ILLINOIS RESIDENTIAL RENTAL APPLICATION

(1 form per applicant)

THE PROPERTY
(TO BE COMPLETED BY LANDLORD)

Property Type: ☐ Apartment | ☐ Condominium | ☐ Home | ☐ Other: ____________________

Property Address: _____________________________________________________________
Beds (#): ____________ Baths (#): ____________ Square Feet (SF): _________________
Lease Type: ☐ Fixed term ☐ Periodic Lease Start Date: ______________ (mm/dd/yyyy)
Pets allowed? ☐ Yes ☐ No Smoking allowed? ☐ Yes ☐ No Parking? ☐ Yes ☐ No
Monthly Rent: $___________________ Application Fee: $___________________

THE APPLICANT

nader abbas abbas khalil saad SSN: _____________________

Applicant’s Full Name: _______________________________ 850355028
11/04/1979
Date of Birth: ______________ (mm/dd/yy ) 8573031844
Phone Number: _______________________
[email protected]
E ail: _____________________________
Photo ID: ☐ Driver’s License ☐ Passport ☐ Other: ____________
S300-6217-9314
ID#: ________________
Additional Occupant(s)? ☐ Yes ☐ No
If yes, describe: _________________________________________________________
Pet(s)? ☐ Yes ☐ No
If yes, describe: _______________________________________________________________

CURRENT RESIDENCE

Property Type: ☐ Apartment | ☐ Condominium | ☐ Home | ☐ Other: ____________________

2203 olen dr, Mahomet, IL 61853
Property Address: _____________________________________________________________
Monthly Rent ($): __________
1250 3
Beds (#): ______ 2
Baths (#): ______ 1200
Square Feet (SF): _______
Lease Start:01/01/2024
______________ (mm/dd/yyyy) 07/31/2024 (mm/dd/yyyy)
Lease End: ______________
Reason for Moving: ____________________________________________________________
job relocation
jsj management
Landlord Name: __________________________________
Landlord Email: [email protected]
_________________________ Landlord Phone: ________________________

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 PREVIOUS RESIDENCE - 1

townhouse
Property Type: ☐ Apartment | ☐ Condominium | ☐ Home | ☐ Other: ____________________
Property Address: 29 beach point pl., boston, Ma, 02125
_____________________________________________________________
2800
Monthly Rent ($): __________ Beds (#): ______
3 1
Baths (#): ______ 1100
Square Feet (SF): _______
06/19/2021
Lease Start: ______________ (mm/dd/yyyy) 12/31/2023
Lease End: ______________ (mm/dd/yyyy)
job relocation
Reason for Moving: ____________________________________________________________
harbor point/CMJ management
Landlord Name: __________________________________
Landlord Email:[email protected]
_________________________ Landlord Phone: 6174360771
________________________

PREVIOUS RESIDENCE - 2

Property Type: ☐ Apartment | ☐ Condominium | ☐ Home | ☐ Other: ____________________

Property Address: _____________________________________________________________
Monthly Rent ($): __________ Beds (#): ______ Baths (#): ______ Square Feet (SF): _______
Lease Start: ______________ (mm/dd/yyyy) Lease End: ______________ (mm/dd/yyyy)
Reason for Moving: ____________________________________________________________
Landlord Name: __________________________________
Landlord Email: _________________________ Landlord Phone: ________________________

CURRENT EMPLOYER

aspen dental
Company Name: ______________________________________________________________
220 west washington street, east peoria, IL, 61611
Employer’s Address: ___________________________________________________________
dentist
Title / Occupation: ________________________
15000
Gross Monthly Income: $__________________ Start Date: 06/24/2024
______________ (mm/dd/yyyy)
kim o conner
Supervisor Name: __________________________________
3193608579
Supervisor Phone: _______________________ [email protected]
Supervisor Email: _______________________

PREVIOUS EMPLOYER

promise health care

Company Name: _____________________________________________________________
819 bloomington Rd, champaign,IL,61820
Employer’s Address: ___________________________________________________________
dentist
Title / Occupation: ________________________
12000
Gross Monthly Income: $__________________ 6
For how long? __________ Months
jennifer henry
Supervisor Name: __________________________________
2173561558
Supervisor Phone: _______________________ Supervisor Email: [email protected]
_______________________

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 VEHICLE(S)

Do you own a vehicle? ☐ Yes (describe below) ☐ No

nissan
Make: ________________________ pathfinder
Model: ________________________ Year:2023
___________
white
Color: _________________ EP888673
Plate #: ___________________ IL
State: ______________________

Do you own a second vehicle? ☐ Yes (describe below) ☐ No

honda
Make: ________________________ odyssey
Model: ________________________ 2012
Year: ___________
Color: _________________
black EQ99222
Plate #: ___________________ State: ______________________
IL

REFERENCES

hesham farag, DDS,BDS

Full Name: _____________________________ Relationship: __________________________
[email protected]
E ail: ________________________________ Phone: _______________________________

eslam mosaad,DDS,BDS
Full Name: _____________________________ Relationship: __________________________
[email protected]
E ail: ________________________________ Phone: _______________________________

Full Name: _____________________________ Relationship: __________________________

E ail: ________________________________ Phone: _______________________________

BACKGROUND INFORMATION

Have you ever been evicted or a defendant in an eviction action? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

Have you ever filed, or are you in the process of filing bankruptcy? ☐ Yes ☐ No
If yes, describe: _________________________________________________________

Do you have any outstanding balances with past landlords? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

Have you ever been asked to move for a lease violation of any kind? ☐ Yes ☐ No
If yes, describe: _________________________________________________________

Have you ever been convicted of a crime? ☐ Yes ☐ No

If yes, describe: _________________________________________________________

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 CONSENT & ACKNOWLEDGMENT

I hereby certify that I am at least 18 years of age and that all information given on this
application is true and correct. I authorize the Landlord and its agents to obtain an investigative
consumer credit report including but not limited to credit history, OFAC search, landlord/tenant
court record search, criminal record search and registered sex offender search. I authorize the
release of information from previous or current landlords, employers, bank representatives, and
personal references. I agree to furnish additional credit and/or personal references upon
request. I understand incomplete or incorrect information provided in this application may cause
a delay in processing which may result in denial of tenancy. This investigation is for resident
screening purposes only and is strictly confidential. I hereby hold Landlord and its agents
free and harmless of any liability for any damages arising out of any improper use of this
information.

Important information about your rights under the Fair Credit reporting Act:
• You have a right to request disclosure of the nature and scope of the investigation.
• You must be told if information in your file has been used against you.
• You have a right to know what is in your file, and this disclosure may be free.
• You have the right to ask for a credit score (there may be a fee for this service).
• You have the right to dispute incomplete or inaccurate information. Consumer reporting
agencies must correct inaccurate, incomplete, or unverifiable information.

Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania
Avenue N.W., Washington D.C. 20580.

In connection with my application for housing, I understand that the property owner/agent may
obtain one or more consumer reports, which may contain public information, for the purposes of
evaluating my application. These consumer reports will be obtained from one or more of the
following consumer reporting agencies:

• Equifax, E.C.I.F., P.O. Box 740241, Atlanta, GA, 30374-0241, (800) 685-1111
• Trans Union, Regional Disclosure Center, 1561 Orangethorpe Ave., Fullerton, CA,
92631, (714) 738-3800
• Experian (TRW), Consumer Assistance, P.O. Box 949, Allen, TX, 75002, (888) 397-
3742

These consumer reports are defined as investigative consumer reports. These reports may
contain information on my character, general reputation, personal characteristics and mode
of living. In connection with my application for housing, I authorize owner/agent to obtain a
consumer report from the consumer reporting agencies listed above.

Application Fee: $__________________

07/19/2024
Applicant’s Signature: __________________________________ Date: ______________

Printed Name: __________________________________

nader saad

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