Centerline Park Towers Apartments

8033 E. 10 Mile Rd.

Application
Center Line, MI 48015 For Occupancy
Phone: 586-755-2270
Fax: 586-755-1536
Date Received: ________________

Application #: _________________
All household members ages 18 and over MUST complete a separate application. Please complete all sections leaving
no blank areas and sign the last page.

Name: Street Address:

City: State: Zip:

Home Phone: Work Phone: Email Address:

Marital Status: □ Married □ Single □ Widow □ Living apart

Emergency Contact: Name:_________________________Relationship:__________________Phone Number:______________

What size apartment are you looking for? (Please Circle) 1 Bedroom 2 Bedroom Other:________________________

How did you hear about us? ___________________________________When do you expect to move?___________________

What is your reason for moving? ________________________________________

Household Information
List all the persons (including yourself) who will occupy the apartment:
Full Name Relationship Soc. Sec. # Birthdate Sex

1. Head of Household

2.

3.

4.

5.

6.

7.

For Each Household Member list all states in which they previously resided
Name States Resided in
1.________________________________________________________________________________________________________________________________________________________________________
2________________________________________________________________________________________________________________________________________________________________________

3 ________________________________________________________________________________________________________________________________________________________________________.

4.________________________________________________________________________________________________________________________________________________________________________

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Do you have any pets? (Please Circle) Yes No If Yes, please describe: ______________________________
_________________________________________________________________________

Is anyone in the household a full-time or part-time student? Yes or No (circle one) If yes, list below
List all persons in household who are full-time or part-time students:

Full Name Name and Address of School Phone Period of Enrollment

_______________________________

_______________________________

1.

_______________________________

_______________________________

2.

_______________________________

_______________________________

3.

Housing Status
Do you have need of accessible features such as lowered sinks, wider doorways, etc.? (Please Circle) Yes No

Do you own the home you are currently living in? [ ] Yes [ ] No; If yes, then skip down below to the question: “How long have
you lived at this address”.

Present Are you sharing Is the apartment

Landlord: your apartment? lease in your name?
[ ] Yes [ ] No [ ] Yes [ ] No

Address of Street City/State Landlord

Landlord: Telephone Number:
( )

Monthly Average Size of

Rent: Utility Bill Present
(If you don’t contribute to the monthly rent, Per Month: Apartment:
please write “0”)
Do you pay your own rent? If not, who does? Is your landlord a relative? Do you currently have a Section 8 voucher?
[ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No
_______________________________________________________________________________________________________________________________
How long have you lived at If you have lived at your current address less
this address? than 3 years what was your previous address?
___________Years _____________Months Provide below.

Name of
Previous Landlord:

Address of Street City State Zip

Previous Landlord:

Previous Landlord's Previous

Telephone Number: Rent:

Reason for moving

From previous address:

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Income from Employment
List all full and/or part time employment for all household members. Include self-employment earnings.
See below for non-employment sources of income.

Household Member's Name Occupation Name and Address of Employer Length of Gross Earnings Before Taxes
Employment

_______________________________ ______________

_______________________________ ______________

1. $ _________per_____________

_______________________________ _______________

_______________________________ _______________

2. $ _________per_____________

_______________________________ ______________

_______________________________ ______________

3. $ _________per_____________

_______________________________ _______________

_______________________________ _______________

4. $ _________per_____________

Income from Other Sources

(Examples: Social Security, S.S.I., AFDC/TANF, pension, disability compensation, unemployment compensation, interest, baby sitting, caretaking,
alimony, child support, annuities, dividends, income from rental property, Armed Forces reserves, regular and service pay), cash contributions:

Household Member's Name Type of Income Gross Amount Before Deductions

1. $ ___________ per ______________

2. $ ___________ per ______________

3. $ ___________ per ______________

4. $ ___________ per ______________

Assets
Complete each category as applicable.

Checking Bank Account Number Balance

Accounts:
1. $ _____________________

2. $ _____________________

Savings Bank Account Number Balance

Accounts:
1. $ _____________________

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 2. $ ____________________
_______________________________________________________________________________________________________________________________
Passbook Savings/Money Market Account and/or Certificate of Deposits (CD)

1. $ _____________________

2. $ _____________________
IRAs, 401K, Annuity

1. $ _____________________

2. $ _____________________
Stocks and Bonds Savings Bonds
Value: Value:
$ ______________________ $ __________________

Others: Others:

Value: Value:
$ ______________________ $ __________________

Life Insurance: Amount:

 Whole  Universal  Term

1. $ _____________________

2. $ _____________________

Do you NOW own real estate? If "yes," what is the value?

 Yes  No
$ _______________

Have you EVER owned real estate? If "yes," when?

 Yes  No
_______________________________________________________________________________________________________________________________
Has any adult household member sold, given away, or otherwise disposed of any assets during the past two years?  Yes  No

If yes, list each asset and the amount received for each asset: ______________________________________________________________________

Childcare and Medical Expenses

Do you pay for babysitting while you or any other adult family If "yes," list babysitter's
member are employed?  Yes  No name, address and telephone number:

Names of those children ___________________________________________ _______________________________________________________

requiring the service: ___________________________________________ _______________________________________________________
___________________________________________ _______________________________________________________

What is the cost of babysitting?

$ per _________ week OR $ _________ per month

If you are 62 or older, or handicapped, or disabled, do you If "yes," amount

anticipate any health care related expenses for the next 12 months
which are not covered by any insurance plan?  Yes  No

Amount of monthly medicare deduction: $ ______________________ Cost of other medical insurance $ ___________ per ______________

Program and Other Information

Do you presently reside in a development where your rent is If "yes," please explain:
based upon your income?  Yes  No

Were you or any member of your household ever convicted of a crime? If yes, when? Explain circumstances briefly.

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_______________________________________________________________________________________________________________________________
Are you or any member of your household subject to a lifetime state sex offender registration program in any state?

_______________________________________________________________________________________________________________________________
Is any member of your family a military veteran? If yes, which branch?

Have you or any member of your household ever been evicted? If yes, when? Explain circumstances briefly.

Have you or any member of your household ever committed fraud? If yes, when? Explain circumstances briefly.

Do you have any vehicles? (Please Circle) Yes No

If Yes, please provide make, model, color and license plate: ____________________________________________________

The following information is required for statistical purposes so that the Racial Group Identification (Used for statistical purposes only).
U.S. Department of Housing and Urban Development may determine the Please check the one group which identifies the head of household:
degree to which its programs are utilized. This information must be
completed. It will not affect the processing of this application. White (Non Hispanic Origin): ____________

Black (Non Hispanic Origin): ____________

Hispanic: ____________

American Indian: ____________

Alaskan Native: ____________

Asian or Pacific Islander: ____________

I acknowledge that a credit background check of all adult household members will be part of the application process and I authorize that check. By
signing below, I also acknowledge that, upon clearing a credit background check, a further criminal background check will be required of all adult
household members.

Signature of applicant: ________________________________________________ Date: _________________________________

WARNING: MISLEADING WILLFUL FALSE STATEMENTS, MISREPRESENTATIONS, OR INCOMPLETE INFORMATION IN THIS APPLICATION
WILL BE GROUNDS FOR REJECTION OF THIS APPLICATION.

I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Signature of applicant: ________________________________________________ Date: _________________________________

An Equal Housing Opportunity

Rental Application for Residents and Occupants

1. Criminal and Rental History Sections are now two (2) separate sections
a. Rental History (to be completed by all applicants)
b. Criminal History (do not complete this section if the unit for which you are apply is located in Detroit)

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NEW DISCLOSURE FOR DETROIT APPLICANTS

Detroit Fair Chance Housing Ordinance. Pursuant to Chapter 26, Article V, of the 1984 Detroit City Housing Code, we will not
inquire about or request that you disclose your criminal conviction history until we have determined your qualification to rent the unit
for which you are applying under all other rental criteria not related to potential past criminal convictions or an unresolved arrest. Once
we have determined your qualification to rent the unit for which you are applying under all other rental criteria not related to potential
past criminal convictions or an unresolved arrest, we will then perform a criminal conviction history review.

Adverse Action Based on Criminal Conviction History. You will be notified of any prospective adverse action and the items
forming the basis for the prospective adverse action prior to us taking such action if we intend to base the adverse action related to
eligible housing on an item or items in your conviction history. We will also provide you with a copy of your background check
report. 

You have fourteen (14) calendar days from the notice referenced above to provide us with evidence, in writing, of the inaccuracy of
the item(s) of your conviction history or evidence of rehabilitation or other mitigating factors. 

We will delay any adverse action for a reasonable period of not less than five (5) calendar days after receipt of the information to
reconsider the prospective adverse action in light of the information you provide. Once a determination has been made, we will
promptly notify you of any final adverse action based upon your conviction history or contents of your criminal background check.

For Office Use Only For Office Use Only

Applicant name: _____________________________________ Applicant Verification Code:____________________________________

Did the applicant pass a credit background check ?___ Yes ___No Date of Verification: _________________________

Date:_________________________ Signature of Verifier:_________________________

I acknowledge that a criminal background check of all adult household members will be part of the application process and I authorize that check.

Signature of applicant Date

WARNING: MISLEADING WILLFUL FALSE STATEMENTS, MISREPRESENTATIONS, OR INCOMPLETE INFORMATION IN THIS APPLICATION
WILL BE GROUNDS FOR REJECTION OF THIS APPLICATION.

I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

Signature of applicant: ________________________________________________ Date: _________________________________

Centerline Park Towers Apartments does not discriminate on the basis of disability in the admission
or access to, or employment in, its federally assisted programs and activities.

Continental Management does not discriminate on the basis of disability in the admission or access to, or treatment or employment in, its federally assisted
programs and activities. The person named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of
Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988). Senior Vice President, Continental Management,LLC,32600
Telegraph, Bingham Farms, MI 48025 (248) 731-7806MI TTY 1-800-649-3777.

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