Great River Country Village

GREAT RIVER COUNTRY VILLAGE

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MOBILE HOME / MANUFACTURED HOUSING COMMUNITY APPLICATION

FOR

GREAT RIVER COUNTRY VILLAGE

Every line MUST be filled out completely or a reason given in writing on the line why not (except for ownership of mobile home if you don't yet own one) for the application to be reviewed and/or considered

FIRST NAME_______________________MIDDLE__________________LAST NAME________________________

DATE OF BIRTH___________________

SOCIAL SECURITY NUMBER___________________________________________________

PRESENT ADDRESS___________________________________________________________

CITY_____________________________STATE___________________ZIP_________

HOME PHONE_____________________ MOBILE PHONE ______________________

MARITAL STATUS Married Divorced Single (Circle appropriate) HOW LONG_____________

SPOUSE’S OR CO-RESIDENT’S

FIRST NAME_______________________MIDDLE__________________LAST NAME________________________

SPOUSE’S OR CO-RESIDENT’S DATE OF BIRTH_________________________________________

SPOUSE’S OR CO-RESIDENTS SOCIAL SECURITY NUMBER_________________________

OTHER PERSONS WHO RESIDE WITH YOU

NAME_____________________________________________________AGE_______________ RELATIONSHIP_______________

PET The rules provide limitations..Please review Dog Cat (Circle One)

(Kind) _____________________(Weight) _______

PRESENT EMPLOYER__________________________________ SUPERVISOR NAME_____________________

ADDRESS_____________________________________________________________________

CITY__________________________STATE_____TELEPHONE______________________

HOW LONG EMPLOYED_______________________________

JOB TITLE_________________________________

MONTHLY SALARY____________________________

PREVIOUS EMPLOYER__________________________________SUPERVISOR NAME ________________

ADDRESS______________________________________________________________

CITY______________________STATE_______TELEPHONE____________________

HOW LONG EMPLOYED________________________________

JOB TITLE_________________________________

SPOUSE’S OR CO-RESIDENT’S EMPLOYER_______________ SUPERVISOR NAME _____________________

ADDRESS______________________________________________________________

CITY______________________STATE_______TELEPHONE____________________

HOW LONG EMPLOYED________________________________

DO YOU CURRENTLY RENT OR OWN RESIDENCE? RENT OWN (Circle one)

IF YOU CURRENTLY OWN RESIDENCE, NAME OF PRESENT LIENHOLDER(if any)______________________________________________________________

ADDRESS ____________________________________________TELEPHONE____________

IF YOU CURRENTLY RENT, NAME OF LANDLORD___________________________________________________

ADDRESS_________________________________TELEPHONE__________________

PREVIOUS LANDLORD____________________________________________________________________________

ADDRESS______________________________________________TELEPHONE___________

PRIOR TO PREVIOUS LANDLORD (IF MORE THAN ONE)_________________________________________________________

ADDRESS______________________________________________TELEPHONE___________

AUTOMOBILE MAKE______________________COLOR_____________________

MODEL_____________________YEAR___________LICENSE NO.___________________

2nd AUTOMOBILE MAKE______________________COLOR___________________

MODEL_____________________YEAR___________LICENSE NO.__________________

OTHER LICENSED VEHICLES (campers, boats, RVs, etc.) The rules provide limitations..Please review

MAKE___________________________________COLOR_______________________

MODEL__________________YEAR________LICENSE NO.____________________

MAKE___________________________________COLOR_______________________

MODEL__________________YEAR________LICENSE NO._____________________

MOBILE HOME/MANUFACTURED HOUSING YEAR____________ MAKE____________________

TITLE NO.________________________

SERIAL/VIN NO.____________________MODEL____________________LENGTH_______

WIDTH________________

NAME OF SELLER_____________________________________________________________

SELLER’S ADDRESS___________________________________________________________

LIENHOLDER__________________________________________________________

LEINHOLDER’S ADDRESS_____________________________________________________

BALANCE OWED______________________________________________________________

PRESENT LOCATION OF MOBILE HOME_________________________________________

PERSONAL REFERENCES (Require minimum of two)

NAME____________________________________TELEPHONE __________________

ADDRESS_________________________________RELATIONSHIP_______________

NAME____________________________________TELEPHONE __________________

ADDRESS_________________________________RELATIONSHIP_______________

DO YOU USE A BANK/OTHER FINANCIAL INSTITUTION? YES NO (Circle one)

NAME OF INSTITUTION ____________________________ADDRESS___________________

CHECKING ACCOUNT YES__________ NO_____________

SAVINGS ACCOUNT YES__________ NO_____________

INSTALLMENT LOAN YES__________ NO_____________

NAME OF INSTITUTION IF MORE THAN ONE IS USED________________________ADDRESS_____________________________

CHECKING ACCOUNT YES__________ NO_____________

SAVINGS ACCOUNT YES__________ NO_____________

INSTALLMENT LOAN YES__________ NO_____________

DO YOU USE A CREDIT CARDS? YES NO (Circle one) HOW MANY ____________

CREDIT CARDS

KIND OF CARD (VISA, MASTER CHARGE, ETC) ________________________________ ADDRESS____________________________ NAME ON CARD ____________________________

KIND OF CARD IF MORE THAN ONE(VISA, MASTER CHARGE, ETC) _______________ ADDRESS____________________________ NAME ON CARD ____________________________

KIND OF CARD IF MORE THAN TWO(VISA, MASTER CHARGE, ETC) _______________ ADDRESS____________________________ NAME ON CARD ____________________________

NAME OF SOMEONE YOU KNOW RESIDING IN THE COMMUNITY___________________________________________

DATE OCCUPANCY IS DESIRED_______________________________________________

MUST ANSWER NEXT SIX QUESTIONS COMPLETELY AND IN DETAIL

(use back of application for providing detailed explanation).

Have you ever been arrested on a charge involving the use of illegal drugs, substance abuse or any related charge? YES_______ NO_________. If yes, please indicate the date of arrest, the name of the arresting authority, the law violations with which you were charged and any other details of which you are aware.

Have you ever been convicted on a charge involving the use of illegal drugs, substance abuse or any related charge? YES__________NO__________. If yes, please indicate the date of conviction, the court in which you were convicted, the law violations of which you were convicted and any other details of which you are aware.

Have you ever been arrested on a charge of a felony or aggravated misdemeanor? YES_______ NO_________. If yes, please indicate the date of arrest, the name of the arresting authority, the law violations with which you were charged and any other details of which you are aware.

Have you ever been convicted of a felony or aggravated misdemeanor? YES_______NO_____. If yes, please indicate the date of conviction, the court in which you were convicted, the violations of which you were convicted and any other details of which you are aware.

Have you ever been a defendant in a Forcible Entry and Detainer (eviction) action? YES____NO____. If yes, give details of time and circumstances.

Have you ever been sued for rent? YES______NO_______. If yes, please explain the circumstances and outcome.

I HAVE READ THE RULES AND REGULATIONS OF THE COMMUNITY AND IF I AM A RESIDENT, I AGREE TO ABIDE BY THEM. FURTHERMORE, I REPRESENT THAT THE ABOVE INFORMATION CONTAINED IN THIS APPLICATION AND AGREEMENT IS TRUE AND COMPLETE. I AUTHORIZE THE OWNER OF THE COMMUNITY, OR ITS AGENTS, TO VERIFY THE INFORMATION PROVIDED ABOVE, OBTAIN ADDITIONAL INFORMATION CONCERNING MY CREDIT STANDING AND TO FURNISH THE SAME TO OTHERS. IF IT EVER BECOMES NECESSARY FOR SERVICE OF PROCESS UPON ME, IN ADDTION TO ALL OTHER LAWFUL FORMS AND METHODS OF SERVICE, I HEREBY AUTHORIZE SERVICE OF PROCESS UPON ANY PERSON IDENTIFIED IN MY REGISTRATION FORM TO BE CONTACTED IN CASE OF EMERGENCY AND I AGREE THAT SUCH SERVICE SHALL BE DEEMED GOOD AND SUFFICIENT FOR ALL PURPOSES AS IF I HAD BEEN SERVED PERSONALLY. FINALLY, I AGREE THAT IF THERE IS A CHANGE IN ANY OF THE INFORMATION CONTAINED IN THIS APPLICATION, I WILL NOTIFY THE LANDLORD OR MANAGER WITHIN TEN (10) DAYS OF SAID CHANGE. THE UNDERTAKINGS IN THIS AGREEMENT WILL CONTINUE EVEN AFTER THE EXECUTION OF A RENTAL AGREEMENT.

SIGNED __________________________________

Applicant

Date _____________________

SIGNED __________________________________

Co-Applicant

Date _____________________

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1979 Monaco 2 Bedroom

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