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STANDARD RENTAL APPLICATION Todays Date 5/2/2012 Prospective Address 95 Lincoln Ave

Tenant Ralph Cueva

Social Security #079-82-9519 Home Phone (347)602-2334 Date of Birth 6/10/1991 Driver's License #_____________________ Present Address 40-14 10 ST APT 2A How Long? 3 years City Long Island City State NY Zip Code 11101 Previous Address NONE Current Landlord's Name NONE, I do not have one Phone_______________ Why are you leaving? I am going over to Pennsylvania for an Internship. Employer's Name Media Services Union College Phone Address 807 Union ST, Schenectady NY 12308 Position Technician How Long? 3 Years Your Superior Jermaine Wells Monthly take-home pay $3,000

Sources Working for General Electric

Character Reference Kelli Johnson (not a family member) Phone(870) 723-5078


Corey Wicks Social Security #________________________ Date of Birth____________________ Home Phone ______________________________ Relation to tenant_______________ Driver's License #_______________________ Present Address_________________________________ How Long? _____________ Previous Address Current Landlord's Name___________________________ Phone________________ Why are you leaving?____________________________________________________ Employer's Name_______________________________Phone______________________ Address_______________________________________Position___________________ How long?___________________Your Superior_______________________________ Monthly take-home pay_____________


Character Reference ___________________________________________________ (not a family member) Phone__________________________________ Total number of occupants 2 Do you have any pets? NO How many?________ Type____________ List all motor vehicles, including RVs, to be kept at the dwelling unit. Include make, model, year, and license plate number for each. Vehicle #1 NONE License__________________ Vehicle #2____________________________ License__________________ Please list any outstanding loan balances and monthly payment: 1.NONE 2._________________________________________________________________________



In an emergency contact Rafael Cueva Phone (646)260-5456 Address

40-14 10 ST APT 2A Long Island City NY 11101

Have you ever been evicted from any tenancy? Have you ever willfully and intentionally refused to pay rent when due? Do you know of anything, which may interrupt income or ability to pay rent?

[] yes

[X] no

[ ] yes

[X] no

[ ] yes

[X] no

I hereby certify that the answers I have given in this application are true and correct and hereby authorize E.C.R.M. Inc. to obtain a credit report to verify the information contained here. I understand that any false answers or statements made by me will be sufficient grounds for eviction and loss of any security deposit. I further authorize the landlord or his agent to verify the above information including but not limited to contacting creditors, both listed herein or not, and present or former landlords. Dated May 2,2012

Tenant Ralph Cueva Cotenant________________________________________________________ Discrimination It is against the law to discriminate against tenants on the basis of race, religion, national origin, age, or neighborhood racial makeup.