UNITY PROPERTY MANAGEMENT

1217 N. West Street
Jackson, Mississippi 39202
(601) 969-1895 ?(601) 969-5300 fax


 

Date:  
 
 
GENERAL INFORMATION




 
Applicants Name:      Social Security #    
Street Address:          Apartment Number:  
City:        State:        Zip:  
Daytime Phone #        Home Phone #  
Cellular Phone #  
Marital Status (check one) Single Separated Divorced Married
Reason For Wanting To Leave?


Co-Applicants Name:      Social Security #    
Street Address:          Apartment Number:  
City:        State:        Zip:  
Daytime Phone #        Cellular Phone #  


Bedroom Size Requested:   1 Bedroom 2 Bedroom 3 Bedroom
Type Dwelling:   House Apartment

If a house or an apartment is not available at this time would you like to be placed on our waiting list?
Yes No



 

INCOME INFORMATION



1.    Employment wages or salaries? (include overtime, tips, bonuses, commissions and payments received in cash). All income must be verifiable.
       Household Member:     Name Of Company:  
       Amount:  

       Household Member:     Name Of Company:  
       Amount:  

 
2.    Self-employment? (include overtime, tips, bonuses, commissions and payments received in cash).
       Household Member:     Type Of Business:  
       Amount:  

       Household Member:     Type Of Business:  
       Amount:  

 
3.    Regular pay as a member of the Armed Forces?
       Household Member:     Base Name & Branch:  
       Amount:  

       Household Member:     Base Name & Branch:  
       Amount:  

 
4.    Unemployment benefits or workmanís compensation?
       Household Member:     Contact Person:  
       Amount:  

       Household Member:     Contact Person:  
       Amount:  

 
5.    Public Assistance (TANF or Food Stamps).
       Household Member:     Contact Person:  
       Amount:  

       Household Member:     Contact Person:  
       Amount:  

 
6.    Child support or Alimony?
       Household Member:     Payer:  
       Amount:  

       Household Member:     Payer:  
       Amount:  

 
7.    Social Security, SSI, Veteranís benefits, or Pensions.
       Household Member:     Source Of Benefit:  
       Amount:  

       Household Member:     Source Of Benefit:  
       Amount:  



 

ASSET INFORMATION



Checking or savings account?
       Household Member:     Source Of Benefit:  
       Amount:  

       Household Member:     Source Of Benefit:  
       Amount:  



 

ADDITIONAL INFORMATION



1.    Will you or your household be receiving Section 8 rental assistance at time of move-in?    Yes No
       Name Of Agency:     Contact Person:  

 
2.    Have you or any household member ever been convicted of drug use or manufacture, or any other felony? Yes No
       If yes, explain.
      

 
3.    Have you or your household member ever been evicted from any housing? Yes No
       If yes, explain.
      



 

HOUSEHOLD INFORMATION



List all household members that are applying to live in this unit with you.
Name Relationship To Head Of Household Male/Female Social Security # Birthdates
Do you expect any additions to the household within the next 12 months?   Yes No
Name and relationship:  
Explanation:  



 

REFERENCE INFORMATION



CURRENT LANDLORD
Name:  
Address:  
Home Phone:      Business Phone:  

PREVIOUS ADDRESS
Previous Landlord Name:  
Address:  
Home Phone:      Business Phone:  
How long did you reside in housing?  
Reason For Leaving?

THREE REFERENCES Only ONE can be a family member. The other two have to be non-family members.

Name:  
Address:  
Phone:  

 
Name:  
Address:  
Phone:  

 
Name:  
Address:  
Phone:  



 

VEHICLE IDENTIFICATION



List vehicle information for all vehicles that are owned or operated by any household member.
Vehicle 1
Tag/License Plate #:      State Issued:  
Make/Model/Year:  
Vehicle 2
Tag/License Plate #:      State Issued:  
Make/Model/Year:  



 

EMERGENCY CONTACT



List someone in the area that is not already on the application.

Name:  
Address:  
Phone:      Relationship:      Years Known:     



 

SIGNATURE CLAUSE



I understand that management is relying on this information to prove my householdís eligibility for housing. I certify that all information and answers to the above questions are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility. I understand that providing false information or making false statements may be grounds for denial of my application.
 
I authorize my consent to have management verify information contained in this application for purposes of proving my eligibility for occupancy. I will provide all necessary information including source names, addresses, phone numbers, and account numbers where applicable and any other information required for expediting this process. I understand that my occupancy is contingent upon meeting managementís resident selection criteria and requirements.
 
It is understood that this application is not a rental agreement/lease and that applicant has no rights to a property until a written Rental Agreement/Lease is duly executed after the approval of this application.
 
A non refundable $15.00 fee to process this application is to be given by applicant when this application is turned in for processing. Money orders or cashiers check required.

 

All ADULT household members must sign below:

Signature:   Date:  
Signature:   Date:  
Signature:   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.