M&P Plus 3, LLC

Application for Rental

(660-853-8441)
Married persons may complete a joint application. Single/Unmarried persons must each complete a separate application.

PLEASE PRINT – all information must be complete. All blanks must be filled in. The decision to rent to you will depend in great
part on the information or lack thereof included below. Only clean, responsible people who pay rent on time need apply.

How did you find out about us? Sign[___] Newspapaer/Ad[___] Local Realty[___] Internet[___] Friend[___] Other[___]

Personal Information

Full Name:_Jeffrey Daniel Boulay_________________________________________ Phone:__4026571205______________

Work Phone:____________________

S.S.N. __508________-__37________-_7245_________ Current Driver’s License #H13636680__________________________

State:__Nebraska____________

Present Address:_917 Centennial Drive_____________________________ City:_Maryville____________________

State:_MO__________ Zip:__64468___________

How Long? __8 months__________ Landlord/Manager Name:_Northwest Missouri State

University_____________________________ Phone Number:_6605621212________________

Why are you leaving?___I do not want to live on campus

anymore.___________________________________________________________________________________

________________________________________________________________________________________________________

Current Rent $ _1,000________________

Previous Address:_5709 South 166th Avenue Circle_____________________________ City:___Omaha__________________

State:_NE__________ Zip:_68135____________

How Long? __18 years__________ Landlord/Manager Name:_Mom & Dad_____________________________ Phone

Number:_4028961374________________

Why did you?__Going to

college__________________________________________________________________________________________

________________________________________________________________________________________________________

Rent Payment $ __Unknown_______________

Present Employer: _None______________________________ Position: ____________________________ How

long?____________

Address: ________________________________Contact Person: ______________________ Phone:_______________________

Gross Monthly Income before deductions $__________________ Other Income $_________________ Source______________

Former Employer: _Lori______________________________ Position: __Manager__________________________ How

long?__4 months__________

Address: __12152 L Street______________________________Contact Person: ______________________

Phone:_4023304140______________________

Gross Monthly Income before deductions $__________________ Other Income $_________________ Source______________

Why did you leave? _______________________________________________________________________________________

Have you ever been evicted? Yes{ } No{Nope } Have you ever had a foreclosure/repossession? Yes{ } No{Nope }

If yes, date:_______________________ Explain:________________________________________________________________

Have you ever filed for bankruptcy? Yes{ } No{ Nope }. If yes, Chapter 7{ } or Chapter 13{ }.
Date:_________________________

Explain:__________________________________________________________________________________________________

Have you ever been convicted of a crime other than a traffic violation? Yes{ } No{Nope }. If yes, explain:
________________________________________________________________________________________________________

Spouse Information

Full Name:__________________________________________ Phone:________________ Work Phone:____________________

S.S.N. _________-__________-__________ Current Driver’s License #__________________________ State:________________

Present Employer: _______________________________ Position: ____________________________ How long?____________

Address: ________________________________Contact Person: ______________________ Phone:_______________________

Gross Monthly Income before deductions $__________________ Other Income $_________________ Source______________

Former Employer: _______________________________ Position: ____________________________ How long?____________

Address: ________________________________Contact Person: ______________________ Phone:_______________________

Gross Monthly Income before deductions $__________________ Other Income $_________________ Source______________

Why did you leave? _______________________________________________________________________________________

Have you ever been evicted? Yes{ } No{ } Have you ever had a foreclosure/repossession? Yes{ } No{ }

If yes, date:_______________________ Explain:________________________________________________________________

Have you ever filed for bankruptcy? Yes{ } No{ }. If yes, Chapter 7{ } or Chapter 13{ }. Date: ___________If yes, explain:
________________________________________________________________________________________________________

Have you ever been convicted of a crime other than a traffic violation? Yes{ } No{ }. If yes, explain:
________________________________________________________________________________________________________

Personal References
List 2 persons, OTHER THAN YOUR RELATIVES, that we may contact to verify your character

Name _Max Pawlowski___________________________________ Relationship Friend______________________ Phone #

6605410621______________________

Address ______________________________________ City__Maryville_____________________ State_MO_________ Zip

_____________

Name __Jake Shonka__________________________________ Relationship_Friend_____________________ Phone #

_14023679416_____________________

Address ______________________________________ City__Maryville_____________________ State_MO_________ Zip

_____________

Emergency Contacts
List 2 persons we may contact in an emergency, starting with your nearest relative.

Name__Ann Boulay_______________________________ Relationship _Mother________________________Phone

__4026572825______________________
Address______________________________________ City________________________ State____________ Zip____________

Name__David Boulay_______________________________ Relationship _Father________________________Phone

_4026572826_______________________

Address______________________________________ City________________________ State____________ Zip____________

I declare that this application is complete, true and correct and I herewith give my permission for anyone contacted to release the personal or
credit information of the undersigned applicant to Management or their authorized agents, at any time, for the purposes of entering into and
continuing to offer or collect on any agreement and/or credit extended. I further authorize Management, or their authorized agents, to verify
the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers
and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement
entered into with Management. Any false information will constitute ground for rejection of the application, or Management may at any
time immediately terminate any agreement entered into in reliance upon misinformation given on this application.

Applicant’s Authorization:__Jeffrey Boulay_______________________________ Spouse’s Authorization:

____________________________

Date:_4/16/2018_____________________ Date:___________________________