Page 4 - 5D.Charlotte.Sydney

Pixel

Pixel

APPLICATION FOR RENTAL
Notice: All adult applicants (18 years or older) must complete a separate application for rental.
The undersigned hereby makes application to rent an Apartment at Pixel.
APPLICANT INFORMATION
LAST NAME FIRST NAME M.I. SSN DRIVER'S LICENSE #
Noels Charlotte 338-92-****
BIRTH DATE PHONE #1 ALTERNATE PHONE EMAIL
4/5/1996 (203) 970-5991 cnoels@colgate.edu
CURRENT ADDRESS
STREET ADDRESS CITY
53 Park Pl New York
STATE ZIP DATE IN DATE OUT MONTHLY RENT
NY 10154 current $3,750.00 / Mo.
LANDLORD NAME LANDLORD PHONE
MYCKI KUJACZNSKI (212) 233-6766
EMPLOYMENT & INCOME INFORMATION
OCCUPATION EMPLOYER/COMPANY SALARY
Associate Blackstone $200,000.00/Yr.
SUPERVISOR SUPERVISOR PHONE START DATE END DATE
Ryan Cullen current
EMPLOYER ADDRESS CITY STATE ZIP
345 Park Ave New York NY 10154
EMERGENCY CONTACT
NAME ADDRESS PHONE RELATIONSHIP
Jessica Noels (203) 803-9590 Mother
BACKGROUND INFORMATION
Have you ever filed for bankruptcy?
NO
Have you ever willfully or intentionally refused to pay rent when due?
NO
Have you ever been evicted from a tenancy or left owing money? If yes, please provide Property Name, City, State, and Landlord Name.
NO
Have you ever been convicted of a crime? If yes, please provide Type of Offense, County, and State.
NO
ADDITIONAL INFORMATION
AQUARIUM? WATERBED? BOAT? MOTORHOME? MOTORCYCLE? OTHER?
NO NO NO NO NO NO

1