WELCOME HOME TO OUR COMMUNITY! - media.apts247.info · SALEM VILLAGE APARH1ENTS 3510 Broadway...

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SALEM LLAGE APARTS 3510 E. Broadway Periand, Tas 77581 281-485-4866 281-485-4524 WELCOME HOME TO OUR COMMUNITY! Below is a list of important and helpful numbers to assist you with your move. Rhino Solutions Green Mountain Reliant Energy TXU Energy NO DISH ALLOWED Comcast Police Department Municipal Cou Schools: Harris Elementary Alexander Middle School Pearland Jr. High East Pearland High School 2314 Schleider Drive 3001 Old Alvin R d 2315 Old Alvin Rd 377S South Main Your scheduled move in date is ____ _ Monthly rent 2mount due on the 1 st every month ___ _ _ Prorated rent due upon move in is _____ _ 281-786-1125 1-866-767-5817 1-866-222-7100 1-800-711-9112 713-341-1000 281-997-4100 281-652-1608 281-485-4024 832-736-6700 281-485-2481 281-997-7445 Your new address is 3510 East Broadway # ____Pearland, Texas 77581 Deposit _____ _ Date paid _______ _ Admin Fee.____ _ Date paid, ________ (Non-refundable} App Fee._____ _ Date paid. ________ (Non-refundable) ___ I understand that my APPLICATION AND ADMINISTRATION FEE are NON REFUNDABLE and will NOT be refunded if J have a FELONY or EVICTION !'LEASE NOTE: Money orde r s REQUIRED at Initial lease and Move In. ONCE YOUR APl'LICAT101' HAS BEEN APPROVED TUE DCOSIT JN NON - REFUNDAULE.

Transcript of WELCOME HOME TO OUR COMMUNITY! - media.apts247.info · SALEM VILLAGE APARH1ENTS 3510 Broadway...

Page 1: WELCOME HOME TO OUR COMMUNITY! - media.apts247.info · SALEM VILLAGE APARH1ENTS 3510 Broadway Pellriand, Texas 77581 281-485-4866 281-485-4524 WELCOME HOME TO OUR COMMUNITY! Below

SALEM VILLAGE APARH1ENTS 3510 E. Broadway

Pellriand, Texas 77581 281-485-4866281-485-4524

WELCOME HOME TO OUR COMMUNITY!

Below is a list of important and helpful numbers to assist you with your move.

Rhino Solutions

Green Mountain

Reliant Energy

TXU Energy

NO DISH ALLOWED

Comcast

Police Department

Municipal Court

Schools:

Harris Elementary

Alexander Middle School

Pearland Jr. High East

Pearland High School

2314 Schleider Drive

3001 Old Alvin Rd 2315 Old Alvin Rd

377S South Main

Your scheduled move in date is ____ _

Monthly rent 2mount due on the 1st every month ____ _

Prorated rent due upon move in is _____ _

281-786-1125

1-866-767-5817

1-866-222-7100

1-800-711-9112

713-341-1000

281-997-4100

281-652-1608

281-485-4024

832-736-6700

281-485-2481

281-997-7445

Your new address is 3510 East Broadway # ____ Pearland, Texas 77581

Deposit _____ _ Date paid _______ _

Admin Fee. ____ _ Date paid, ________ (Non-refundable}

App Fee. _____ _ Date paid. ________ (Non-refundable)

___ I understand that my APPLICATION AND ADMINISTRATION FEE are NON REFUNDABLE and will

NOT be refunded if J have a FELONY or EVICTION

!'LEASE NOTE: Money orders REQUIRED at Initial lease and Move In. ONCE YOUR APl'LICAT101' HAS BEEN APPROVED TUE DCl'OSIT JN NON-REFUNDAULE.

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SALEM VILLAGE RE?fl'AL CRITERIA

The follm,,jng items make up t�e Rental Standards wbicll ar.e to be follo\'\·et.l by aU cmployecs :.nid n:side:o1S; Avail�bility oflhe specific apMtID.errt Monthly g,ross income cqu.11 IO 3 time!'> monlhl)' nmt Com�lete a credit check and criminal ltistof"J

o Credit Bureau -Minimum 3 �ounLc; in good standing. -No bad c:r fate �)' record -No criminal 11c1iviry -Good bank record o Bon�

Employml!'llt -Miulmum 6 months v:iili th<:: same company. -Previous employment over i year.

P�ut Address �Prompt paymeut rec-ord wlth su:H'icicnt notice givt:n. -Previous f�(Jl<le11.ce- mh1imum .snti..jfnctory 6 w 9 months

lncome; '.V�kly, bi-weekly� or mcntii iy �lt!I)' -:i No aHow<1.nce Fron, parents o !'i:<J �hok1.rships, �tudy ;ubsidfc:s, ett:-. o Na inc,;ns:isteni. incc.mc:

No folsiG�tion of inform:itioa on rental .-pp!h::adon. Only I� ye.1rs or otder cnn ilpply. No more: rlum 2 n!s�dents in a I bedrnclll :ipan:mem. No rr..o-;e th<.n 4 resid�n1..> l..1. a 2 be<lroo1-;1 a:pDimlcnt. No more than 5 n::siden.ts ·ma 3 bedroom apartment Rem )s tluo 'and payable by the first of-each month. Pmi:d p.�yml!ntS .?re not ac.crpted. Roommaic> ar:e eqm.l:y resp:i,nsibl= for the uniL $40.00 applk.arion and 5:50.00 administrztie:n fee i� due be.fore er,plk.!:ioa s:;;il be co:1sid�rl!d- { _ _.;.pp;ic<..:ion and Admin.is.trat1on foes 2re >tON-;efon.d�ble.). ThL!re is: :a S75.UG dolbrdeUnquent charge on •b� morning: of the 46 and $5.00 da!l.irs per day ;J1t:rc .i.:k,. All insu([i�ji..:m checkl cc.suit in i'.I. SS0.00 .�er-vice charge ph!.S late fo�s: ,J:.r,,t �pply frarr, ;;he .1f·. Pet-fj.'. On!y ca Ls or do� weighing 25 lbs a lcs.s wheri 1·t21l grov.'n.

A picture ar.:..l s-he:. �Ord llll!S!. b;:; on fil�. o S5t10.00 PET DEPDSlT-S200 00 �D�-RE-FL�D-�ilLE. v Only i {0�1tJ pct r�; apJrunen;.

�..;o.:-di�crlmh•:.n:ion- X'on-discrimination on the b:is!.S of r.1ce., c::olor. �ex, fammJI .�t..\tll.'i: .:.tgk!� national origin is the i:om prehcm-ive policy of ibis cnmp:,any.

RCSIDENT _____________ _

RESlDf.NT____ _ ______ _ DATE

AGE/\T DATE. ___ ____ _

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CONSENT FOR RELEASE or INFORMATION (rr.l:ninB lO affordable h.ousing. rcnttl appliciltion)

We, the Ufldt:rsigned applicillll(.s), ;,.uthorizc ::ill pcn;ons ar comp;mtcs in th:: categoric� liiaed below m relc-.i.-s-c: wiH10ll'.l !i:,,Difay. ;111 iClform;uiun rege.rrting ouf cmpl.Oymcot, h1coml.': cintVor �sscts. Tlll! i;ifr.irm:i1ion m:i)' he rclt:J.Se.::I only Lo the run�: d1·.itmng. O\L'llcr named bc.lolV. The purpose ol' ?clc�jng lhc infonn:uir111 LS to verify info!'n:l.Jtion Wc'\!C givco Ol'I ;i r1::r11;il applic;.Hino.. Jn(orma11on cov-ercd, We undcrStJ.Od 1hc11 pre·,icus or cuncnt io[orm-,ti-on raoiy tc:. neeCt:d. Ycrific3tion:; ,md inq.uirit:� llml may ht: t:questcd L"lc!ude, hm are not Ii.mired to: per.son.ol (tlcn:tity, employmenl, income:, il::sets and a!!uwuncc for c:-n:M Cilli:: or rn::dic.:: puJposts. This aulhriri2!lion cunnol be used lo vbtaliJ; any information OOou\ o,; li•:.H dC'C$ not r�1c h.l ;.1ur,::Ugibili1y for ;-cnli!.I h,)�!i-ing from the ?mpt�·w awnti mm1td below. This ,;.r:flcr.fl consent may nor be used l'> rcquc:s.\ i! copy of a :lx rc:1urn. If a �apy 1..'i :i. t�:i; rclurn is necr1ed,JR.S fot"m 4S05-T-enlitlcd "'Reqticst for Tr:m�rip!OfT.ax Form� musl be pr�p;mid and sign,;-:d Sj,,.-p•u;,td}"· Grnup nr individua1s ,vbo n1oy IJe asked. 1'he groups or im:Jividuals who ni.>y rc(casc £he .ab(wc. in.fom . .:i1ioo indud�, b,1;, .irr Hot limbed to:

P\'eS(:nt .!,�c.! .PiaSt Employers .Prcse;n ar!O P�l L::odJo;-ds

(lnducHn� Public Hr;;,UM.1g. • .!-o>t:1!clc.s) Supp:o.rt illld .4.Ji�y r�rovider,s

Wclfi.rc Ag,,·.ncie-,;. Si.!le Uncmployrnt:nc Agcncie�.1 Soci.il Security Adm!nis:truicn :,..k.dic:ril and Ctlilrl. C,1n: Provicfr:r,;

V<!i�r;ms AdrninC�lrJlll.\rl Retin:mtm S,·stems Ffo:ttl':lci:.it Im[Hm\o7\s (Banks, d1: . .1 C:c-dit Repornng Agcnci�

C-ontliUoJts for rde-a:u:-. i.Vi!. ag,ret 1h:it .i photocopy of th� �uthori:za[i.O� :01ay he us..""(! [or rh,;;. 3t,.r,\.•� r:.:irp-u�. Tt,t'.. i�ri:;C.iai ui.' �ht"S .ii;llJoriz��lion i;:; oa file illld \\'rU -srny in e:Ikc� for :3 mor.lhS !torn lh·� 1.J;,Lc �lgucl. Wt h;;r.·c :i d�!a ,o r\!\i�w Ll1e fde mo co:i,:;,;t Jny ioforrnJ[iOtt lh:>1 is foo.,rr�L R.:!nml d1='1ellif1g own�r. 'The :iti:'.lve inform:i.Uor: rn�y only llc ;r:k::i!itd to lhc. rr.nr;;,:I ll'l'.it:lling own� or mar.;1gem::m ccmp.jny n;ii;,i::d hc!o1

.',':

Ow:1..:;':5 n=i.nu.:. (prin<c.!) �];u:i: \1.i!lac-,J

Ptintc.,I :-.�me

�----- -

-P,-1r-.to-,-,-�m_e ________ "ss"'N-,------- 54;�------ -

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TEXAS APARTMENT ASSOCIATION Each co-resident and each occupant over 18 must submit a separate Apprication Rental Application for Residents and Occupants

M E. M B E R

Date when filled out:

Full name (exactly as it appears on driver's license or govt. ID card)

Formername(ifapp!icablel ____________________________________ _

Gender __________ Birthdate _________ Social Security# ______________ _

Driver's license U ______________________________ State ________ _

Government ID# State (if applicable) ________ _

Home phone ___ ________________ Cell phone __________________ _

Work phone Email address _________________ _

Marital status D single D married U.S. citizen? Dyes O no Do you or does any occupant smoke? D yes O no

I am applying for the apartment located at�3"'5"'1=0.....,E..,._.B,.r..,o,,,a,edsew=a;,y ___________ ___________ _

Is there another co-applicant? Dyes D no

Co-applicant name ______________________ Email _______________ _

Co-applicant name Email _______________ _

Co-applicant name EmaiJ _______________ _

Co-applicant name Email _______________ _

Full name ___________________________ Relationship ___ ____ ___ _

Birthdate __________ _ _______ Social Secu(ity# _______ ___________ _

Driver's license�------------------ ------------ State _______ _

Government ID•--------------------- ---- State (if applicable) ________ _

Full name ______________________ _____ Relationship __________ _

Birthdate ________ __________ Social Security;; ______________ ____ _

Driver's license�--------- --------------------- State _______ _

Government ID# ______________________ ___ State /if applicable) ________ _

Full name ____________ _______________ Relationship __ _ _______ _

Birth date __________________ Social Security e __________________ _

Driver's license#" ____ ________________________ __ State _______ _

Government ID# __________________ _______ State /if applicable) ________ _

Full name ___ ________________ ________ Relationship __________ _

8irthdate _________ _________ Social Security# _______________ _ __ _

Driver's license-;;- ______________________________ State _ _____ __

Government ID# _____ _ ___________________ State (if applicable) ________ _

Current home address (where you live now) ______________________________ _

City _ __ ______________________ St(1te _ ________ Zip _______ _

Do you D rent or ·:J own? Beginning date of residency: Monthly payment$ ______ _

Apartment name ________________________________________ _

Name of owner or manager ___________________________ _________ _

Phone ________ _ __ Reason for leaving _________ _________________ _

(The fol/awing Is only applicable if at current address for Jess than 6 months.)

Previous home address - ---------- ---------------------------

City _________________________ State _ ________ Zip _______ _

Do you D rent or O own' Dates: From _________ To __________ Monthly payment$ _____ _

Apartment name ________________ __ ______________________ _

Name of owner or manager ______ ______________________________ _

Phone ____________ Reason for leaving _________________________ _

Current employer ________________________________ ________ _

Address __________________ _____ ____________________ _

City _____________ _ ___________ State _______ __ Zip _______ _

Work phone __________ Beginning date of employment _____ ________________ _

,'�20t7 T�XAS APArm��NT ASSOCl/,TION, l�C. P,;GE lo�.:

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-� _;--_,_.;.., . . ...... ;., . .._,-.,... .. . . -:..""::; __ · .. ---

Gross monthly income $ __________ Position ________________________ _

Supervisor _____________________________ Phone __________ _

(The following is only applicable If at current employer for less than 6 months.}

Previous employer _______________________________________ _

Address _____________________________________ _

City _______________________ State _________ Zip ______ _

;: Work phane ____________ Oates: From ____________ To ____________ _

;: Gross monthly income$ __________ Positlon ________________________ _

Supervisor _____________________________ Phor,e __________ _ . - ... ,:-:· · .. :��y_r:--� �- �..

.· .....

... �

. �:.

--: �

j".7

-:-:-:..

• '• ••

'•· .

.

� �

.

� - .�-!:.-'.

(Income must be verified to be considered./

; •• ..;.--.. • • • •. !."�

Type _____ __________ Source _____________ Gross monthly amount$ ____ _ _

Type _______________ Source _____________ Gross monthly amount$ _____ _

If apPlicable, plea<e explain any past credit problem: ___________________________ _

Check only if applicable.

Have you or any occupant listed in this Application ever. O been evicted or asked to move out? O moved out of a dwelling before the end of the lease term without the owner's consent? 0 dedared bankruptcy? 0 been sued for rent? 0 been sued for property damage? 0 been convicted or received probation (other than deferred adjudication) for a felony or sex crime?

Please indicate below the year. location, and type of each felony or sex crime for which you were convicted or received probation. We may need to discuss more facts before making a decision. You represent the answer Is ·no• to any item not checked above.

0 Online search [websiteaddress) __________________________________ _

D Referral from a person or locator? Name------------------------------­

Cl Social media (please be specific) ----------------------------------

00ther __________________________________________ _

Emergency can tact person over 18 who will not be Jiving with you:

Name ___________________________ Relationship ____________ _

Address ________________ __________________________ _ City ________________________ State _________ Zip _______ _

Home Phone Cell Phone ______ ____________ _

Work Phone Email Address _________________ _

· (lfapp1icable)

List all vehicles owned or operated by you or any occupants (including cors, trucks, motorcycles, trailers, etc.)

Make Model Color

Year License# State

Make Model Color Year License� State

Make Model Color

Year Ucense # State

Make Model Color

Year LkensQ # State

,2011 TeXAS APAAnmn ASsoc;:,..TIOH, NC. PAGE 20'4

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(if applicable}

Yoo may not have any animal in your unit without management's prior authorization in writing. If we allow your requested animal, you must sign a separate animal addend um, which may require additional deposits, rents, fees or other charges.

Kind _____________________________ Weight ____________ _

Breed Age ____________ _

Kln<I _____________________________ Weight ____________ _

Breed _____________________________ Age _____________ _

Application Agreement

The following Application Agreement will be signed by you and all co-applicants prior to signing a Lease. While some of the informaf,on below may not yet apply to your situation, there are some provisions that may become applicable prior to signing a Lease. In order to continue with this Application, you'll need to review the Application Agreement carefully and acknowledge that you accept the terms.

1.

2.

3.

4.

5.

6.

7.

8.

9.

Apartment lease information. The Lease contemplated by the parties will be the currentTAA Lease. Special information and conditions must be explicitly noted on the Lease.

Approval when Lease is signed in advance. If you and all co-applicants have already signed the Lease when we approse the Application, our representative will notify you (or one of you if there are co-applicants) of our approval, sign the Lease, and then credit the application deposit of all applicants toward the required security deposit

Approval when Lease isn't yet signed. If you and all co-applicants have not signed the Lease when we approve the Applica· tion, our representative will notify you (or one of you if there are co-applicants) of the approval, sign the lease when you and all co-applicants have signed, and then credit the application deposit of all applicants toward the required security deposit.

If you fail ta sign Lease aft or approval. Unless we authoriz,, otherwise in writing, you and all co-applicants must sign the Lease within 3 days after we give you our approval in person or by telephone or within 5 days after we mail you our approval. If you or any co-applicant fails to sign as required your Application will be deemed withdrawn, and we may keep the application deposit as liquidated damages, and terminate all further obligations under this Agreement.

If you withdraw before approval. If you or any co-applicant withdraws an Application or notifi•s us that you've changed your mind about renting the dwelling unit, we'll be entitled to retain all application deposits as liquidated damages, and the parties will then have no further obligation ta each other.

A!)proval/non-approval. if we do not approve your Application withir, 7 days after the date we received a completed Applica­tion, your Application will be considered •di,approved.• !Xotincation may be in person or by mail or telephone unless you have requested that notification be by mail. You must not assume approval until you receive actual notice of approval. The 7-day time period may be changed only by separate written agreement.

Refund afternon-approvaL If you orany co-applicant is disapproved or deemed disapproved under Paragraph 6, we'll refund all application deposits within 30 days of such disapproval. Refund checks may be made �ayable to all co-applicants and mailed ta one applicant

Extension of deadlines. If the deadline far approving or refunding under paragraphs 6 or 7 ialls an a Saturday, Sunday, or a state or federal holiday, the deadline will be extended to the end of the next business day.

l(eys or access devices. We'll furnish keys and/or access devices only after: (1) all parties have signed the Lease and other rental documents referred to in the Lease; and (2) all applicable rents and security deposits have been paid in full.

10. Application submission. Submission of an Application does not guarantee approval or acceprance. It does not bind us to CK· cept the applicant or to sign a Lease. Images on our website may represent a sample of a un·,t and may not refiect specific details of any unit. For information not found on our websiti:- regarding unit availability, unit characlcristic::s, pricing or other <;uesrions, ple.ase call or visit our offic�.

11 Notice to or from co-applicants. Any notice we give you or your co-applicant is considered notice to all rn-applicar.ts; and any notice from you or your co-applicants is considered notice from all co-applicants.

Disclosures

l. Application fee (nan-refundable). You agree to pay ta our representative the non-refundable application fee in the amount indicated in paragraph 3. Payment of the application fee does not guarantee that your Application will be accepted. The applica­tion fee offsets the cost of sc,eenlng an appllcant for acceptance.

2. Application deposit {may or may not be refundable). In addition to any application fees. you agree to pay to our represent•· tive an application deposit In the amount indicated in paragraph 3. The iiillppllcation deposit is not;, security depolit, The appllca· tion deposit will be credited toward the required security deposit when the Lease has been signed by all parties; OR, it will be refunded under paragraph 7 if the applicant is not approved; OR it will be retained by us as liquidated damages if you fail to sign or withdraw under paragraphs 4 and 5 of the Application Agreement.

3. Fees d�e. Your Application will not be processed until we receive your completed Application (and the completed Application of all co-appJieants, if applicable) and the following fees:

A. Application fee (non-refundable): S __ ....,.. ___ ,... B. Application deposit (may or may not be refundable)$ ______ _

4. Completed Application. Your Application will not be considered ·complete• and wlil not be processed until we receive the following documentation and fees:

A . Your completed Application; 8. Completed Applications for each co-applicant (if applicable): C. Application fees far ail applicants; 0. Application deposit.

Authorization and Acknowledgment

I authorize Salem Multi Family Pa:rtne:rs, LTD

{name of 0\1Jner/eigent} to obtain reports from any con.sumer or criminal record reporting agencies before, during, and aftei residency on mat­ters relating to a lease by the above owner to me and to verify, by all available means. the information in this Application, including criminal back­ground information, income history and other information reported by employer\s) to any state employment ,ecurity agency. Work history in­formation may be used only for this Application. Authority to obtain wo,k history information expires 365 days from the date of this Application.

-:-2017 TCXA.S APAJm,t:xr ASS0O.r.TIO,"<(, l�:c. PA.GC3C14

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Payment Authorization

I authori�e Sale,g Mill ti Family Partnars. LTD

!name of owner/agent) to collect payment of the application fee and application deposit in the amounts specified under paragraph 3 of the Disclosures.

Non-sufficient funds and dishonored payments. If a check from an applicant is returned to us by a bank or other entity for any reason, if any credit card or debit card payment from applieant to us is rejected, or !f we are unable, through no fault of our own or our bank, to successfully process any ACH debit, credit card, or debit card transaction, then:

1. Applicant shall pay a charge of$ 5 0 • 00 for each returned payment; and 2. We resente the right to refe< the matter for criminal prosecution.

Acknowledgment

You declare that all your statements in this Application are true and complete. Applicant's submission of this Application, including pay­ment of any fees and deposits, is being done only af-ter applicant has fully investigated, to its satisfaction, those facts which applicant deems material and necessary to the decision to apply for a rental unit. You authorize us to verify your information through any means, including consumer-reporting agencies and othe, rental-housin g owners. You acknowledge that you had an opportunity to re,iew our rental-sefection criteria, which include reasons your Application may be den;ed, such as criminal history, credjt history, current in­come and rental history. You understand that If you do not meet our rental-selaction criteria or If you fail to answer any question or give false information, we may reject the Application, retain all application fees as liquidated damages for our time and expanse, and terminate your right of occupancy. Giving false information is a serious criminal offense. In lawsuits relating to the Application or Lease, the prevaifing party may recover from the non-prevailing party all attorney's iees and litigation costs. We may at any time furnish information to consumer-reporting agencies and other rental-housing owners regarding your performance of your I egal obligations. including both favorable and unfavorable information about your compliance with the Lease, the rules, and financial obligations. Fax or electronic signatures are legally binding. You acknowledge that our privacy policy is available to you.

Ri9ht to revie,v the Lease. Before you submit an Application or pay any fees or deposits, you have the right to review the Application and Lease, cts welf as any community rules or polrcies we have. You may also c onsult an attorney. These documents are binding legal documents when signed. We will not take a particular dwelling off the market until we receive a completed Application and any other reQuired Informa­tion or monies to rent that dwelling. Additional provisions or changes may be made In the Lease if agreed to in writing by all parties. You are entitled to a copy of the Lease after it is fully signed.

Images on our website may represent a sampie of a unit and may not renect specific details of any unit. For information not found on our web· site regarding availability, unit characteristics or other questions, please call or visit our office.

This Application and the Lease are binding documents whQn signed. Before submitting an Application or signing a Lease, you may tab a copy of these documents to review and/or consult an attorney. Additional provisions or changes may be made in the Lease if agreed to in writing by all parties.

Appl icant's signature Date

Application Fee and Payment Method

You hereby authorize a one-time payment by credit card for the total application fee due. The application fee is non-reiundable. Refer to your Appl ication for details.

Name on Application

Salem Village Name of property

Credit card type

Name as it appears on card

Oty

ACH Payment Option:

Bank account#

Name of account holder

City

Date of Application submission

Name of (management) company

Credit card F Exp. date (MM/VY)

Billing address

State Zip

Sank routing•

Address

State Zip

FOR OFFICE USE ONLY

l. A�.nam�ardwtllin.gaddr1Bs{1tr�er,(ity): Salem Multi Family Partners r LTD Uni1'0riype: --------l. Persona«epling21pplki1tioi\: _______ _________ Phon�: ________ _ 3. Ptnonproce.u1ngap,pliut1on: -----�----=�--=---c--=---=---- Phor,e: ________ _ -1, �te that tM applicant orco-�plicant wa.s notl�d [) by iii!ltphone, a byll!Uer. CJ byem�II. or O In p�rson ofO acccp.ancccr O�cc�pca.nce-: ______ _

IDMdline fo, cppli<om nnd i,llco·Gpp/1t:Gn:s to sign ftost is 1tiree days ofter notifiatictt cf Gccepra11cr in :,trs0t1 or by ,,�phon.e. :'i•IC doy,s. ,f bj mail,) S. N;'lme ot p�non or pe.rsoru notifl�d {lft.':itr�0temorc-rhan oot oppl/can:. en /eo,tonr ofcliemmus: btne>�lf:tdf. ______________

___ _ 6. Name of owner's r�prtseruativewhonotitled ll'lc applic,;mt: ______ _

Addltjonal comrntt1ts: -----------------------------------------