Completed Application with signed Permission to Access Credit. Completed Request for Rental History

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1 New Applicant Check List Please be sure to include the following: Completed Application with signed Permission to Access Credit Proof of Income Signed Agency Disclosure Signed Background Check Completed Request for Rental History Signed Lead Paint Disclosure Notes: PLEASE FAX TO OR TO

2 Smith & DeGroat Real Estate 27 E. Jericho Tpke., Mineola, NY Property Management APPLICATION Loca on: Date Occupancy Desired: Name:(Permi ee): DOB: SS#: Spouse: Children & Ages: Present Address: Zip Code Contact: Home: Work: Cell: How Long There: Why Moving: Current Landlord: Tel#: Mail Address Landlord: Fax#: Place of Employment: # Years on Job: Posi on: Annual Income: Business Address: Business Telephone: Fax#: Name of Supervisor: Phone #: Bank & Loca on: Phone #: Type of Account: Account #: Personal Reference: Rela onship: Address: Phone #:

3 CO-PERMITTEE Co Permi ee: DOB: SS#: Co Permi ee Present Address: Zip Code Co Permi ee Telephone: Home: Work: Cell: Co Permi ee How Long There: Why Moving: Co Permi ee Current Landlord: Tel #: Co Permi ee/landlord Mail Address: Fax #: Co Permi ee Place of Employment # Years on Job: Co Permi ee Posi on: Co Permi ee Annual Income: Co Permi ee Business Address: Co Permi ee Business Telephone: Fax #: Co Permi ee Name of Supervisor: Phone #: Co Permi ee Bank & Loca on: Phone #: Type of Account: Account #: Personal Reference: Rela onship: Address: Phone #: PERMISSION TO ACCESS CREDIT I, give my permission to Smith & DeGroat Real Estate to access my full credit report including public records. Permi ee Signature Date Co Permi ee Signature Date

4 Smith & DeGroat Real Estate 27 E. Jericho Tpke., Mineola, NY Property Management REQUEST FOR RENTAL HISTORY INFORMATION Authorization I hereby authorize to release information regarding my rental history. (Current Landlord) Landlord Telephone #: Applicant Name: Applicant Signature: Date: Resident Address: Street: Apt. City: State: Move-In Date: Lease Expiration Date: Rental Amount: $ Additional Monthly Charges: YES NO If YES: Amount $ Reason: Have you ever been evicted? When: To be completed by Landlord Is the account current? YES NO Was sufficient notice given? YES NO Does Resident Pay on Time? YES NO If NO, Please indicate number of late payments: Any NSF s: YES NO Number of Returned Checks Dispo s Filed? YES NO Number of Dispo s Filed Pets? YES NO Number of Pets Additional Comments: Completed By: Title: Contact Information: Signature: Date: PLEASE FAX TO OR TO DMARDER@SDNYREALTY.COM

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9 Permit Rules A. Permittee agrees to obey the following rules and regulations: (1) The toilet bowls and water apparatus shall not be used for any purpose other than that for which they are constructed and sweeping, rubbish, rags or other articles shall not be thrown therein; (2) No changes or displays of any type whatsoever, including signs, advertisements etc., shall be attached to or placed on the outside of the premises, including, but not limited to television or radio aerials, awnings, fences, ornamentations, trellises, lighting, fixtures, signs, flags, laundry, etc.; (3) Nothing shall be thrown by Permittee or his visitor or servants out of the window or in the passages of the building, nor shall anything be hung on or out of the windows or placed on the windowsills, patios, or balconies; (4) Garbage is to be placed only in proper receptors or receptacles; (5) No fixtures, or appliance of any sort shall be attached to or connected with the gas, electric, or water fixtures within the leased premises, which will overload the system, nor shall stream pipes, radiators, or air ducts be moved or tampered with in any manner whatsoever or doors removed from the hinges; (6) Permittee, his servants or guest, shall not use the roof of the premises under any circumstances; (7) Permittee shall not replace window shades or Venetian blinds, cabinets or any other personal property or fixtures used in connection with the operation of the premises unless Permittee first obtains County s consent in writing; (8) If the Premises is a residence, the Premises is to be used for residential purposes only and shall not be used for business or professional purposes; (9) Permittee will under no condition use the name of the County in any kind of advertising medium whatsoever; (10) If a terrace or patio or balcony area is provided with the premises, Permittee shall not enclose or cover the said areas in any manner whatsoever without the consent of the County in writing. Permittee shall not keep, store or display bicycles, baby carriages, toys, play facilities, tires, and /or air dry clothing of any type whatsoever in the aforesaid areas, except Permittee may use terrace or patio furniture thereon;

10 (11) Permittee will keep, said balcony and patio neat, tidy and clean at all times and will not store, hang or drape rugs, towels, laundry, wash or other household items on the railing or other portions on the balcony or patio; (12) Permittee shall not require permit or allow any window in a licensed building to be cleaned from the outside in violation of Section 202 of the New York State Labor Law or any future or other law governing same. (13) If a storage room is available, Permittee agrees to use said storage room at his own risk, and herby releases County from any liability with respect to any items stored therein. (14) Permittee shall not have the right to use any grounds area around the Premises, except as specifically provided by the County Facility Supervisor. (15) No Pets shall be permitted upon the Premises without prior written approval of the County. B. In addition to the rules and regulations contained in paragraph above, if the premises is a two or three family house, the following rules and regulations will also apply: (1) The entrance, foyers, halls, passages, stairways, fire escapes and grounds shall not be obstructed by Permittee or used for any purpose other than to enter and leave from the Premises; nor shall Permittee or guest or visitors to the premises loiter or sit around the vestibules, stairs or halls or exterior of the premises or obstruct the same with baby carriages, bicycles, or other objects; (2) Permittee shall not make or permit any disturbing noises in the building by himself, his family, guest, friends or servants, nor do or permit anything by such persons that will interfere with the rights, comfort or convenience of any other Permittee, nor shall Permittee entertain therein any person of bad character or improper behavior. No Permittee shall play upon or suffer to play upon any musical instrument of permit the operation of a radio, television, tape recorder, stereo, or the like, between the hours of 10:00 p.m. and the following 8:00 a.m.; (3) Permittee shall not sweep dirt, rubbish, trash or other items in any manner which will cause dirt, rubbish, trash, etc., to fall upon the property or ground below or in any way annoy the Permittee below; (4) No cooking, broiling barbecuing or use of any cooking device or equipment shall be permitted on any terrace/ balcony or patio, or anywhere, else except in the kitchen of the Licensed Premises;

11 (5) That regardless of any reason, no animal or bird of any nature shall be taken into or kept in the premises for any period of time whatsoever. No consent to the retention of any animal shall be valid unless in writing signed by County, and County may, in its sole and absolute discretion, permit or prohibit any pet or pets for any and all Permittees from time to time and may revoke any granted permission for any or no reason at any time. C. All units will include a refrigerator and cooking stove. Other appliances may be installed with the written consent of the County. Installation charges shall be paid by the Permittee. Such Appliances supplied by Permittee shall be the sole property of the Permittee. D. Permittee expressly agrees as follows: (1) That no washing machine dishwasher, clothes dryer, air-conditioning units, fans, ventilating equipment or other electrical or mechanical equipment or device which County determine is detrimental to building or the interests of County in any manner whatsoever shall be installed, used, nor in any manner kept or stored in the premises other than those, if any, supplied by County; (2) That no bed or other article of furniture which has as its contents water or any other liquid matter shall be maintained or used in the subject premises; (3) Permittee shall not alter or replace locks or install any other attachments such as knockers, upon any doors.

12 Smith & DeGroat Real Estate 27 E. Jericho Tpke., Mineola, NY Property Management PERMITTEE CHECK LIST We have provided you with the following information to help in the expedition of the approval of your Permit Agreement. All information may be dropped off, faxed, ed or sent overnight mail to the address listed above. First 24 Hours: 1. Complete an APPLICATION. 2. Supply an up to date credit report for all applicants (If you cannot supply a credit report, Smith and DeGroat will run one for you. In order for Smith and DeGroat to run your credit report we need you to sign PERMISSION TO ACCESS CREDIT on application. 3. Supply proof of income for all applicants. (Proof of income is a current pay check stub, W-2, 1099 or income tax return.) Upon Credit and Income Approval: 4. Provide security check in the amount of one/(two) month(s) permit fee made out to, Smith & DeGroat Real Estate as agents for Nassau County. 5. Provide a commission check in the amount of one month permit fee made out to, Smith & DeGroat Real Estate. Meet With County Official: 6. Before moving in to any Nassau County Landmark property, all Permittees must meet with a Nassau County official. This is an informal interview where the county official has an opportunity to meet with any and all Permittees. The purpose of this meeting is to become acquainted with each other and to review the privileges and guidelines of occupying a Nassau County Landmark Property. These meetings take place Monday thru Friday, between 9 a.m. and 5 p.m. at the discretion of the Nassau County official. Page 1

13 To Move In: 7. After meeting with the Nassau County official, you are considered to be, move in ready. At that point the final steps are as follows: First (1 st ) months permit fee is due and payable to, Smith and DeGroat Real Estate as Agents for Nassau County.* *If the Permit Fee is $ or more, the Permit Agreement must also be approved by the Nassau County Legislatures. 8. Certificate of Insurance must be received by Smith and DeGroat Real Estate naming, County of Nassau as additionally insured as per the Permit Agreement. The minimum requirements are as follows. The Permittee shall furnish to the County a certificate of personal liability insurance issued to and covering the liability of the County and the Permittee, with respect to the ownership and use of the Premises. Such liability policy shall name the County of Nassau as a certificate holder and an additional insured. The limits of liability in such policy shall not be less than $300, per occurrence for all damages arising out of personal injury and bodily injury, including death at any time resulting there from, and destruction to property. Such insurance is to be kept continuously in force during the currency of this Permit and any renewals thereof, and shall be written by a carrier licensed to do business in New York State and satisfactory to the County. The premium for such insurance is to be paid by the Permittee. The County reserves the right to require the Permittee to provide such additional insurance, including other types and higher amounts of insurance, as the County may request in its sole discretion. Page 2