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APPLICATION FOR HOUSING Buffalo Creek Commons 1291 Indian Church Rd. #19 West Seneca, NY 14224 Office (716) 677-0963 Fax (716) 712-0870 How many bedrooms are you requesting: 1:____ 2: ____ 1st Floor_____2nd Floor Upper: ____ Please attach a personal check or money order in the amount of $35.00 per applicant over the age of 21, made payable to Buffalo Creek Commons.

HOUSEHOLD INFORMATION (List all the household members including yourself.)

Name Relationship to Head of Household

Gender (M or F)

Social Security Number

Birth date (mm/dd/yyyy)

Marital Status

Student Status

(Y or N) H of H

COPIES OF DRIVERS LICENSE FOR ALL HOUSEHOLD MEMBERS MUST BE ATTACHED TO THIS APPLICATION. Mailing Address: _________________________________________________________________________ Street City State Zip Current Physical Address (if different): ________________________________________________________________________________________+ Street City State Zip Daytime Phone #: ______________ Cell Phone #: _________________E-mail: ________________________ Daytime Phone # ______________ Cell Phone # __________________Email _________________________ Do you have a Pet (Y or N): ______ Description of Pet (type, age, breed, weight):______________________ How did you hear about the property? ________________________________________________________ Were you referred by a current resident at Buffalo Creek Commons? ______ Yes _______ No If yes, please state their name and unit number: ___________________________________ #___________

For Office Use Only Date Received: Time Received:

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PLEASE COMPLETE: Vehicle Information: __ _Vehicle Information: 2nd Vehicle Make: ___________________________________ _______________________________________ Model: ___________________________________ _______________________________________ Year: ___________________________________ _______________________________________ Color of Vehicle: __________________________ ______________________________________ License Plate #: ____________________________ _______________________________________

Have you on anyone on the application ever filed for bankruptcy, or been evicted from housing?__________ Explanation: ________________________________________________________ Are you currently receiving any rental subsidy? _________ Name of agency: _______________________________________________________ Agency Contact & Phone Number: _________________________________________ Subsidy Amount: _______________________________________ Have you or anyone on the application ever been convicted of a crime?__________ Explanation: ____________________________________________________________________________ _______________________________________________________________________________________ INCOME INFORMATION FOR EVERYONE 18 AND OLDER

Current Employment Household Member: _________________________________________________ Place of Employment: _______________________________________________ Supervisor: ________________________________________________________ Start Date: _________________________________________________________ Occupation: ________________________________________________________ Work Phone Number: _______________________________________________ Salary, Gross Monthly: ______________________________________________!

Household Member: _________________________________________________ Place of Employment: _______________________________________________ Supervisor: ________________________________________________________ Start Date: _________________________________________________________ Occupation: ________________________________________________________ Work Phone Number: _______________________________________________ Salary, Gross Monthly: ______________________________________________

Please provide copy of proof of income with this application (example: paystub, social security check, pension statement, investment statement). Also a copy of driver’s license must be submitted at time of application.

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Please provide information on Checking and Savings Accounts: YES NO Checking Accounts?

Household Member Financial Institution Current Balance ____________________ ________________________ ____________________ ____________________ ________________________ ____________________

Savings Accounts? Household Member Financial Institution Current Balance ____________________ ________________________ ____________________ ____________________ ________________________ ____________________

HOUSING HISTORY – PLEASE LIST YOUR LAST 3 LANDLORD’S (If no landlords, list a professional, but non-related, reference) Current Property Name: _____________________ Landlord: ________________ Dates:________ Address: ___________________________________________________________________________ Amount of Rent Paid: ____________Telephone: ________________Fax:______________________ Property Name: _________________________ Landlord: ____________________ Dates:_________ Address: ___________________________________________________________________________ Amount of Rent Paid: ____________Telephone: ________________Fax:______________________ Property Name: _________________________ Landlord: ____________________ Dates: __________ Address: ____________________________________________________________________________ Amount of Rent Paid: _____________Telephone: ________________Fax:______________________ List 3 Professional References: Name:___________________________ Title: _______________Phone Number:________________ Name:___________________________ Title: _______________Phone Number:________________ Name:___________________________ Title: _______________Phone Number:________________ Emergency Contact Information: Please provide the name, relationship of and phone number of the best person to contact in the case of emergency: Name: _________________________ Relationship: _______________ Phone number:_____________________ Name: _________________________ Relationship: _______________ Phone Number: ____________________

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SIGNATURE PAGE I understand that management is relying on this information to prove my household’s eligibility for the rental of an apartment unit at Buffalo Creek Commons and I certify that all information and answers to the above questions are true and complete to the best of my knowledge. I consent to the release of the necessary information to determine my eligibility. I understand that providing false information or making false statements will be grounds for denial of my application. I also understand that such action may result in criminal penalties. I authorize my consent to have management verify the information contained in this application for purposes of proving my eligibility for occupancy. This includes calling through the Landlord and professional references I have provided, as well as electronically running a credit report and criminal background check on all persons 18 years of age and older included on this lease. I will provide all necessary information including source names, address, phone numbers, accounts numbers where applicable and other information required for expediting this process. I understand that my occupancy is contingent on meeting management’s criteria for occupancy at the property. ALL HOUSEHOLD MEMBERS 18 AND OVER MUST SIGN ____________________________________________________ ____________________________ Head of Household Date ____________________________________________________ ____________________________ Applicant Date ____________________________________________________ ____________________________ Applicant Date