Rental Applicaton Rental Application ApplyProperty Address example: 22 Hamilton St SW #33Full Name Reginald F. Lewis Applicant Type*Lease HolderOccupantGuarantor/Co-SignerPersonal InformationAlias Used (If Applicable) PhoneEmail Birth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Social Security Number555-55-5550Please upload an image of your ID or Drivers License*Max. file size: 100 MB.Please upload an image of your Social Security Card*Max. file size: 100 MB.Please upload your voucher/subsidy Drop files here or Select files Max. file size: 100 MB. Please upload your proof of income (SSI, TANF) Drop files here or Select files Max. file size: 100 MB. Marrital StatusSingleMarriedDivorcedMarried SinceMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Current Spouse Name First Last Divorced Since MM slash DD slash YYYY Former Spouse Name First Last Rental HistoryCurrent Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Contract Rent $Owner/Management Name Email PhoneSince*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is Your Rent Up To Date?*YesNoPlease explain* Why are you leaving? Have you given notice?YesNoHave you been asked to leave?*YesNoDid the Owner/Management issue you a 30 Day Notice to Correct/Cure or Vacate?YesNoPlease explain why Former Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Length Of Stay 4/29/95-7/22/18Total Contract Rent $Email Former Owner Management name PhoneWas your rent up to date?YesNoPlease explain Reason for leaving Did you give a notice?YesNoWere you asked to leave?YesNoDid the Owner/Management issue you a 30 Day Notice to Correct/Cure or Vacate?YesNoPlease explain.. OccupantsName First Last Relationship BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name First Last Relationship BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name First Last Relationship BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name First Last Relationship BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name First Last Relationship BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PetsDISCLAIMER: All pets must be authorized by DaDukes LLC, in writing, prior to occupying the rental unit. Any tenant found with an unauthorized pet will be subjected to an immediate 30 Day Notice to Correct or Vacate and will be penalized a fee not to exceed $2,000.00.Do you have pets?YesNoTotal PetsType/breed & size/weight Type/breed & size/weight Housing Subsidy Voucher HoldersVoucher/Subsidy Type DCHA (Unexpired Voucher) DBH DHS Rapid Rehousing Other Case Manager Name First Last Case Manager's Email Case Manager's PhoneEmploymentCurrent Employer Dates Emplyoyed 7/22/18-Present Street/City 11th St NW/Washington D.CPosition Annual IncomeSupervisor Weekly Work Hours1-1111-2121-4040+Employer’s Phone #Employer’s Email ReferenceNon-Relative Reference First Last How are you acquainted? PhoneEmergency Contact First Last How are you acquainted? CreditHas any signer ever sued for bills?YesNoHas any signer everfiled for bankruptcy?YesNoHas any signer ever been sued for eviction?YesNoHas any signer ever broken a lease?YesNoHas any signer ever been guilty of a felony?YesNoAre you or any person who will occupy the rental unit currently under the supervision of a parole or probation officer?YesNoParole Officer/Probation Officer Name PhoneHas any signer or any person who will occupy the unit a registered sex offender?YesNoDate and location of registeration Authorization and Certification1)I, the undersigned applicant, authorizes DaDukes LLC (hereinafter known as “DaDukes) to contact past and present landlords, employers, creditors, credit bureau, neighbors and any other sources deemed necessary to investigate me. All the information is true, accurate and complete to the best of my knowledge. I am aware that DaDukes reserves the right to disqualify me if the information is not as represented. 2)I, the undersigned applicant, certify under penalty of perjury, that all information provided is correct and complete and hereby authorize DaDukes to conduct a credit check, background check and make any inquiries DaDukes feel necessary to evaluate my tenancy and credit standing. I understand that giving incomplete or false information is grounds for rejection of this application. I am aware that if any information is supplied on this application is later found to be false, this is grounds for termination of tenancy. The applicant has the right to dispute the accuracy of any information provided to DaDukes by the screening service or credit reporting agency. Rental Verification Authorization (Please Initial Below)* DISCLAIMER: In the event DaDukes is unable to obtain written or verbal rental verification from your current and/or previous landlord within 5 business days after initiating the request, DaDukes reserves the right to disqualify you on the grounds of not being able to fully process your application.Hold Harmless and Indeminification (Please Initial Below)* HOLD HARMLESS AND INDEMNIFICATION: I, the undersigned applicant, declare that I shall indemnify and hold harmless DaDukes LLC, its agents, successors and/or assigns from and against all claims, causes of action, damages, losses, and expenses including but not limited to attorney’s fees, legal cost, and expenses arising out of, or resulting from any legal matters associated or may arise out of DaDukes’s disqualification and/or denial of my rental application.Please Write Your Full Name Below* ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME. Date of CompletionMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Δ