RESIDENTIAL RENTAL APPLICATION

564535 STRAIGHT ST. PATERSON Hackensack St, Carlstadt NJ -1st FLOOR

DATE: ___09/25/2023____

APLICANT DETAILS

FULL NAME: __Dominick Johan Travez Fernandez_ D.O.B.___05/29/2002_______

ADDRESS: ______276 Hamilton Place, Hackensack NJ 07601_______
PHONE #___5512288797______ DRIVER’S LICENSE #: _______in
process___________
EMAIL ADDRESS: ___menick2002@gmail.com___________
EVER BEEN EVICTED? ___YES _X__NO
EVER FILED BANKRUPTCY? ___YES __X_ NO
PETS: ____ YES __X___ NO
SMOKE ____ YES __X__ NO

CURRENT EMPLOYMENT
COMPANY NAME: __Perez & Perez Contracting_____ OCUPATION/TITLE: ___
Manager Assistant______
HOW LONG? ___1 year ___ GROSS INCOME: $ _29,000____
STREET ADDRESS: ___495 Washington Avenue____ CITY: __Hackensack_____
STATE: __NJ___ PHONE #: __20189380421________ SUPERVISOR
NAME___Marco Perez_________

LIST OF OCCUPANTS:
NAME: __Dominick Johan Travez Fernandez___ D.O.B: __05/29/2002_
PERSONAL REFERENCES

FULL NAME: __Jarleth Carrion______ RELATIONSHIP: __ex-roomer_

E-MAIL: ____ap100100100@gmail.com_______ PHONE #:
___+12018990572_________
FULL NAME: ___Tatiana Perez___________ RELATIONSHIP: ___coworker_______
E-MAIL: ____tvasquez@gmail.com______________ PHONE #:
_____2016228932________

LANDLORD INFORMATION:
NAME: __Jarleth Carrion_________ PHONE #: __12018990572___

ADDITIONAL DETAILS (IF ANY) NO KITCHEN / NO PARKING

I am studying from 6 to 9 pm at bergen community college, and working at

mornings at contractors company.
I hereby certify that I am at least 18 years of age. Applicant represents that all information given on this
application is true and correct. Applicant hereby authorizes verification of all references and facts, including
but not limited to current and previous landlords, employers, and personal references. Applicant agrees to
furnish additional credit and/or personal references upon request. Applicant understands that incomplete
or incorrect information provided in the application may cause a delay in processing which may result in
denial of tenancy. Applicant hereby waives any claim and releases from liability any person providing or
obtaining said verification or additional information.

APPLICANT’S SIGNATURE: _________________________ DATE:

__09/25/2023_______