|Have you ever filed a petition for bankruptcy? Have you ever been evicted from any tenancy or had an eviction notice served on you?
Have you ever willingly and intentionally refused to pay any rent when due?
Have you ever been convicted of a misdemeanor or felony other than a traffic or parking violation?
Are you current illegal abuser or addict of a controlled substance?
Have you been convicted of the illegal manufacture or distribution of a controlled substance?
If yes to any of the above, please indicate date & nature of occurrence:
I DECLARE THAT THE FOREGOING IS TRUE AND CORRECT, AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF A CREDIT REPORT. I agree to pay the landlord a non-refundable screening fee not to exceed $30.00. I understand that I am entitled to a copy of any consumer credit report obtained by the Landlord. I further agree that the Landlord may terminate any agreement entered into in reliance on any misrepresentation made above.