Kentucky Rental Application Form

In the case of a lease agreement that is being signed between a landlord and a tenant in the State of Kentucky, the following form has to be completed and submitted.

Extracted Text for Proper Search

 2011 Woda   Management  & Real Estate, LLC .                                                                   Form  4  MI  Application/TC04/Rev. 09.11/Page 2 of  4 	
RENTAL APPLI CATION 	
I/We hereby offer to lease an apartment.  For your information in considering the offer, I/we present the following 
references, which Management may choose to investigate. Falsification of any information listed herein is cause 
for rejection of this  application and/or termination of the Lease Agreement.  
 Date Received: 	__________________________	   Time Received: 	_______________	   Desired Move- in Date: 	_____________________	 Rental Rate: $	__________________________	 	 Leasing Agent: 	_________________________________________________________________________________	   Unit Type/Address: 	_______________________________________________ 	 	
APPLICANT AND FAMILY INFORMATION   	
ANY QUESTIONS NOT APPLICABLE TO YOU PLEASE MARK “NA”. LEAVE NO BLANK LINES 	List all household members who will live in the apartment upon move -in or within the next twelve months.   	Be sure to include any temporarily absent family members (such as military/student family members who will be returning to th e household), 	
CHECK ONLY ONE (most current  status):	 	
Never Married 	      Married 	      Divorced 	     Separated 	      Widowed 	          Roommates (require separate applications)  	                              Planning or Current                   FULL LEGAL NAME                 RELATIONSHIP      DATE OF BIRTH       AGE                S S #                    Student    Full/Part	                                                                        \
                     	                                                                        \
                                                     	                                                                        \
                                                     	      	                                                                      	 	 1.     	_____________________________  _____Self _______   ________________  _______     _________________  Y  or N      F or P	 	   None 2. 	____________________________    _______________   ________________    _______     _________________  Y  or N      F or P 	  3.  	____________________________   _______________   ________________   ____\
___     _________________  Y  or N      F or P  	
 4. 	____________________________   _______________   ________________   _______  \
   _________________  Y  or N      F or P  	
 5. 	____________________________   _______________   ________________   ____\
___     _________________  Y  or N      F or P  	
 6. 	____________________________   _______________   ________________   ____\
___     _________________  Y  or N      F or P  	
 7. 	____________________________   _______________   ________________   ____\
___     _________________  Y  or N      F or P 	
 8. 	____________________________   _______________   ________________   ____\
___     _________________  Y  or N      F or P  	
 Of the household members listed above do you have legal custody if minor?  	 Yes  -or - 	 No If no, explain: ______________ ___________ 	 ________________________________________________________________________\
______________________________________________ _   Are you expecting any changes to your household size over the  next twelve months?    	 Yes  -or - 	 No If yes, explain: _______________ _ 	________________________________________________________________________\
_______________________________________________  Are there any temporarily absent family members, not listed above?   	 Yes  -or - 	 No If yes, explain: _______________________________ 	 Will a live -in care attendant be required in your household?    	 Yes  -or - 	 No I f yes , who: ________________________________________ 	 Are any foster children included above?  	 Yes  -or - 	 No     If yes, who: ________________________________________________________ 	 Of those listed above,  have they attended school full time in the past five months?   	 Yes  - or- 	 No  If Yes, Who  _ ______________ 	 Would any member of your household benefit from a special needs adaptable/equipped rental? 	 Yes  -or - 	 No    If yes, explain  need only :  	
________________________________________________________________________\
______________ 	 	
 	
EMPLOYMENT INFORMATION  	 Employer: _______________________________________________________________________\
 Phone: ___________________   
Address: _________________________________________ City: ______________________ State: _________ Zip: ___________  
Date Started: __________ Occupation:  _________________________________ Supervisor’s Name: _______________________  
Salary $______________  ( including overtime, commission and severance pay)  	 week 	 month 	 year 	 other 	_ ________ 	 Do you have a second job?  	 Yes  -or - 	 No If Yes, W here: _________________________ Salary $___________ per ________ 	 	 If employed less than 2 years:  Name, address and phone of previous employer __________________________________________ SPOUSE’S INFORMATION ONLY 	(CO -APPLICANT’S MUST COMPLETE SEPARAT E APPLICATION)	 	 Employer: ___________________________________________________________________ Phone: _______________________  Address: ________________________________________ City: ________________________ State: _________ Zip: __________  Date Started: _________ Occupation:  _______________________________ Supervisor’s Name: __________________________   Salary $______________ ( including overtime, commission and severance pay)	 week 	 month 	 year 	 other 	__________ 	 Do you have a second job?  	 Yes  -or - 	 No If Yes, W here: _______________________ Salary $___________ per __________  	
 
If employed less than 2 years:  Name, address and phone of pr evious employer __________________________________________

 2011 Woda   Management  & Real Estate, LLC .                                                                   Form  4  MI  Application/TC04/Rev. 09.11/Page 3 of  4 	
C REDIT REFERENCES & RESIDENCE HISTORY:  (List all monthly payments) 	
 Have you ever been evicted or refused to pay rent when due?   	 Yes   	 No  If Yes, why: ___________________________________________	 	 Have you ever filed for bankruptcy: 	 Yes  	 No   If Yes, When: __________ Type: _____________Why: _______________________________ 	 	                                                Discha rge date of bankruptcy: ____________________________ (Please supply a copy of the discharge)  	 Has anyone in household ever been convicted of  domestic violence, any sex or drug related convictions  or a felony?       	 Yes    	 No  	 Do you have any pets?  	 Yes   	 No Age: _______________ Breed: _______________________________ Weight: _____________________ 	 Will this address  serve as your primary residence?    	 Yes    	 No   If no, give details________________________________________________	 	Must have two full years of address history; use a new page attached to application if necessary	 	 Current Address: ______________________________________________________________________________________________    City: ___________________________________________________ State: ________________________________ Zip: _____________  	
 Rent -or - 	 Own your home 	 Live with Family   Month and year moved- in ______________ Monthly R ent/Mortgage:  $_________ 	 Reason for leaving:________________________________________________________________________\
______________________  Landlord/Mortgage Company: __________________________________________________ Phone:  (________) __________________  Address: _____________________________________________ City: ________________________ State: _____ Zip:______________ ================================================================================================ ==========  Previous Address: ________________________________________________________________________\
______________________  City:___________________________________________________ State:________________________________ Zip:_______________  	
 Rent -or - 	 Own your home 	 Live with Family      Monthly Rent/Mortgage:  $__________________ 	 Month and year of move- in ______________________________  Month and year of move- out _________________________________  Reason for leaving: _______________________________________________________________________\
_______________________  Landlord/Mortgage Company: __________________________________________________ Phone:  (________) ___________________   Address: ______________________________________________ City: _____________________ State: ________ Zip:_____________ ==========================================================================================================  Previous Address:______________________________________________________________________________________________  City: _____________________________________________________ State: _____________________________ Zip: ______________   	
 Rent  -or - 	 Own your home 	 Live  with Family     Monthly Rent/Mortgage:  $_________________ 	 Month and year of move- in ______________________________  Month and year of move- out _________________________________   Reason for leaving: _____________________________________________________________________________________________   Landlord/Mortgage Company: __________________________________________________ Phone:  (________) __________________   Address: ______________________________________________ City: _____________________ State: ________ Zip: ____________  	
OTHER INFORMATION	 	
 Vehicles:    Year __________ Make ____________ Model  ______________ Color ______________ License # _____________ State ____            	  Year __________ Make ____________ Model  ______________ Color ______________ Li cense # _____________ State ____ 	ONLY VEHICLES LISTED ABOVE ARE PERMITTED.  All vehicles must be registered to the name of an approved occupant on this applic ation. The following Race and Ethnicity Data is Optional:    Race:   __ Hispanic/Latino  __ Non-Hispanic /Latino         __ Male     __ Female                                     __American Indian/Alaksa Native   __ Asian  __ Black/African American  __ Native Hawaiian/Other Pacific Islander    __White       	 	 Current Home Phone: (_______)______________________________ Current Work Phone: (_______)____________________________  Other Phone or Pager: (_______)_____________________________ E -Mail Address: _________________________________________  EMERGENCY CONTACT: List closest relative not living with you,  whom we may contact in case of emergency:    Name: ________________________________________ Relationship: ___________________ Telephone: (_______)________________  Address:________________________________________________________________________\
________________________________

 2011 Woda   Management  & Real Estate, LLC .                                                                   Form  4  MI  Application/TC04/Rev. 09.11/Page 4 of  4 
    I/W e hereby apply to the above named community for an apartment on substantially the terms set forth herein and agree 
that rent is payable on the first day of each month in advance.  I/W e warrant to Ownership and Management of the  property 
that all statements contained herein are true and correct.    I/W e have been advised, understand and agree that residency at 
this community entails certain income guidelines and that residency is subject to rental qualifications.  I/W e understand  and 
agree that deliberately submitting false information or withholding information constitutes fraud.  Federal Law specifies 
fines up to $10,000 and imprisonment for terms of up to five years and is grounds for eviction if any information 
falsification o ccurs.  
   
   
  I/We hereby offer $___________ as a non -refundable application fee.  If I/we do not meet any of the  Resident Qualifying 
Standards, my application will be rejected and my/our application fee WILL NOT  be refunded ( under any circumstance).     
 
     I/W e hereby waive any claim to damages by reason of non- acceptance. Upon acceptance of this application, my security 
deposit shall be due in full.  W hen so approved and accepted, I/we understand and agree to pay the full security deposit 
within five d ays,  unless otherwise agreed .  The full deposit is $_______________.   I/W e agree to execute a Lease 
Agreement before possession is delivered and to pay the balance of any other deposits and other move- in costs in the form 
of a check or money order.  NO CASH  WILL BE ACCEPTED.   I/W e understand that if I/we withdraw this application within 
72 hours of applying, the security deposit will be returned to me/us.  If the notice of cancellation is received after the 72 
hours, the security will be forfeited.  	
 
ONCE APP ROVED, IF I FAIL TO TAKE POSSESSION OF THE PREMISES FOR ANY REASON,  
I/WE UNDERSTAND THAT MY FULL SECURITY DEPOSIT WILL BE FORFEITED.  	
 
    If Management cannot have an apartment for me/us by the desired move-in date listed on page 1 of this application, 
whe ther it is not ready for occupancy or because another resident holds over or for any other reason, Management and 
Ownership are not liable to me/us for damages.  I/W e will not be required to pay any rent until the apartment is available.  If 
Management is not able to deliver possession to me/us within thirty days of projected date, I/we may cancel the lease 
without further obligation and my/our security deposit will be refunded within thirty days.  
 
     I/W e agree:  (a) to be bound by and comply with the Lease and all addenda; (b) that The Community will retain this 
application whether or not it is approved; (c) that everything stated on this application is true to the best of my/ our 
knowledge; and (d) That I grant The Community authority to check my/our cr edit, employment, rental and criminal history, to 
secure follow up credit reports and employment verifications, and to answer questions about its credit experience with 
me/us.  If rejection of my/our application occurs for the rental of an apartment with t he above Community, I/we hereby 
authorize you to share information with any community affiliated with management or the ownership of this community for 
purposes related to rental of an apartment or residency of any type.   	
 	
RESIDENT RELEASE AND CONSENT  	
       I/W e, the undersigned hereby authorize all persons or companies in the categories listed below to release without 
liability, information regarding employment, income, credit history, criminal history and/or assets to the above named 
community, its owners and agents for purposes of verifying information on my/our apartment rental application.  
        I/W e understand that previous or current information regarding me/us may be needed.  Verifications and inquiries that 
may be requested include, but are not limited to:  personal identity; employment, income, and assets; medical and child care 
allowances, criminal background checks, previous rental history, and credit history.  I/W e understand that this authorization 
cannot be used to obtain any information about me/us that is not pertinent to my eligibility for and continued participation as 
a Qualified Resident.  Credit reports may be accessed during and/or after occupancy for the purpose of collections.  
The groups or individuals that may be asked to release t he above information includes, but are not limited to: 
Past & Present Employers	 	W elfare Agencies	 	Veterans Administration	 	
Current 	& Previous Landlords 	 	
Support and Alimony Providers 
Public Housing Agencies  
State & Local Law Enforcement	 	
State Unemployment A	gencies	 	
Social Security Administration 
Utilities Companies 
All	 Law Enforcement	 Agencies	 	
Retirement Systems	 	
Banks or Financial Institutes.  
W eb Site (access granted)  
Credit Bureaus	 	
      I/W e agree that a photocopy of this authorization may be used for the purposes stated above.  The original of this 
authorization is on file and will stay in effect for a year and one month from the date signed.  I/W e understand I/W e have a 
right to review this file and correct any information that is incorrect.  
SIGNATURES  
 
_ ______________________________________         ___________________________________       ________ _ 
Applicant               (Printed Name)                Date   
 
_______________________________________        _________________________\
__________       _________ 
Spo use                            (Printed Name)              Date