BOSTON COURT APARTMENTS

275 Manship Street
Jackson, Mississippi 39202
(601) 969-1895
 
RENTAL APPLICATION

The information collected below will be used to determine whether you qualify as a tenant. It will not be disclosed without your consent except to your employer(s) for verification of income and employment and to financial institutions for verification of assets, and as required and permitted by law. You do not have to provide the information, but if you do not your application may be delayed or denied.
 
Applicants Name:    Social Security Number:     Home Phone:  
Present Address:     City:     State:     Zip Code:  
Number Of Years At Present Address:  
Former Address (If present less than 2 years):  
City:    State:   Zip Code: 
Number Of Years At Former Address:  
Name/Address Of Employer: 
Type Of Business:  Self-Employed?  Yes No
Business Phone Number:   Position/Title:   # Yrs. On Job: 
Name and Address of Previous Employer (if present position less than 2 yrs.) 
Number Of Years Employed   Business Phone 
 
 
Co-Applicants Name:    Social Security Number:     Home Phone:  
Present Address:     City:     State:     Zip Code:  
Number Of Years At Present Address:  
Former Address (If present less than 2 years):  
City:    State:   Zip Code: 
Number Of Years At Former Address:  
Name/Address Of Employer: 
Type Of Business:  Self-Employed?  Yes No
Business Phone Number:   Position/Title:   # Yrs. On Job: 
Name and Address of Previous Employer (if present position less than 2 yrs.) 
Number Of Years Employed   Business Phone 

Annual Income
Source Applicant Co-Applicant Other Household Members
18 or Older
Total
Salary    Job 1
Salary    Job 2
(if needed)
Overtime Pay
Commissions
Fees
Tips
Bonuses
Interest and/or Dividends
Net Income From Business
Net Rental Income
Social Security, Pensions,Retirement Funds, etc., received periodically
Unemployment Benefits
Workers Compensation
Alimony, Child Support
Other

TOTAL:

 
 
Assets Cash Value Income From Assets Bank Name Account Number
Cash On Hand
Checking Account
Savings
Credit Union



HOUSEHOLD COMPOSITION
List the head of your household and all members who live in your home.
Give the relationship of each family member to the head.
Member # Full Name Relationship Date Of Birth Social Security # Full-Time
Student
(yes/no)
H.O.H.
2
3
4
5
6
7
8
9
10

Does anyone live with you now who is not listed above?     Yes No

Does anyone plan to live with you in the future who is not listed above?     Yes No

Please explain if you answer "Yes" to either question above.

Has any household member ever been covicted of a felony?     Yes No

If yes, give a brief explanation.

Are ALL household members full-time students?     Yes No

If you answered YES to the above question does the household qualify for one of the following exceptions?

Yes No

1. Married and filing a joint tax return.

Yes No

2. Single parent(s) with minor child(ren) and both the parent(s) and child(ren) are not a
    dependent of a third party.

Yes No

3. At least one member of the household receives assistance under Title IV
    of the Social Security Act (i.e., AFDC assistance).

Yes No

4. At least one member of the household is enrolled in a job training program
    receiving assistance under the Job Training Partnership Act,
    or similar federal, state, or local laws.
 

How many autos (including company car) will you keep at the address?

Make/Model of Car

Year

License No.

Applicant's License No.          Co-Applicant's License No.   
 

Please list 3 references who can vouch for your character (only one can be a family member).

Name

Address

Phone #

Relationship

The information provided on these pages are true and complete to the best of my knowledge and belief. I/We consent to the disclosure of income and financial information from my/our employer and financial references for purposes of income and asset verification related to my/our application for tenancy.

Applicant         Date   

Co-Applicant         Date   

 
 

EQUAL HOUSING OPPORTUNITY


We encourage and support the nationís affirmative housing program in which there are no barriers to
obtaining housing because of race, color, religion, sex, national origin, handicap or familial status.