TIMOTHY PARK RENTAL APPLICATION

Each apartment may not be occupied by more than one family or three individuals. In the case of 
individuals, each must complete a rental application.

A $25.00 nonrefundable application fee is required for processing of each application. All information 
must be completed for processing of application.

No pets are permitted

Mail completed application to Timothy Park, 1000 East Harvest Loop, Ellensburg WA 98926

APPLICANT

Name (last,first,middle):		
Birthdate:						
Social Security #:
Driver’s License # (State & Number):
Present Address:
Phone: 						
E-mail: 						

Co-signer’s Name (last,first):
Birthdate:				
Social Security #:
Driver’s License # (State & Number):				
Date Occupancy Desired:
Unit Desired: 					

Employer:
Contact Name:
Address:
Phone: 						
Years Employed:
Months:
Annual Income:
Other Income: 					

Name(s) of other persons living with you: 									
Emergency Contact:
Relationship: 					
Address:
Phone: 						

Personal Reference #1:
Relationship: 					
Address:
Phone: 						

Personal Reference #2:
Relationship: 					
Address:
Phone: 							


Have you ever been evicted (y/n)?
Have you ever been convicted of a crime (y/n)?
Have you ever had a judgment of any kind entered against you by any court of law (y/n)?

List last two (2) previous addresses other than your current address:
Street:
Apt #:
City, State, Zip:

Street:
Apt #:
City, State, Zip:

Vehicle Make:
Model:
Year:		
License Plate: 	

I have a physical or mental handicap (y/n explain if yes): 							
I will not keep or harbor pets of any kind on the premises without the permission of the landlord (y/n):



I, the undersigned, certify that all information on this application is true and correct. I understand that this 
application, should I be accepted as a tenant, will become a part of my Rental Agreement. I also 
understand that a false or willfully omitted statement on this application will be at the option of the 
owner/agent, grounds for cancellation of the rental agreement.

I hereby give my permission for a complete screening of my application by a screening company as the 
owner/agent may select. I understand that if my application is denied, I will receive notification in writing.

Signature of Applicant:

Date: 				


Signature of Co-Signer:			

Date:				
									




OFFICE USE ONLY

VERIFICATION ID: 	
APPLICATION APPROVED:
APPLICATION APPROVED WITH CONDITIONS (LIST): 					
								
									
	
APPLICATION DENIED:
LEASING AGENT SIGNATURE:
DATE: