Bill Your Properties, 2728 Tierra Circle, Winter Park, FL 32792, (740) 360-2142; FAX: 321-5844

Which property?_____________________

Each adult should complete a separate application

What is your motivation for wanting to move (list any and all reasons)?___________________________________________________________________________

Ideally when do you want to move?____________________________ Will you need range or refrigerator? __________________________

Your Name:___________________________________________________Please include middle initial or name and suffixes

Where do you live now:____________________________________________________________ Phone: _________________ City/Town:______________________________State_______ Zip Code____________ e-mail address:____________________

Current rent: _________ Anything included in the rent? (utilities, appliances etc.)____________________________________________________________________________

PROPOSED RESIDENTS: No. of adults:_____ No. of minors:_____ List each proposed ADULT resident including yourself:

Name:__________________________________ Birth date:________________

Social Security No._________________________________

Name:__________________________________ Birth date:________________

Social Security No._________________________________

Name:__________________________________ Birth date:________________

Social Security No._______________________________

Name:__________________________________ Birth date:________________

Social Security No.__________________

Has any proposed resident ever been known by any other name? If so, who and what name?_____________________

RESIDENCE HISTORY: Starting with where you live now, provide a history in order of where all you have lived in the last 10 years no matter how short of a period you may have resided in any location:

Address where you live now:_____________________________________ Date you moved in:_________________ to present.

Landlord’s Name:__________________________________ Phone Number:________________Is your landlord related to you in any way?________If so, how?________________________Was any previous landlord related to you in any way?________ If so, how and at which address?_______________________________________________________________________

Address prior to current one:______________________________________ Date you moved in:_____________Date you moved out:__________________ Landlord’s Name:__________________________________Phone Number:______________

Previous address:___________________________________Date you moved in: _________________Date you moved out:___________________ Landlord’s Name:__________________________________Phone Number:___________________

If more than 3 residences in 10 years, provide the above information for each residence on the back of this sheet.

Do you have pets?_____If so, how many?_____ Indicate what type of pet and the breed if applicable,______________________

________________How old is each pet?_____________________________ How long have you had each pet?______________

OBLIGATIONS: Who do you owe or regularly make payments to?

_____ Vehicle Payment. How much?________ Weekly or Monthly? (Circle) Who receives payment?____________________

Approximate total amount owed?__________ How long until you are finished paying?__________________________

_____ Loan Payment. How much? ________ Weekly or Monthly? (Circle) Who receives payment? _____________________

Approximate total amount owed?__________ How long until you are finished paying?__________________________

_____ Child Support Payments. How much? _________ Weekly or Monthly? (Circle) Are you up-to-date with your payments or behind? ________________ If not current/up-to-date, how much are you behind?____________

_____ Credit Card Payments. Monthly Payment:____________. Total amount owed on all cards? __________________

_____ Child Care Expense. How much? __________ Payable monthly or weekly (circle one). Payment required: $__________

_____ Any Unpaid Bills/Amounts Owed to anyone:_____________________________________________________________

_____ Any negative information on your credit record: ________________________________________________________________________________________________________


Are you employed now? _____ Where do you work? _____________________________When did you start there? ______________ What is your position? ___________________________If not working, when were you last employed? __________________Where did you work?________________________________ List all inclusive date of unemployment over the past 5 years: ___________________________________________________________________________________

List any previous employers working backwards in order to your current employment:

Where did you work? ________________________________ Date Started?______________Date Terminated:______________

Where did you work? _________________________________ Date Started?______________Date Terminated:_____________

Where did you work? _________________________________ Date Started?______________Date Terminated:_____________

If not employed, what is your source of income?________________________________________________________________

Since 18 years of age, have you lived anywhere else other than Marion County, OH?_____________ If so, where and which inclusive dates? ______________________________________________________________________________________

Have you or any other adult in your household ever served in the military? If so, who and when?__________________________

Are you now or have you ever been a resident in Marion Metropolitan Housing or Section 8 programs?_________ If so, when and where were you a resident under any program of this type?____________________________________________________

Are you currently approved for Marion Metropolitan Housing?____________________________________________________

Are you now or have you ever lived anywhere that you were not obligated to pay rent or paid less than market rent? (Do not count housing provided to you before you turned age 18, before graduating from high school, or, if applicable, while a college student and less than 23 years of age)_________________________________________________________________________

Who provided that housing to you?__________________ When and where?______________________________________________________________________________________________________

Give us the details of any negative housing/rental experiences you have had:___________________________________________________________________________________________________


Not counting minor traffic citations, please indicate if any of the following situations are applicable to you:

____Yes ____No Have delinquent credit accounts

___ Yes ____ No Have civil actions where a money judgment is involved.

____Yes _____No Criminal record involving misdemeanors. Charge(s)__________________________________________

____Yes _____No Criminal record involving a felony(ies). Charge(s)___________________________________________

____Yes _____No Am being evicted now or have been asked to vacate my current home

____Yes _____No Have been evicted in the past, If yes, how many times?_____Which landlord(s)____________________

____Yes _____No Have declared bankruptcy. Has the bankruptcy been discharged?_____ When was that?______________

____Yes _____No Am planning to declare bankruptcy or have recently filed

____Yes _____No Have lost a house to foreclosure/bankruptcy or signed back a house

____Yes _____No Have had a vehicle repossessed or signed back a vehicle

____Yes _____No Someone in my family has been adversely affected by lead/lead-based paint

____Yes _____No Baby sit children in my home other than my own children

____Yes _____No Have a home-based business. If so, nature of that business:_____________________________________

____Yes _____No Is your 2016 income verifiable? Attach W-2’s, 1099’s or other verification of that income

____Yes _____No Is your 2017 income year-to-date verifiable? Attach pay stubs/payroll record or other verification

Do you have tenant’s insurance?________________________ Do you have a currently valid driver’s license or state ID?_____________

Please note here any additional information you think we should know: _______________________________________________________________________________________________________




PLEASE ATTACH ANY AND ALL AVAILABLE VERIFICATIONS OF INCOME FOR BOTH LAST YEAR AND THIS YEAR (Check stubs/payroll record, 1099’s, W-2’s, Award letters). Employer letters or bank statements are not acceptable.

In signing below, I affirm that all information provided is an accurate representation of facts. In signing here, I give my permission to verify the information on this application for purposes of evaluating the qualifications of myself and the members of my household so that I (we) may be approved to lease this property.

Today’s Date:__________________________

Applicant’s Signature:__________________________________________________________

Phone Nancy, 740-751-2010, when you are ready to submit your application.

William X. Your, Trustee for the trust that owns these properties, is a licensed real estate broker in the state of Ohio.

Comments are closed.