Fillable Printable Mississippi Standard Rental Application
Fillable Printable Mississippi Standard Rental Application
Mississippi Standard Rental Application
RENTAL APPLICATION
(NOTICE:
CO-APPLICANT
MUST
FILL
OUT
A
SEPARATE
APPLICATION)
Non-
Refundable
Application
Fee
of,.::t::$
__
must
be
included
with
this
Application.
PLEASE
TELL
US
ABOUT
YOURSELF:
Full
Name
--------------------------------------------------
Social Security
Number
___________________
Date
of
Birth
____
_
Spouse'sFullN~e
__________________________________________
__
Spouse's Social Security
Number
______________
Date
of
Birth
____
_
Phone Email
---------------------------
RENTAL
HISTORY
(For
the
past
2 years, beginning with
most
current)
Current address
----------------------------------------------
Owned-
Rented-
Other
How
Long? From:
___________
To:
__________
_
Landlord/1vlanager Name
___________________
Phone
______________
_
Previous Address
---------------------------------------------
Owned-
Rented-
Other
Ho\v Long? From:
_____
To:
____________
_
Landlord/Manager
N~e
Phone
______________
_
EMPLOYMENT INFORMATION
Employment
Status,
please
Circle
one:
Employed
Full-
Time,
Part-time,
Student,
Retired,
Unemployed,
Other
Cunent
Employer: Position
1vlonthly
Salary$
_______
Annual Salary $
_________
_
Supervisor's
N~e
Telephone Number
( )
If
employed
by
above less
than
6 months, give
n~e,
address,
and
telephone #
of
previous
employer
or
school
Spouse's Name
_________
Position
______
l\1onthly Salary $
__
_
Supervisor's Name
___________
Telephone
Number~======
If
spouse employed
by
above less than 6 months, give name, address, and
telephone#
of
previous~ploy~orschool
___________________
~
Other Income: $
_____
Source~ยท
==========================
NAMES
OF
OCCUPANTS
(All persons occupying
pr~ises
must
be listed)
Name Relationship Date
of
Birth
EMEGENCY CONTACT
_________
Relationship-------
Address Telephone
Number
_______
_
PLEASE LIST YOUR
BANK
AND
CREDIT REFERENCES
Bank
___________
City/State
_____
Checking Acct. #
____
_
Bank
___________
City/State
_____
Checking Acct. #
____
_
Credit Reference:
__________
Telephone Number
_________
_
Credit Reference:
__________
Telephone Number
_________
_
AUTOlviOBILE INFORNIATION
l\1ake
_________
Color
____
Year
__
Tag
Number
______
_
Make
_________
Color
____
Year
__
Tag
Number
______
_
HAVEYOUEVER:
Filed for bankruptcy? YES
NO
Been evicted from tenancy? YES
NO
Willfully or intentionally refused to pay rent when due? YES
NO
Please give
any
additional information, which
might
help management evaluate this application:
PETS
Pets: (Yes
or
No) Number: ( 1 or 2) Combined Weight:
_____
pounds
Type:
____________________________________________________
__
GRANT
PROGRAM
PARTICIPATION
As participants
of
the
Eco-Cottage and I
or
the Mississippi Alternative Housing Program
vve
must
identify
your
current housing situation. Please check
box
that
applies:
Mississippi disaster survivors
vvith
temporary housing needs
met
via.
FEMA
financial or
direct housing assistance.
Disaster survivors who are pre-disaster residents of:tvfississippi and currently receiving
Federal disaster housing assistance through other Federal programs
Disaster survivors who are pre-disaster residents
of
Mississippi who
do
not
currently
receive housing support
but
have on-going housing needs.
Any other person
vvith
on-going housing needs.
1/We certify,
under
penalty
of
purjery
that
the
information given
here
is
true
and
correct.
Signature
of
Applicant:
_____________
Date
_____
_
Signature
of
Spouse: Date
_____
_
To
return
by
mail, please send to:
