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Highland Meadows Owned and Operated by Out Front Properties, Inc. 2202 Gregg Rd, Bellevue, NE 68123 402-293-8786- Office 402-614-1575- FAX I hereby make an application to rent a Highland Meadows Apartment to be used as a dwelling unit. I understand that I must submit a nonrefundable $20 fee for the credit & criminal checks. One applicant per application. Civilian applicants must be age 21 or older; active military applicants must be age 19 or older. Landlord does not accept cosigners or Section 8. Landlord does not knowingly rent to sex offenders or felons. Landlord does not allow subletting. Applicant Information Last Name: First Name: Social Security # - Date of Birth: Current Address Street Address: Middle Initial: Maiden Name (if applicable): Driver’s License #: State: Apt. # City: State: Zip: How long have you been living there? ____ years ____months Cell Phone Number: (_______) ________-____________ If we need to contact you by phone or email regarding this application, we should: ____ leave message with results of application (approval/denial) ___ leave message with name and phone number only ___ do not leave any type of message May we mail information regarding this application and Highland Meadows to your current address? How much is the monthly rent/mortgage payment? Apartment Management Company or Mortgage Company: Have you given written notice to leave: ___yes ___no Are you being evicted/foreclosed on? ___yes ___no Home Number: (_______) ________-____________ Email address: ______________________________ Regarding this residence, are you the: ___ Owner ___ Leaseholder ___Occupant (Proceed to the “Pest Control” Section) ___Guest (Proceed to “Pest Control” Section Phone Number of Management Company/Mortgage Company: (_____) ______- ______________ Page 1 of 4 ___ yes ___ no. By selecting this, if your application is denied, we will be unable to mail you adverse action paperwork. You will need to come into the office to get this paperwork. Pest Control Has your current living quarters, you, or your occupants had, or been exposed to, any of the following during the last six months? Bed bugs? ____ yes ____ no Cockroaches? ___ yes ____no Any other unwanted pests, rodents or insects? ___yes _____no If you answered yes, please lists dates and method(s) of treatment completed: ________________________________________________________________________________________________ ________________________________________________________________________________________________ Please list a source, such as pest control company or landlord, who can confirm these treatments:_______________________ phone number: ______________________ Income Name of Employer: Position/Title: Street Address: City: How long have you worked there? _____ years ____months State/Zip: Monthly Salary: ___________ Is this ___gross (before taxes) ___ net (after taxes) Please list any additional employers here: Supervisor’s Name: Supervisor’s Phone #: Income from additional employment: Any additional income (child support, student loan, etc.) Your vehicle Make: Model: Color: License Plate Number: State: Total number of vehicles that you and your occupants will be parking at Highland Meadows:__ Your Financial History Have you declared bankruptcy? ___ yes ___no (If yes, what year did bankruptcy occur?_______) Do you have any unpaid court judgments? ___ yes ___no Have you broken a rental agreement/lease?___ yes ___no Do you have past due balance with a landlord? ____ yes ____no Have you been asked to move out by landlord or evicted? ___ yes ___no Have you had your security deposit deducted, or not returned, because of damage to rental unit? ___ yes ___no Do you have any accounts that are currently in collections? ___ yes ___no If you answered yes to any of these questions, please explain: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Page 2 of 4 Criminal History Have you been convicted of a felony? ___ yes ___ no Are you required to register as a sexual offender? _____ yes ____no Have you been convicted of assault and/or battery? ___ yes ___ no Have you been convicted of a gun or weapon crime? ___ yes ___ no Have you been convicted of drug trafficking or intent to deliver? ___yes ___no Have you been convicted of any sexual offense or sexual abuse? ____ yes ____no Are you awaiting trial on any type of criminal case? ___yes ___no Are you on probation, out on parole, on supervised release, or under house arrest? __yes __no Have you been charged with a felony or sexual offense and are awaiting trial? ___yes ___no If you answered yes to any of these questions, please explain: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ Other residents Not including yourself, please list the legal names & ages of ALL other people who will occupy the unit below: Legal Name Age _____________________________________ ______ _____________________________________ ______ _____________________________________ ______ Total Number of people living in the apartment (including you): ______ Are any of your potential occupants required to register as sex offenders? ___ yes ___no Are any of your potential occupants convicted felons and/or convicted sex offenders? ___ yes __no Are any of your potential occupants awaiting trial/judgment for a crime, felony or sexual offense? ___ yes ___no Are any of your potential occupants under probation, on parole, under supervised release, or under house arrest? ___yes ___no If you answered yes to any of these questions, please explain: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ Pets Cats as pets are allowed in designated buildings for a $200 non-refundable fee. No monthly fee for cats. Do you need an apartment that is located in a building that accepts cats as pets: ___ yes ____no If you have a pet(s), other than a cat, please list the animal type here: ________________________________ Are you requesting an apartment that is located in a no-pet building? ____yes _____ no Referral If a current resident of Highland Meadows Apartments referred you to us, please list their name:___________________ By submitting this application, I (the applicant) am affirming that: I, the applicant, hereby state and represent that the information that I listed on this application is complete and accurate. I understand that in the event a lease is entered into it may be cancelled by the Landlord if any of the information provided in this application is materially inaccurate, misleading, false, or incomplete. I hereby authorize the Landlord, Tenant Data Services, Inc., or Landlord’s agents to verify the information on the application. Verification or re-verification of any information contained in the application will be retained by the Page 3 of 4 Landlord. I understand that such investigations typically include (but are not limited to) verification of employment and salary, rental history, credit, check-writing history, police (criminal) checks and consumer credit reports. I specifically and unconditionally release and hold owner and agent harmless from any unintentional consequences to me, of such inquiries. I authorize the Landlord to obtain information about my tenant history from any previous address and/or landlords listed by Tenant Data Services, even those that I did not list on this application. I hereby authorize & instruct any entity or person contacted by Tenant Data Services Inc. or the Landlord or Landlord’s agents to release such information to them. Upon request, Landlord, Landlord’s agents, or Tenant Data will provide the name & phone number of the source of the information used in the verification process. I understand that the Landlord retains the right to reject an applicant for housing, where the applicant or any occupant of the applicant, has been convicted of a felony, sexual offense, assault, weapons, terroristic threats, criminal street gang activity, prostitution, burglary, robbery, unlawful use and/or discharge of firearms, drug trafficking, and/or intent to deliver illegal substances. I understand this application form does not list all of the reasons why an application may be denied. Furthermore, I understand the following: ∙The $20 application fee is nonrefundable (no exceptions). The application fee goes towards paying for a credit and criminal check. The fee is not credited towards a security deposit or apartment rent. ∙The Landlord considers affordability of the apartment to be that rent does not take more than 30% of the total of all applicants verifiable income applying as Leaseholders for the apartment. I understand that only the income of approved applicants will be used in calculating whether applicant(s) can afford an apartment. ∙If approved for an apartment, there is a $200 deposit which is refundable based on normal “wear & tear”. For active military, the deposit is $99, which is refundable based on normal “wear & tear”. ∙Smoking is not allowed inside the apartment units, common areas, in the Clubhouse or within 20 feet of the playground area. ∙Any additional occupants (not listed on the application) must be approved in writing by the Landlord before he/she may move in. A criminal check must be done on any occupants age 19 or older. ∙Because Landlord is furnishing water, trash, and sewer & and to comply with Sec. 15-65 and Sec. 15-66 of the City of Bellevue Housing Code, the occupancy rate is a maximum of two (2) persons per bedroom. The living room, den, storage room, kitchen, bathroom, laundry closet, communicating corridors, and closets are not considered bedrooms. ∙Approval of this application does not guarantee that an apartment meeting my preferences will become available at Highland Meadows. ∙The Landlord will retain this application for a minimum of seven years. Once this application is submitted, the Landlord will not return this application for any reason. ∙ If my occupants and myself are bringing more than two vehicles to Highland Meadows, I will need to rent a garage for each additional vehicle. This is subject to the availability of garages. Printed Name: __________________________ Date: ___________________ Signature:__________________________________ How to return to this application: Drop off or mail to: Highland Meadows 2202 Gregg Road Bellevue, NE 68123 Phone (402) 293-8786 Fax to: (402) 614-1575 Out Front Properties, Inc. strictly adheres to the Fair Housing Act. Fair Housing is the right to buy, rent, insure, or live in housing under the same terms and conditions as everyone else without regard to race, color, religion, national origin, sex, familial status, or disability. Page 4 of 4