2008 Today’s Date __________
Gary A. Michael 39 South Main St. Petersburg, WV 26847 
(304) 257-2149 E-Mail Gam99@Frontiernet.net Visit us at www.Geocities.com/Garyamichael/

Print Below All Persons Who Will Be Living In The Apartment

Name____________________________________________________ Age__________ Phone #_______________________

Employer________________________________ Monthly Income_________ How Long______ Phone #______________

Name____________________________________________________ Age__________ Phone #_______________________

Employer_______________________________ Monthly Income_________ How Long_______ Phone #______________

Child____________________________ M/F Age_______ Child_____________________________ M/F Age___________

Do You Have Any Pets (Yes) or (No) If Yes, Describe________________________________________________________

No Pets over 10 lbs must have picture of Pet (Deposit for pet $500.00)

Present Landlord Name_______________________________________________ Phone #__________________________

Amount of Rent You Pay Now_________________________ How Long Have You Lived There_____________________

References (Must List 1 & Phone Number)

Name________________________________________________ Phone #________________________________

When Do You Want To Move? ________________________ How Many Vehicles? ______________________

Note: Photo ID required with this application
Security Deposit is the amount of the rent. Must be paid in full before moving in. 
(Non-Refundable if you change your mind about moving)

(X) Mark what you are interested in
					                     
(  )  2 Bed Room Town House Rent $500.00 1 – Year Lease (60 day notice)  
(  )  2 Bed Room Town House Rent $600.00 Month with No Lease (30 day notice)  
(  )  2 Bed Room Stonewood Rent $600.00 1 – Year Lease (60 day notice)  
(  )  2 Bed Room Stonewood Rent $700.00 Month No Lease (30 day notice)  
(  )  1 Bed Room Crestview Rent__$400.00_ (60 day notice)
(  )  2 Bed Room Crestview Rent_ $450.00__ (60 day notice)
(  )  2 Bed Room Foreman Rent $400.00 1 – Year Lease (60 day notice)            
(  )  2 Bed Room Foreman Rent $500.00 per Month with No Lease (30 day notice)
(  )  2 Bed Room Grant St. Rent _$400.00__ 
(  )  Elderly Apts. Rent Based On Income Must Be 62 or Older, Disabled, or Handicap





Sign___________________________________________________ Date___________________________