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PEABODY PROPERTIES, INC.

536 GRANITE STREET, BRAINTREE, MA 02184 TEL: 781-794-1000 FAX: 781-794-1001

RENTAL APPLICATION

SITE

MANAGEMENT USE ONLY

Date/Time Received:
Received By:
Unit Size:			BR
Priority:
Affordable:	 80%	 60%	 50%  30%
Market Rate:	
RA Request:		RA-1: 	RA-2: 

NAME 1:

FIRST

LAST

SOCIAL SECURITY NUMBER

NAME 2:

FIRST

LAST

SOCIAL SECURITY NUMBER

ADDRESS:

STREET

APT #

TOWN OR CITY

STATE

ZIP CODE

ADDRESS:

STREET

APT #

TOWN OR CITY

STATE

ZIP CODE

RESIDED SINCE:

(1) HOME TEL.:

BUSINESS TEL.:

MOBILE TEL.:

(2) HOME TEL.:

BUSINESS TEL.:

MOBILE TEL.:

Reason for applying at this development?

How did you hear about this development?

PRESENT LANDLORD

TEL.#:

FAX #:

ADDRESS:

STREET

APT #

TOWN OR CITY

STATE

ZIP CODE

Is apartment rented to you?

YES  NO 

If NO, explain:

Are you presently under lease?

YES  NO 

If YES, when does lease expire?

Reason for leaving:

Amount of rent per month $

No. of Bedrooms:

No. of Occupants:

Do you usually pay rent in a timely manner?

Did you receive any notice of termination of tenancy? YES  NO  If YES, explain:

PREVIOUS LANDLORD

TEL.#:

FAX #:

LANDLORD ADDRESS:

STREET

APT #

TOWN OR CITY

STATE

ZIP CODE

APPLICANT'S ADDRESS:

STREET

APT #

TOWN OR CITY

STATE

ZIP CODE

Was apartment rented to you?

YES  NO 

If NO, explain:

Length of tenancy: from

Amount of rent per month

Were you then under a lease?

YES  NO 

If YES, did you remain for its term? YES  NO 

Did you receive any notice of termination of tenancy?

YES  NO 

If YES, explain:

The reason for your leaving:

Page 1 of 4

Landlord Address:

Please provide list of all states in which any household member has resided:

Add Landlord Address if you lived at any of the above for a total of less than seven (7) years.

Previous Apartment Address:

Landlord Name:

Why did you leave this apartment?

Did you ever receive any notices of termination of tenancy while at this apartment? YES  NO 

If yes, please explain:

Complete the following information for each member of your family, including yourself, who will be occupying the apartment:

NAME

RELATIONSHIP

DATE OF BIRTH

SEX

OCCUPATION

F.T. STUDENT	SOCIAL SECURITY
YES / NO	NUMBER

EMPLOYMENT (for each household member aged 18 or over):

Individual Employed:
Employer Name:
Address:
Dates of Employment:	FROM	TO
Gross Wages / Salary	$	PER	TEL. #:
Contact Person / Supervisor:			FAX #:
Individual Employed:
Employer Name:
Address:
Dates of Employment:	FROM	TO
Gross Wages / Salary	$	PER	TEL. #:
Contact Person / Supervisor:			FAX #:

OTHER SOURCES OF INCOME (for all Household Members):

	AMOUNT RECEIVED PER MONTH	PERSON RECEIVING SUCH INCOME
Social Security	$

Supplemental Security Income (SSI)	$

Pension / Annuity / Trust	$

Public Assistance (TANF / AFDC / EAFDC / GR)	$

Unemployment Compensation	$

Worker’s Compensation	$

Child Support / Alimony	$

Student Financial Assistance	$

Other Income (please specify)	$



© 1999 Peabody Properties, Inc. All Rights Reserved. Revised July 2012		Page 2 of 4

RELATIVES (Please list two relatives not living with you):

NAME

RELATIONSHIP

ADDRESS

(AREA CODE)

TELEPHONE NUMBER

ASSETS Please list the assets now owned or disposed of within the last two years of anyone living in your household (Include Checking, Savings, IRA, Money Market Account, and Term Certificates; and Real Estate, Stocks, Bonds, and Certificates.):

ASSET DESCRIPTION	SOURCE / BANK NAME	AMOUNT OR VALUE	ACCOUNT NUMBER
		$

		$

		$

		$

		$

		$

		$

CREDIT HISTORY (Include payments, loans, credit cards, etc.):

OWED TO	ACCOUNT NUMBER	CURRENT BALANCE	MONTHLY PAYMENT
		$	$

		$	$

		$	$

		$	$

		$	$

Do you pay for utilities?	YES  NO 	If yes,
Do you pay child support?	YES  NO 	If yes,
Do you pay alimony?	YES  NO 	If yes,
Do you pay child care?	YES  NO 	If yes,

$per month.

ADDITIONAL INFORMATION:

Are you or any member of the household subject to lifetime sex offender registration requirement in any state? YES  NO 

Do you have a Water Bed?	YES  NO 
Do you have a Washing Machine?	YES  NO 
Do you have a Dryer?	YES  NO 
Do you currently have a Household Pet ?	YES  NO ; if YES, what type?

How many cars will be parked at the premises?		(copies of registration must be provided)
Year:	Registration #:		Make/Model:
Year:	Registration #:		Make/Model:

PLEASE NOTE: COMMERCIAL/RECREATIONAL VEHICLES ARE NOT PERMITTED ON THE PREMISES WITHOUT WRITTEN PERMISSION FROM THE LESSOR.

Do you or any household members currently reside in Federally Assisted Housing or have you or any household members ever resided in Federally Assisted Housing? YES  NO 

Have you or any household member ever committed any fraud in connection with any Federal Housing Assistance program? YES  NO ; if YES, please explain:

Have you or any household members on Federal Assistance ever been terminated for fraud? YES  NO ; if YES, please explain:

Page 3 of 4

EQUAL OPPORTUNITY / FAIR HOUSING INFORMATION

Peabody Properties, Inc. does not discriminate on the basis of race, color, religion, national origin, gender, disability, familial status, marital status, sexual orientation, genetic information, veteran/military status, receipt of public assistance, ancestry, age, gender identity or other basis prohibited by federal, state, or local law in the access or admission to its programs or employment or its programs, activities, functions or services.

The following information will be required by the Federal Government to monitor this owner / management agent's compliance with Equal Housing Opportunity and Fair Housing Laws. The law provides that an applicant may not be discriminated against on the basis of the information supplied below whether or not the information is furnished.

Note: HUD Race and Ethnicity Data Form(s) must be attached for Subsidized Sites.

ETHNIC CATEGORIES

 Hispanic or Latino	 Not-Hispanic or Latino
RACE CATEGORIES
 American Indian or Alaska Native		 Asian	 Black or African American
 Native Hawaiian or Other Pacific Islander		 White	 Other

I do not wish to furnish the above information

I hereby certify that the information provided in this application is true and complete to the best of my knowledge and hereby acknowledge the understanding that this application constitutes my request for consideration as a tenant in the above development. It does not constitute a lease or a promise by the owner or management agent that an apartment will be made available to me. I understand that additional information may be requested to complete processing of my application.

I understand and grant permission for all of the above information to be verified by the owner / agent. I further understand and grant permission to authorize a credit bureau service to make any consumer report and investigative consumer report, whereby information is obtained through public records, personal or telephonic interviews with my neighbors, friends, or others with whom I am acquainted. This inquiry may include information as to my character, credit worthiness, credit standing, and credit capacity. I understand that I have the right to make a written request within a reasonable period of time to receive information about the nature and scope of any such report that is made.

I understand that a false statement or misrepresentation of any information on this application will affect approval for residence; and, in the event that I take occupancy, it shall be considered material non-compliance with the lease and a basis for termination of tenancy.

Finally, I understand and grant permission that information regarding my tenancy can and will be made available to a consumer credit agency, criminal checks, and / or other inquiring about my tenancy with the apartment complex during and after my tenancy period.

RIGHT TO REASONABLE ACCOMMODATION

Peabody Properties, Inc. will consider a reasonable accommodation, upon request for qualified people with disabilities when an accommodation is necessary, not just desirable, to ensure equal access to the development, its amenities, services and programs. Reasonable accommodations may include changes to the building, grounds, or an individual unit and changes to policies, practices, and procedures.

_______ Please check here if you would like to make a request for a reasonable accommodation. Management will then provide

you with a Request for a Reasonable Accommodation Form (RA-1) and complete a Referral Form (RA-2) to the property’s Resident Service Coordinator to follow-up with you directly consistent with Management’s Reasonable Accommodation Policies and Procedures.

Date:Signature:

Signature:

Signatures and proof of identification will be required of all those who sign lease.

FOR MARKET USE ONLY

A deposit (one month's rent) is required with this application. It will be based as follows:

1.Applied to your first month's rent if application is approved;

2.Returned to the Applicant if application is not accepted with explanation of denial;

3.Retained as liquidated damages if application is approved and Applicant cancels his or her application.

Amount of Deposit $		Check #		Occupancy Date:

Signature:Date:

Page 4 of 4

Question	Answer
Form Name	Peabody Properties Application Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	peabody properties application, peabody properties form, peabody properties application make, application apartment peabody printable

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