LEASE APPLICATION

© 2016 by Chicago Association of REALTORS® - All rights reserved

Each co-applicant and occupant 18 years or older must submit a separate application

Property Address: ___________________________________________________________________________________

Galewood Flats Condo Apartmenrs
Requested Lease Start Date: _______________
08/01/23 or ASAPRequested Lease Term: _______________
24 Months Monthly Rent: $__________
Ex: 1 year, 18 months, etc…

Applicant’s Name (first, middle, last) ____________________________________________________________________

Brian L Ball
Is there a co-applicant? ✔
□ yes □ no if yes, co-applicant must submit a separate application
Social Security No. _________/_________/_________
404 08 3309 Date of Birth: _________/_________/_________
02 02 1972
Driver License No. _________________________________________
B400-0727-2033 in ______(state)
IL
E-mail: bballatc@aol.com
__________________________________________ Home Phone: ______________________________________
Mobile Phone: ____________________________________
773-797-6789 Work Phone: ______________________________________

Name of ALL other persons who will occupy the Property:

Name: ________________________________________
Kentrell Marsh Relationship:__________________
Friend DOB: __________________
02/21/1995
Name: ________________________________________ Relationship:__________________ DOB: __________________
Name: ________________________________________ Relationship:__________________ DOB: __________________
Name: ________________________________________ Relationship:__________________ DOB: __________________

Emergency Contact Information:

Name:______________________________
Kentrelll Marsh Relationship:_______________________
Friend Phone:______________________
773-797-6789
Address: __________________________________________________________________________________________

Applicant’s Current Address: Applicant’s Previous Address:

_______________________________________________
3759 S Lake Park Ave. #2S _______________________________________________
__________________________________(city,
Chicago, IL 60653 state, zip) __________________________________(city, state, zip)
Landlord’s Name: Marj
________________________________
Gruzk, Property Mgr Landlord’s Name: ________________________________
Landlord’s Phone: 312-656-9933
________________________________ Landlord’s Phone: ________________________________
Landlord’s E-mail: gkamax@aol.com
________________________________ Landlord’s E-mail: ________________________________
*Moved-In Date: Move-Out Date: Moved-In Date: Move-Out Date:
_______________
6/21 ______________
6/23 _______________ ______________
*If less than two years, also complete Previous Address Monthly Rent: $__________________
Monthly Rent: $__________________
3500.00 Reason for moving: _______________________________
Reason for moving: Downsize
_______________________________
and move west
Applicant’s Current Employer: Applicant’s Previous Employer:
_______________________________________________
Major League Baseball Players Pension _______________________________________________
Chicago Whitesox Baseball Club
Address: P.o.
_______________________________________
Box 1096 Address: 333
_______________________________________
W 35th St.
_______________________________________________
Sparks, MD 21152 _______________________________________________
Chicago, IL 60616
Supervisor’s Name: ______________________________ Supervisor’s Name: Ed______________________________
Cassin
Supervisor’s Phone: ______________________________ Supervisor’s Phone:_______________________________
312-961-9500
Supervisor’s E-mail: ______________________________ Supervisor’s E-mail: ______________________________
*Start Date: 10/20/23
_____________ Position:_______________
Retired Member Start Date: 09/11/2000
______________ End Date:10/31/2021
______________
Gross Monthly Income: $__________________________
7833.33 Gross Monthly Income: $__________________________
175,000.00 per year
*If less than two years, also complete Previous Employer

Other Income:
Source: ________________________ Amount: $____________ When/How often received: _______________________

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List All Pets (if permitted) to be kept on the Property (dogs, cats, birds, etc…): Spayed or Rabies Shot
Type & Breed Color Weight Age Gender Neutered? Declawed? Current?
_________________________________________________________________ □ yes □ no □ yes □ no □ yes □ no
_________________________________________________________________
NONE □ yes □ no □ yes □ no □ yes □ no
_________________________________________________________________ □ yes □ no □ yes □ no □ yes □ no

Yes No Explanation (If answered yes)

Will any waterbeds or water-filled furniture be on the property? □ ✔□
Does anyone who will occupy the property smoke? □ ✔□
Has Applicant ever:
had a notice of eviction filed against them in the last 7 years? □ □
✔
if yes, provide year and explanation
breached a lease or rental agreement? □ □
✔
if yes, provide year and explanation
filed for bankruptcy in the last 7 years? □ □
✔
if yes, provide year and explanation
lost property in a foreclosure? □ □
✔
if yes, provide year and explanation
Is there additional information Applicant wants considered? □ □
✔
Personal or Professional References:
Name: ____________________________
Tiffany Cassin Relationship: ______________
Friend Phone/E-mail: __________________________
224-501-1831
Name: ____________________________
Sheldon Ross Relationship: ______________
Friend Phone/E-mail: __________________________
443-800-0525
Authorization & Notification: Applicant authorizes Landlord and Landlord’s Representative to: (1) obtain a copy of
Applicant’s credit report; (2) obtain a criminal background check related to Applicant; (3) verify any rental, employment,
eviction, or criminal history or verify any other information related to this Application with persons knowledgeable of
such information; and (4) release this Application and any information contained herein in furtherance of these
purposes. Applicant represents that the statements in this Application are true and complete. Applicant understands
that submitting this Application does not guarantee acceptance and that providing false or inaccurate information is
grounds for rejection and a breach of any lease. Applicant understands lease documents may be signed electronically.

Applicant submits a non-refundable application fee of $_________ for processing and reviewing this Application.

□ Paid by Check □ Paid in Cash

or
Check One: □ Visa □ Master Card □ American Express □ Discover

_____________________________________________ _______________________________________
Name as it appears on card Billing Address

_____________________________________________ _______________________________________
Card Number Billing City, State Zip

_____/_____ _________
Expiration Date Security Code

Brian L. Ball 07/18/23

Applicant’s Signature Date

Brian Ball will be using a Guarantor

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