University

Housing
Tenant Information Form
Tamara Mariel Benitez
Name: ________________________________________________________________________________________________________________________

Lease Term (circle one): May-May or August-August Gender: M F

Lavalle 1647 4A
Local Address: _______________________________________________________________________________________________________________
Street
Ciudad Autónoma Buenos Aires 1048
_______________________________________________________________________________________________________________
City State Zip

Lavalle 1647 4A
Home Address: ______________________________________________________________________________________________________________
Street

Ciudad Autónoma Buenos Aires 1048

______________________________________________________________________________________________________________
City State Zip

+5491130979259 Home Phone:________________________________________

Cell/Local Phone: _______________________________________________
tami_b88@hotmail.com
Email Address: ______________________________________________________________________________________________________________
Maria Ibarra -Armando Benitez
Parents’ Names: _____________________________________________________________________________________________________________

Father: Work Phone: +5491158409485

____________________________________ Home Phone: _______________________________________

Mother: Work Phone:+5491124722805

____________________________________ Home Phone: _______________________________________
Do you require accessibility under the Americans with Disabilities Act? Yes No
Do you have a Disability that requires an Emotional Support Animal (ESA)? Yes No
Roommate 1.________________________________________________ Email 1.______________________________________________________

Roommate 2.________________________________________________Email 2._______________________________________________________

Roommate 3.________________________________________________Email 3._______________________________________________________

How did you hear about us (Circle One)

Website Facebook Apts.com Google Word of Mouth Referred By:___________________________________

University Housing will need a copy of your driver’s license or passport

before a lease agreement can be signed.

Feb. 19th, 2023

Date: ______________________________
Signature: ___________________________________________________________________________