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APPLICATION FOR HOUSING Buffalo Creek Commons 1291 Indian Church Rd. #19 West Seneca, NY 14224 Office (716) 677-0963 Fax (716) 712-0870

For Office Use Only

Date Received: Time Received:

How many bedrooms are you requesting: 1:____ 2: ____ 1st Floor_____2nd Floor Upper: ____ Please attach a personal check or money order in the amount of $35.00 per applicant over the age of 21, made payable to Buffalo Creek Commons. HOUSEHOLD INFORMATION (List all the household members including yourself.) Name

Relationship to Head of Household H of H

Gender (M or F)

Social Security Number

Birth date Marital Student (mm/dd/yyyy) Status Status (Y or N)

COPIES OF DRIVERS LICENSE FOR ALL HOUSEHOLD MEMBERS MUST BE ATTACHED TO THIS APPLICATION.

Mailing Address: _________________________________________________________________________ Street City State Zip Current Physical Address (if different): ________________________________________________________________________________________+ Street City State Zip Daytime Phone #: ______________ Cell Phone #: _________________E-mail: ________________________ Daytime Phone # ______________ Cell Phone # __________________Email _________________________ Do you have a Pet (Y or N): ______ Description of Pet (type, age, breed, weight):______________________ How did you hear about the property? ________________________________________________________ Were you referred by a current resident at Buffalo Creek Commons? ______ Yes _______ No If yes, please state their name and unit number: ___________________________________ #___________ ! !

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PLEASE COMPLETE: Vehicle Information: __ Make: ___________________________________ Model: ___________________________________ Year: ___________________________________ Color of Vehicle: __________________________ License Plate #: ____________________________

_Vehicle Information: 2nd Vehicle _______________________________________ _______________________________________ _______________________________________ ______________________________________ _______________________________________

Have you on anyone on the application ever filed for bankruptcy, or been evicted from housing?__________ Explanation: ________________________________________________________ Are you currently receiving any rental subsidy? _________ Name of agency: _______________________________________________________ Agency Contact & Phone Number: _________________________________________ Subsidy Amount: _______________________________________ Have you or anyone on the application ever been convicted of a crime?__________ Explanation: ____________________________________________________________________________ _______________________________________________________________________________________ INCOME INFORMATION FOR EVERYONE 18 AND OLDER Current Employment Household Member: _________________________________________________ Place of Employment: _______________________________________________ Supervisor: ________________________________________________________ Start Date: _________________________________________________________ Occupation: ________________________________________________________ Work Phone Number: _______________________________________________ Salary, Gross Monthly: ______________________________________________! Household Member: _________________________________________________ Place of Employment: _______________________________________________ Supervisor: ________________________________________________________ Start Date: _________________________________________________________ Occupation: ________________________________________________________ Work Phone Number: _______________________________________________ Salary, Gross Monthly: ______________________________________________

Please provide copy of proof of income with this application (example: paystub, social security check, pension statement, investment statement). Also a copy of driver’s license must be submitted at time of application.

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Please provide information on Checking and Savings Accounts: YES Checking Accounts? Household Member Financial Institution ____________________ ________________________ ____________________ ________________________

Current Balance ____________________ ____________________

Savings Accounts? Household Member Financial Institution ____________________ ________________________ ____________________ ________________________

Current Balance ____________________ ____________________

NO

HOUSING HISTORY – PLEASE LIST YOUR LAST 3 LANDLORD’S (If no landlords, list a professional, but non-related, reference) Current Property Name: _____________________ Landlord: ________________ Dates:________ Address: ___________________________________________________________________________ Amount of Rent Paid: ____________Telephone: ________________Fax:______________________ Property Name: _________________________ Landlord: ____________________ Dates:_________ Address: ___________________________________________________________________________ Amount of Rent Paid: ____________Telephone: ________________Fax:______________________ Property Name: _________________________ Landlord: ____________________ Dates: __________ Address: ____________________________________________________________________________ Amount of Rent Paid: _____________Telephone: ________________Fax:______________________ List 3 Professional References: Name:___________________________ Title: _______________Phone Number:________________ Name:___________________________ Title: _______________Phone Number:________________ Name:___________________________ Title: _______________Phone Number:________________

Emergency Contact Information: Please provide the name, relationship of and phone number of the best person to contact in the case of emergency: Name: _________________________ Relationship: _______________ Phone number:_____________________ Name: _________________________ Relationship: _______________ Phone Number: ____________________

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SIGNATURE PAGE I understand that management is relying on this information to prove my household’s eligibility for the rental of an apartment unit at Buffalo Creek Commons and I certify that all information and answers to the above questions are true and complete to the best of my knowledge. I consent to the release of the necessary information to determine my eligibility. I understand that providing false information or making false statements will be grounds for denial of my application. I also understand that such action may result in criminal penalties. I authorize my consent to have management verify the information contained in this application for purposes of proving my eligibility for occupancy. This includes calling through the Landlord and professional references I have provided, as well as electronically running a credit report and criminal background check on all persons 18 years of age and older included on this lease. I will provide all necessary information including source names, address, phone numbers, accounts numbers where applicable and other information required for expediting this process. I understand that my occupancy is contingent on meeting management’s criteria for occupancy at the property. ALL HOUSEHOLD MEMBERS 18 AND OVER MUST SIGN

____________________________________________________ Head of Household

____________________________ Date

____________________________________________________ Applicant

____________________________ Date

____________________________________________________ Applicant

____________________________ Date

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Application buffalo creek  

Application for apartment rental, Buffalo Creek Commons, West Seneca, NY.

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