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Tenant Name (First Last):
 
Apartment Address:
 
Landlord Comments: *

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Tenant Social Security # (LAST 3 DIGITS):

Tenant Driver's License or ID # (FIRST 3 DIGITS):

Landlord/Property Manager:

Evicted/Began Eviction Proceedings?:

Trashed My Apartment?:

Owes Me Money?:

Left Without Notice?:

Dead-Beat Dependents?:

Lied on Application?:

Called Code Enforcement on Landlord?:

 
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