Last Year’s Total Annual Income:
Current Income (Weekly/Monthly/Annual):
Income other than work:
How long do you plan to stay at this property?
Do you plan to buy a home?
Have you ever been sued for bills?
Have you had a lawsuit against you, ever?
Have you ever filed for bankruptcy?
Are you planning on filing for bankruptcy?
Have you ever been charged with a felony?
Have you ever changed your name?
Did you do a debt consolidation loan?
Have you ever willfully refused to pay rent when due?
Have you ever been convicted for dealing or manufacturing illegal drugs?
Have you ever been served an eviction notice or been asked to vacate a property?
Name of your attorney:
Attorney’s Phone number:
Date of Most recent marriage:
Current Spouse’s Name (first middle & maiden name if wife):
Date of most recent divorce:
Former Spouse’s Name (first middle last):
Former Spouse’s current Phone:
Former Spouse’s current email:
Former Spouses’ complete address:
Which of the following do you currently pay?
Name and address utilities are in (gas / electric / water):
Name of additional occupant: Additional Resident LN
Date of birth: December 1, 2021
Name of additional occupant: Additional2 Resident2 LN2
Date of birth: December 6, 2006
Make of Car: Toyota
Model of Car: Camry
License Plate Number: 12kk23l
License Plate State: PA
Lein Holder’s Name: PA Lein Holder
Lein Holder’s City: PA City
Lein Holder’s State: PA State
Other Relative Name: Other Reltive
Home Phone: 5468976548
Work Phone: 9865986587
Address: Other rel add
Other, Rel 12345
Friend In Ohio Name: Friend Ohio
Home Phone: 3256874895
Work Phone: 6578956423
Address: Friend Ohio Address
Friend, Ohio 98709
Other Non-Relative Name: Other nonrelative
Home Phone: 5462589357
Work Phone: 1568269713
Address: Other nonrelative address
Nonrelative, Oh 23691
Mother’s Maiden Name: Mother’s Maiden Name
Spouse’s Mother’s Maiden Name: Spoue’s Mother’s Madene Name
Credit Company’s Name: CC #2
Account Number: 1234
Credit Company’s Address: CC#2 address
Dayton, OH 45255
Monthly Payment: 56486
Is this account current: No
Financial Institution’s Name: Checking and savings #2
Account Number: 98klj
Address: Checking and savings #2 address line 1
Middletown, OH 98789
$$$ Amount in Account: 6584
Currently Active: Yes
Type of Ped: Dog
Number of these pets: 4
Size of Pets: 26
Type of Ped: Cat
Number of these pets: 2
Size of Pets: 89
Type of Ped: bird
Number of these pets: 5
Size of Pets: 5
Type of Ped: dog
Number of these pets: 2
Size of Pets: 20