Dellinger Property Management

Monon Apartments

302 W. Harrison St.
Monon, IN 47959
jeffanddonna9@hotmail.com
(219) 253-6259

Dellinger Rental Application

If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
  • 1 Dellinger Property Management - Rental Application
    Please click here to download a printable version of the Dellinger Property Management - Rental Application and fill out manually

    Rental Application

    Note: Applicant must be over 18 and have the legal capacity to sign a lease.

    This application is to be completed fully and in detail. If additional pages are necessary, please attach them. The information provided will be used in the tenant selection process by Landlord and is subject to verification by Landlord. In the event any information provided is later determined to be false, Landlord may, in Landlord’s sole discretion, terminate any lease. Landlord’s gathering of information from and about prospective tenants is for the benefit of the Landlord, only, and does not create any right of reliance on the part of any tenant or occupant part regarding the behavior or character of any other tenant or occupant of the community.
    Applicant's Full Name
    *
    Apartment Community Desired
    Desired Move Date
    Type and Size of Apartment Desired
    Telephone Number
    *

    Present Residence

    Address
    City
    State
    Zip
    Telephone
    Monthly Payment
    Lived There From
    To
    Reason for Moving
    Landlord Name
    Landlord Telephone
    Landlord Address
    City
    State
    Zip
    Comments

    Previous Residence #1

    Address
    City
    State
    Zip
    Telephone
    Monthly Payment
    Lived There From
    To
    Reason for Moving
    Landlord Name
    Landlord Telephone
    Landlord Address
    City
    State
    Zip
    Comments

    Previous Residence #2

    Address
    City
    State
    Zip
    Telephone
    Monthly Payment
    Lived There From
    To
    Reason for Moving
    Landlord Name
    Landlord Telephone
    Landlord Address
    City
    State
    Zip
    Comments

    Household Composition

    Name of Household Member
    First, Middle Initial, Last
    Relationship to Head of Household
    Social Security Number
    Place of Birth
    Date of Birth
    Full-time Student
    Do you expect any additions to the household within the next twelve months?

    Student Status

    Are you or anyone in your household currently a full-time student or planning to be one within the next 12 months?
    Please explain
    Been required to register as a sex offender?
    Are you currently living in subsidized housing?

    General Information

    Have you, your spouse, or any other proposed occupant ever:
    Filed for bankruptcy?
    Been evicted from any residence?
    Willfully or intentionally refused to pay rent?
    Been arrested and charged with any misdemeanor or felony?
    Please explain
    Been arrested for possession, sale or delivery of any illegal or controlled substance?
    Please explain
    Have you or any other proposed occupant ever, while living in a subsidized community, had tenancy or assistance terminated for fraud, nonpayment of rent or failure to cooperate with the recertification procedures?
    Tenancy terminated?
    Do you have pay any childcare expenses in order to be gainfully employed or to further your education?
    Please provide contact information of childcare provider:
    Name
    Phone
    Address
    City
    State
    Zip
    Do you have any pets?
    Please describe
    Breed
    Weight
    Do you own a waterbed?
    What size?
    How did you hear about our apartment community:

    Vehicles

    List any cars, trucks, or other vehicles owned.
    Type of Vehicle
    Year
    Make
    Model
    Color
    License Plate #
    Monthly Payment
    Loan Payable To

    References

    Local Credit Reference
    Account #
    Type of Acct
    Bank/Credit Union
    Account #
    Type of Acct
    Personal Reference 1
    Relationship
    Telephone
    Personal Reference 2
    Relationship
    Telephone

    Emergency Contact

    Please provide information for two people not planning to occupy the Premises whom we may contact in the event of an emergency, or to locate you
    Name
    Relationship
    Telephone
    Address
    City
    State
    Zip
    Name
    Relationship
    Telephone
    Address
    City
    State
    Zip

    Income

    This form must be completed in its entirety. Please provide the mailing address and phone number for each of these sources in the area provided.
    You must list any income in which you and your household members receive. (You must place a “0” in each column describing each source from which no income is received)
    Salary / Wages / Employment Tips / Bonuses
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Self Employment / Unearned Income Workers Compensation
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Social Security Benefits
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    SSI
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Disability Pension / Death Benefits
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Pension / Retirement Funds
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Welfare
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    AFDC / TANF
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Rental Income
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Child Support / Unearned income from a family member under 17 years of age
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Alimony
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Military Payments / GI Bill / VA
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Unemployment
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Net Farm/Business Income
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Payment Received on Real Estate / Rental Income or Income from a Contract sale of Real Estate
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Interest on Check/Savings Acct.
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Interest on Bonds/CD's
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Investment Dividends
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Stock Dividends / Annuities / Trusts
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Recurring gifts/monetary or not
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Other
    Household Members Who Received The Income
    Monthly Gross Amount Received
    (Enter "0" if you do not receive income from this source)
    Phone Number & Address To Send Verification Form (Please Provide)
    Do you anticipate any changes in income during the next 12 months?
    Explain

    Real Estate

    Do you own any property?
    Type of property
    Location
    Appraise Market Value
    Do you have any land contracts?
    Type of property
    Location
    Terms of Contract
    Do you receive any rent from your property?
    Type of property
    Location
    Amount received per month
    NOTE: In considering this application from you, Landlord will rely heavily on the information which you have supplied. It is most important that the information be accurate and complete. By signing this application, you represent and warrant the accuracy of the information and you authorize Management to verify any references that you have listed.

    I do hereby certify that the information listed on this form and the questions answered are true and complete to the Best of my knowledge.
    Co-Applicant Signature
    Date

    Please sign your name below

    04/27/2024

  • 2 Dellinger Property Management - Consent for Release of Information
    Please click here to download a printable version of the Dellinger Property Management - Consent for Release of Information and fill out manually

    Consent for Release of Information


    Your signature on this form authorizes Landlord to obtain any information that is pertinent to eligibility, for residency at the housing complex in which you have applied. Any individual or organization may be asked to release information.

    Inquiries including, but not limited to, the following information may be made:

    Employment Income
    Social Security Income
    Self-Employment Income
    Disability Income
    Pension Income
    Other Sources of Income
    Family Composition
    Student Status
    Landlord References
    Credit References
    Personal References
    Criminal History

    Photocopies of this authorization may be used for the purpose indicated above. The original is retained by the requesting organization.

    Please Complete This Section:

    I understand that failure to consent to the release of this information will render me ineligible for housing complex at which I have applied. I give my permission for Landlord, as mentioned above, to obtain any information that is pertinent to my eligibility, and to any reference or entity I have identified to release such information to Landlord.

    Applicant Information

    Name
    *
    Phone
    *
    Address
    City
    State
    Zip
    Social Security #
    Birthdate
    Driver’s License #
    State Issued
    Signature
    Date

    Co-Applicant Information

    Name
    Phone
    Address
    City
    State
    Zip
    Social Security #
    Birthdate
    Driver’s License #
    State Issued
    Signature
    Date
If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
Equal Housing Opportunity
This institution is an equal opportunity provider.
Handicap Accessible




0 / 222