Sanford Mill Application, Document Checklist
☐ Application attached. ☐ Asset Verification; please attach a copy of your most recent bank statement. ☐ Income Verification; please attach two most recent paystubs. If not applicable please attach your most recent IRS Form 1040.
☐ Two of the following forms of identification: Drivers License State ID Birth Certificate Social Security Card Passport
☐ Application Fee $35.00 per applicant in the form of Bank / Personal Check or Money Order made payable to: Sanford Mill MT 17 South Street 3rd Floor Portland, ME 04101
☐ Credit / Criminal and Eviction history and background check authorization form _________ Acknowledgment that this is a smoke and drug free property and our animal policy is that we do not allow animals. (Please Note: Service animals are welcome with proper documentation.)
Contact Management with any questions: Wendy Dunton 61 Washington St. Sanford, ME 04073 (207) 502-3833
Rental Application Applicant Information Name: Date of birth: Current address: City: Own Rent (Please circle) Previous address: City: Owned Rented (Please circle) Employment Information Current employer: Employer address: Phone: City: Position:
State: Monthly payment or rent:
State: Monthly payment or rent:
How long? E-mail: State: Hourly
Salary (Please circle)
Fax: ZIP Code: Annual income:
Emergency Contact Name of a person not residing with you: Address: City:
Relationship: Co-applicant Information, if Married Name: E-mail: Date of birth: SSN: Current address: City: State: Own Rent (Please circle) Monthly payment or rent: Previous address: City: State: Owned Rented (Please circle) Monthly payment or rent: Co-applicant Employment Information Current employer: Employer address: Phone: E-mail: City: State: Position: Hourly Salary (Please circle) References Landlord Name:
Phone: ZIP Code: How long? ZIP Code: How long?
How long? Fax: ZIP Code: Annual income: Phone:
I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application. Signature of applicant:
Signature of co-applicant:
Employment Income Verification PLEASE RETURN TO:
Northland Management Corporation
c/o Wendy Dunton, Property Manager 17 South Street 3rd Floor Portland, ME 04101 (207)780-0223 ex. 206 (207)502-3833
Re: Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
Please see next page for release of information The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Date of Employment:
Hourly Rate of Pay:
Number of hours per week:
Number of weeks per year:
Overtime Rate of Pay:
Number of hours of overtime per YEAR:
Annual Tips, Bonuses, Commissions, other:
Anticipated Pay Increase to:
Date of Anticipated Increase:
10. Year-to-date earnings: 11.
! Yes ! No Has Employment been terminated? If yes, last day employed: _______________________ ! Yes Is individual eligible for unemployment benefits?
Employer's Printed Name/Title
! No Date
Employer [Company] Name and Address
NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction. Note to Applicant/Tenant: You do not have to sign this form if either the requesting organization or the organization supplying the information is left blank. PENALTIES FOR MISUSING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at 42 USC 208(f)(g) and (h). Violations of these provisions are cited as violations of 42 USC 408 (f)(g) and (h).
Criminal History & Credit Reports As part of our application process, we require that all applicants provide us with authorization to request and review a credit, criminal and eviction history report for all adults who will be residing in the unit, and a credit report for all individuals who will be listed as a tenant, and who will be responsible for payment of rent and other charges that might be due. Credit reports may be obtained through the following website: http://www.annualcreditreport.com/ Or, you can request your credit report by mailing a request to: Annual Credit report Request Service P.O. Box 105281 Atlanta, GA 30348-5281 AUTHORIZATION The undersigned person(s) request that all of the above statements are true and complete and hereby authorize verification by the landlord. Failure to answer any of the above inquiries entitles the landlord to reject the application. If you provide false information during the application process, the landlord is entitled to (1) request this application and/or (2) terminate tenantâ€™s right to occupancy if the false information is discovered after the applicant takes occupancy.
_____________________________ Signature of Applicant
E-mail: _______________________________ _____________________________ Signature of Applicant E-mail: _______________________________