Indian Hills Apartments - NV

Indian Hills Apartments - NV

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 Indian Hills Apartments - NV.

APPLICANT INFORMATION
LAST NAME FIRST NAME M.I. SSN DRIVER'S LICENSE #
Clark Timothy C. 551-71-**** C2993339 / CA
BIRTH DATE PHONE #1 ALTERNATE PHONE EMAIL
1/25/1965 (928) 565-8650 Mobile timclark1859@gmail.com
CURRENT ADDRESS
STREET ADDRESS CITY
2080 E Hearne Ave Kingman
STATE ZIP DATE IN DATE OUT MONTHLY RENT
AZ 86409 6/10/2019 4/18/2020 $750.00 / Mo.
LANDLORD NAME LANDLORD PHONE
Gary (928) 897-4700
PREVIOUS ADDRESS
STREET ADDRESS CITY
2731 Ridgeline Dr Corona
STATE ZIP DATE IN DATE OUT MONTHLY RENT
CA 92882 1/1/2018 2/15/2019 $1,650.00 / Mo.
LANDLORD NAME LANDLORD PHONE
Ashley (909) 277-4218
EMPLOYMENT INFORMATION
OCCUPATION EMPLOYER/COMPANY SALARY
Maintenance Electrician Graham Packaging $5,500.00/Mo.
SUPERVISOR SUPERVISOR PHONE START DATE END DATE
Billy (702) 890 - 2715 current
EMPLOYER ADDRESS CITY STATE ZIP
875 Amaerician pacific Dr Henderson NV 89014
EMERGENCY CONTACT
NAME ADDRESS PHONE RELATIONSHIP
Ron clark 2544 Furnace creek rd (650) 279 - 6343 father
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.
YES My lease was up I was offered a job in arizona I told them that but they didn't care. I had a cleaning company come in
and clean the apartment and had a deposite that was owed to me. But they wanted the rent and then they would decide on
my deposite. I told them to take my deposit
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
Indian Hills Apartments - NV

OTHER INFORMATION
HOW DID YOU HEAR ABOUT THIS PROPERTY?
Zillow.com
PLEASE INCLUDE ANY OTHER INFORMATION YOU BELIEVE WOULD HELP TO EVALUATE THIS APPLICATION

APARTMENT APPLYING FOR

VEHICLE DESCRIPTION
MAKE MODEL YEAR COLOR PLATE STATE
Cadillac Escalade 2005 Cream Cjt6579 AZ
RENTER'S INSURANCE
INSURANCE SELECTION

I hereby warrant that all statements set forth above are true.
I understand that a consumer report and/or an investigative consumer report may be requested in connection with my prospective or continuing housing and/or employment application with Indian Hills Apartments - NV
through On-Site Manager, Inc. (On-Site). I understand that these reports may include information concerning my character, employment history, general reputation, personal characteristics, public records information,
criminal records information, education, qualifications, motor vehicle record, mode of living, credit and indebtedness information, and any other information which may reflect upon my potential for tenancy or employment
gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information.
I understand that I have the right to make a written request, within a reasonable period of time, for complete and accurate disclosure of the nature and scope of the investigation requested. I understand that I have the right,
upon submitting proper identification, to request from On-Site the nature and substance of the information in the consumer report or investigative consumer report, including the sources of information and the recipients of
any reports on myself, which On-Site has previously obtained about me within a two-year period preceding my request.
I consent to the delivery of all notices or disclosures required by law via any medium so chosen by Indian Hills Apartments - NV or On-Site, including but not limited to email or other electronic transmission. I understand
that all notices shall be deemed received upon being sent.
By submitting this application, I certify that I have read and fully understand the disclosures and my rights detailed above and authorize On-Site to obtain, for the purpose of determining my eligibility for initial or continued
tenancy, and/or employment a consumer report and/or investigative consumer report and to disclose all information obtained by On-Site to Indian Hills Apartments - NV, its affiliates, and assigns now and in the future. I
also certify that I have read and fully understand my rights under the FCRA available at www.on-site.com/resources/consent/fcraDisclosuresConsent.pdf.
By submitting this application, I acknowledge that I would like to receive a copy of my consumer report and/or investigative consumer report.

APPLICATION FOR TIMOTHY C. CLARK SUBMITTED ONLINE on April 12, 2020

***SIGN HERE*** { Timothy C. Clark } {} {105997481} {}

Timothy C. Clark (Applicant) Date

The following charge(s) will appear on your card statement as "Indian Hills Apartments - NV"
Application Fee for Timothy C. Clark - Charge Details
Name on Card Account Number Reference Number Authorized
Tim Clark XXXXXXXXXXXX8224 8615963 $212.00
Transaction Transaction Date Charged
4KJ612CLLA7 4/13/2020 3:29 PM PDT Includes $7.00 convenience fee: $212.00