Each applicant and co-signer (if applicable) must fill out a separate .

Application Date: 12/29/2020 Address Applied For: 3559 West Medill ave #2
Monthly Rent: 1300 Lease Term: short term Lease Start Date: 2/1/2021

Applicant Information

Name: Maria A Iakubovich

First Middle Last

SSN: 6 __
__ 3 - __
0 __ 1 __ 4 __
5 - __ 5 __
2 __ 3 Cell Phone #: 773-2941276

Date of Birth: 09/13/1975 D i e Lice e #: I211-5417-5861 State: IL

Email Address: Maria.yakubovich@gmail.com

Current Address

Street Name: 1364 East Madison Park #1B City/State: Chicago IL Zip Code: 60615
Lease Start Date: 6/15/2020 Lease End Date: current Monthly Rent: 1100
Landlord Name: Adrian Talbot Landlord Phone: 202-262-6733
Reason For Leaving: I am still living, I am just co-signing my daughter's lease as a guarantor

Previous Address

Street Name: 150 N. Humphrey ave #3E Oak Park, IL

City/State: Zip Code: 60302
Lease Start Date: 6/1/2016 Lease End Date: 08/30/2020 Monthly Rent: 1465
Landlord Name: Riverside Property Management Landlord Phone: 708-848-6800
my daughter graduated from high school and I lived with my boyfriend for a year without signing the lease with him
Reason For Leaving:

Employment Information

Employer University of Chicago Start Date: 09/20/2003

Occupation lecturer Supervisor Name n/a
Supervisor Phone: n/a Annual Salary $59695
Other income: Middlebury College Source: tax return

References

Business: Nata Cherashneva Washington DC 302-367-3703

Name Address City/State/Zip Phone

Personal: Natalia Gorbachova 1414 E. 59th street Chicago 60637 617-710-1075

Name Address City/State/Zip Phone

Banking: Ben Peartree 612-817-8998

Name Address City/State/Zip Phone

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 Notify in case of emergency

Rita Rzhetsky Chicago IL 60637 212-542-0963

Name Relationship Address City/State/Zip Phone

Name Relationship Address City/State/Zip Phone

Vehicle information

n/a
Year Make Model Color Plate #

Pets

n/a
Type Breed Sex Color Size

Other occupants

List names and birthdates of all additional occupants 18 years and older:
n/a

List names and birthdates of all dependents 18 years or younger:

n/a https://domu-live.s3.amazonaws.com/ResidentialLeaseApplica

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I warrant that all statements contained in this application are true and accurate and that I have not knowingly
withheld any information which would, if disclosed, affect my application unfavorably. I hereby provide the owner or
its authorized agent with my consent to communicate with my current and former landlords, as well as my current
employer(s) for the purpose of, among other things, verifying the information listed herein. I am aware that a credit
history and eviction search may be conducted in conjunction with my application.

Any person or firm is authorized to release information pertaining to my credit history or suitability as a tenant upon
presentation of this form or a photocopy of this form.

It is understood that any processing fee associated with this application is non-refundable, but that any security
deposit received from me will be refunded if my application is not approved.

___________________________________________________
12/29/2020
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Applicant Signature Date