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Sea Breeze Apartments
Apartment Rentals in Gouldsboro, Maine, USA
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207.963.7240
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deeprose@myfairpoint.net
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Name
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First
Last
Phone
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Email Address
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Driver's License Number & State
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Vehicle Make, Model, Color, & Year
License Plate #
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Additional Occupants
List everyone, including minor children who will live with you.
Current Address
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Dates Lived at Address
MM/YYYY to MM/YYYY
Reasons for Leaving
Landlord / Manager's Name and Phone Number
How much was your monthly rent?
Are you employed full-time?
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Yes
No
Are you employed year-round?
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?
Yes
No
Current Name of Employer
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Employer's Phone Number
Name of Supervisor
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Dates employed at this Job:
MM/YYYY to MM/YYYY
Position or Title
Your position or title at this job.
Name of Previous Employer
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Phone Number of Previous Employer
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Name of Supervisor
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Dates employed at this job
MM/YYYY to MM/YYYY
Position or Title
Your position or title at this job.
Your gross (before taxes) monthly employment income
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Other Monthly Income
List any other forms of income you may have. (ie., rental income, payments you receive, royalties, etc.)
Do You or anyone who will live with you smoke?
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Yes
No
Sea Breeze Apartments are Non-Smoking units to include the prohibition of any form of tobacco, vaping, marijuana, or any other substance.
Do you or anyone who will live with you use Drugs?
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Yes
No
Sea Breeze Apartments are Drug-Free units.
Have you ever: (check all that apply)
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Filed for bankruptcy
Been sued
Sued someone else
Been evicted
Been convicted of a crime
I haven't had any of these.
Explain any Criminal Activity, Convictions, or Checked answers above.
Be thorough and complete with your answers, including charge, month and year of convictions if convicted of a crime.
Do you own a pet or animal?
*
?
Yes
No
I'd rather not say.
Do you require a "reasonable accomodation" under the Fair Housing Act? (FHA)
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?
Yes
No
I'd rather not say.
The Fair Housing Act (Title VIII of the Civil Rights Act of 1968) introduced federal enforcement mechanisms. It outlaws: Refusal to sell or rent a dwelling to any person because of race, color, disability, religion, sex, familial status, national origin, or the right to have a service or emotional support animal.
If yes to "reasonable accommodation" please explain.
Emergency Contacts 1:
Please list your Emergency Contacts and phone number.
Emergency Contacts 2:
Please list your Emergency Contacts and phone number.
Personal Reference Name & Phone Number 1
Someone who we may call to ask about you.
Personal Reference Name & Phone Number 2
Someone who we may call to ask about you.
Name
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First
Last
"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND I UNDERSTAND THAT, FALSE STATEMENTS OR DELIBERATE OMISSIONS ON THIS APPLICATION MAY BE GROUNDS FOR DISQUALIFICATION FROM RENTING AT SEABREEZE APARTMENTS OR, IF DISCOVERED AFTER RENTAL BEGINS, COULD RESULT IN TERMINATION OF THE RENTAL AGREEMENT AND SUBSEQUENT EVICTION.
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