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:
[email protected] 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
1
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
2
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.
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12/29/2020
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Applicant Signature Date
