Kilmer Homes – Rental Application
APPLICATIONS MUST BE RETURNED, BY MAIL ONLY, NO LATER THAN JANUARY 5, 2015 TO:
THE ALPERT GROUP, LLC
ONE PARKER PLAZA
FORT LEE, NJ 07024
Applicant Name: __________________________________________________________________________________________
Last
First
middle initial
Social Security #_____________________________ Date of Birth: _________________ Full time student YES ____ or NO_____
Co-Applicant Name: _______________________________________________________________________________________
Last
First
middle initial
Social Security #_____________________________ Date of Birth: _________________ Full time student YES ____ or NO_____
Other Occupants – Full Names
Date of Birth Social Security #
Relationship to Applicant Student Status
Full, Part or N/A
Do you anticipate any change in household composition within the next 12 months? ___________________
Current Address: _______________________________________________________________________________________
street
apt#
___________________________________
Home Phone #
city
state
_______________________________
Work Phone #
Date: from______________ to _______________ Monthly Rent $__________________
zip
__________________________
Cell Phone #
Monthly Utilities $_______________
Does any member in your household have a disability that requires an accessible unit? ________ Do they require a live-in Aide? ____
Has any member in your household served at least one day of active duty in the US Military? _________
Was your housing impacted by Superstorm Sandy? ________ Have you registered with FEMA? ________
If not, do you have other evidence of displacement? __________
Present Landlord/Mortgage Co: _______________________________________________________________________________
Name
______________________________________________________________________________
street
city
_____________________________________
Landlords phone #
state
zip
Do you own or Rent? ________ ______
Reason for moving?_________________________________________________________________________________________
Previous Address: (Complete only if you have lived at your present address less than one year)
__________________________________________________________________________________________
street
apt#
city
state
zip
SECTION 8 APPLICANTS PLEASE COMPLETE THIS SECTION & PROVIDE A COPY OF YOUR VOUCHER
Housing Authority you receive assistance from: ___________________________________________________________________
Name & phone number of your caseworker: _____________________________________________________________________
Have you been released to move to a new apartment? _____________ Number of bedrooms your voucher is for ( 1 or 2) _______
INCOME INFORMATION: list all full time, part time, seasonal and self-employment of all household members and the anticipated
income from each source of employment during the next 12-month period
Name of household member Name & Address
Position & Supervisors
Monthly Gross Date of hire
Of employer
Name & Phone #
Income
Do you anticipate a change in income within the next 12 months? ____________ If so what?_____________________________
ASSET INFORMATION: list all bank accounts including checking, savings, credit union, certificate of deposits, pension, annuities,
401(k), IRA stocks, bonds, money market, equity in real estate, life insurance policies etc for all household members.
Type of Account
Account Number
Bank Name
Address
Have you disposed of any Assets for less than fair market value in the last two years ? YES _________
NO _____________
TOTAL ANTICIPATED GROSS INCOME THROUGH THE NEXT 12 MONTHS
Applicant Annual Salary (including Tips, Fees, Bonuses & Commissions)
$__________________
Co-Applicant Annual Salary (including Tips, Fees, Bonuses & Commissions)
$__________________
Annual Anticipated Income from Assets
$__________________
OTHER ADDITIONAL INCOME: (provide monthly amount for all items that apply)
$____________ Child Support
$____________ Alimony
$____________ Student Financial Aid
$____________ Social Security
$____________ SSI/Disability
$____________ Self Employment
$____________ Public Assistance
$____________ AFDC
$____________ VA or RR
$____________ Unemployment
$____________ Pension/Annuity
$____________ Recurring Gift
$____________ Other_____________________________
Total Additional income
$__________________
VEHICLE INFORMATION:
Year: ___________________
Make: _________________
Model:______________ Color:_______________
License # and State: _______________________________________ Registered to:
______________________________
Note: Management provides only 1 parking space per apartment. No commercial vehicles allowed
EMERGENCY CONTACT:
Name:__________________________________________________________________
Address:______________________________________________________________________________________________
Phone #:____________________________________ Relationship: ____________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES ____________ NO ________________________
If yes, please explain: ___________________________________________________________________________________
_____________________________________________________________________________________________________
DO YOU OWN ANY PETS? YES ___________
NO ___________________
If yes, what kind?____________________________________________________
STATEMENTS BY ALL ADULT HOUSEHOLD MEMBERS
1.
We certify that all information given in this application and any addenda thereto is true, complete and accurate. We understand that if
any of this information is false, misleading or incomplete, management may decline our application or, if move-in has occurred,
terminate our rental agreement.
2.
We authorize Kilmer Homes to make any and all inquiries to verify this information, either directly or through information exchanged now
or later with rental and credit screening services, and to contact previous and current landlords or other sources for credit and
verification confirmation which may be released to appropriate Federal, State or local agencies.
3.
If our application is approved, and move-in occurs, we certify that only those persons listed in this application will occupy the apartment,
that they will maintain no other place if residence, and that there are no other persons for whom we have, or expect to have,
responsibility to provide housing.
4.
We have been notified that the Resident Selection Criteria is posted in the management office.
5.
We understand that if this application is place on a Waiting List, we may request sample copies of the rental agreement and house
rules. If this application is approved, and move-in occurs, we certify that we will accept and comply with all conditions of occupancy as
set forth therein, including specifically all conditions regarding pets, rent, damages and Security Deposits.
6.
We authorize management to obtain one or more “consumer reports” as defined in the Fair Credit Reporting Act, 15 U.S.C. Section
1681a(d), seeking information on our credit worthiness, credit standing, credit capacity, general reputation, personal characteristic, or
mode of living.
7.
We hereby authorize verification of any and all information set forth on this application including release of information by any employer
(present & former), any bank or savings and loan and any lender, and hereby waive all right of action for any consequence resulting
from such information.
FAIR CREDIT REPORTING ACT
This is to inform you that as part of our procedure for processing your application, an investigative report may be made whereby information
is obtained through personal interviews with third parties - such as family members, business associates, financial sources, friends,
neighbors or other who are aquatinted with you. This inquiry includes information as to you character, general reputation, personal
characteristics, mode of living, income and credit background and also police records. Please be advised all such information herein and
released as authorized will be kept confidential. We do not discriminate on the basis of Race, Religion, National Origin, Color, Creed, Age,
Sex, Handicap or Familial Status.
I/WE HAVE READ AND UNDERTAND THE ABOVE
____________________________________________________________
Applicant Signature
______________________
Date
____________________________________________________________
Co-Applicant Signature
______________________
Date