applicant (2)
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Employers
Name & Address:
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Annual
Amount
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Phone Number
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Contact
Person(s)
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Employers
Name & Address:
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Annual
Amount
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Phone Number
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Contact
Person(s)
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Applicant 1
and 2
GRAND TOTAL:
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Household
Member #
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Income Source(s)
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Annual
Amount
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TOTAL:
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6.
ASSETS: List below all net household
assets in excess of $5,000 for all members of the household, except minors.
(Income from assets under $5,000 should be reported in section 5 of
application.) Assets mean the value of
equity in real property other than investment.
Do not include Automobile or Furniture.
Briefly describe the assets and show the total estimated value. Use additional paper if necessary.
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Household
Member #
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Description
of Assets
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Value
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TOTAL:
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7.
Do
you have a Section 8 Certificate or other Rental Subsidy?
[
] Yes [ ] No
If yes, please explain:
_______________________________________________________
PART 3 – REFERENCES: Please lest previous landlords for the last
five years. If you do not have previous
landlord reference, use this space to provide two other references and indicate
their relationship to you. Also provide
information about any prior evictions.
8.
PREVIOUS
LANDLORDS
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From: To:
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Name
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Rental Period
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Address
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City
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State
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Zip Code
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$
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Telephone
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Rent paid per month
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From: To:
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Name
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Rental Period
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Address
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City
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State
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Zip Code
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$
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Telephone
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Rent paid per month
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9. Prior
Eviction: Have you ever been evicted
from a residence [ ] Yes [ ]
No
If yes, when?
________________________________ and why? ______________________
PART 4: CERTIFICATION
To the best of my/our knowledge and belief, I/we hereby certify that
the foregoing information is true, complete and correct. Inquiries may be made to verify the
statements herein. I/We also understand
that false statements or omissions are grounds for disqualifications. I/We
authorize you to request a credit review as port of our application.
Applicant (1): __________________________ Date____________________
Applicant (2): __________________________ Date ___________________
