KEENSCROSSING.pdf


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RENTAL APPLICATION
PRIMARY APPLICANT
Full Name: HILLARY LIGHT

Phone #:

802-598-1781

LIGHT.HILLARY@GMAIL.COM
Alternate Phone: _________________________Email Address:________________________________________

Social Security #:
Occupation:

009-76-2210

Initial if over 18 years of age

REWRITE TECH II

ADDITIONAL APPLICANTS
ELAINE LIMANEK
2.
Telephone#: 802-238-0673
3.
Telephone#:
4.
Telephone#:

Gross Annual Income:

Email Address:

HL

$35,000

SS#: PLEASE CALL HER
ELAINE.LIMANEK@GMAIL.COM
SS#:

Email Address:
SS#:
Email Address:

Race (Optional): Please enter a number corresponding to each applicant’s race. (ie: two Asian applicants and
one White applicant would enter “2” in the Asian and “1” in White)
[ ] American Indian/Alaskan Native
[ ] Black African American
[ X ] White
[ ] American Indian/Alaskan and White
[ ] Asian
[ ] Asian and White
[ ] Hispanic Descent
[ ] Native Hawaiian/Other Pacific Islander
[ ] Black African American and White
PRIMARY APPLICANT INFORMATION
Present Address: 184 ELM STREET
MONTPELIER
City:
State: VT
9/2014-8/2016
Dates:
Monthly Payment: 1300.00
SARA
GUYETTE
Landlord/Lender:
Previous Address: LIVED WITH FATHER
PLAINFIELD
VT
City:
State:
Dates:
Monthly Payment:
Landlord/Lender:
ADDITIONAL APPLICANT INFORMATION
186 ELM STREET
#2’s Present Address:___
City: MONTPELIER
State: VT
Dates:
Monthly Payment:
Landlord/Lender:
#2’s Previous Address:
City:
State:
Dates:
Monthly Payment:
Landlord/Lender:
ADDITIONAL APPLICANT INFORMATION
#3’s Present Address:__
City:
State:
Dates:
Monthly Payment:
Landlord/Lender:
#3’s Previous Address:__
City:
State:
Dates:
Monthly Payment:
Landlord/Lender:

2
Apt. #:
05602
Zip Code:
RENT
/ OWN

Phone:

802-223-0439

Apt. #:
Zip Code:
RENT
/ OWN
Phone:

2
Apt. #:
05602
Zip Code:
RENT
/ OWN

Phone:
Apt. #:
Zip Code:
RENT
/ OWN
Phone:

Apt. #:
Zip Code:
RENT
/ OWN
Phone:
Apt. #:
Zip Code:
RENT
/ OWN
Phone: