Dates of Residency: _________________ through ________________________ Amount of Rent $____________ Has Lease Expired? YES NO # of Late or NSF’s none 1 2 3 4 or more (If 4 or more, did they occur within the last twelve months? YES NO Has the individual complied with all community policies? YES NO Does this individual keep an animal on the premises? YES NO Has the animal at any time caused a problem or been a nuisance? YES NO Eligible for re-rental YES NO __________________________ Date, Name and Authority ____________________