RENTAL APPLICATION

PRIMARY APPLICANT
Full Name Martha Stella Perea Jimenez . Socia ecurity Date of Birth 06/02/1967 078-05-1120 lS Number e Phone Number 445 19 64 Ho hone 524 40 25 Work Number m marthapereaj@yahoo.com P .. EMail Spouses Full Name Luis Adriano Acosta Pechene . Socia ecurity Date of Birth 14/03/1960 111-03-2222 lS Number Ho e Phone Number 316 703 15 22 hone 645 23 11 Work Number m Luacosta2000@yahoo.com P EMail

PRIMARY APPLICANTS RENTAL HISTORY INFORMATION

Current Address 382 NE 191 st. City Miami State Florida Zip 07212-6002 . Date In 09/08/2013 Date Out 08/08/2014 Rent Amount $ 875.oo Landlords Full Name John J Dow . LandlordS Phone Number (305)591-7845 Landlords E-Mail johnjdw@rentalservice.com Reasons For Moving Business and university study .. Previous Address 3800 NW 115th avenue City Doral State Florida Zip 03237-1149 Date In 15/02/2011 Date Out 12/08/2013 Rent Amount 620.oo. Landlords Full Name Paula Epstein Landlords Phone Number 305-235-2245 Landlords EMail paepstein@mdc.edu Reasons For Moving Business and university study ..

Mother Renter APPLICANTS THAT WILL LIVE IN THE PROPERTY Son Daughter

Full Name Luis A. Acosta P Full Name Martha S. Perea Full Name Favio Acosta Full Name Diana Acosta

e 28 Ag e

Ag 50 e Ag 44 e Ag 23

Relations Fhater hip Relations hip Relations hip Relations hip

PETS THAT WILL LIVE IN THE PROPERTY

Number of pets 1 Name Mateo Indoors Outdoors X Type / Breed Dog/shetland Age 1 year ....

APPLICANTS EMPLOYEMT HISTORY

Current employer Esetec Ing. Supervisors Name Frank Bustos Supervisors phone number 5244030 frabustos@gmail.com Mechanical maintenance Previous Supervisors Engineer Walter Garcia Name Supervisors phone number 3268694 Supervisors E-mail Position Engineer Supervisors E-mail . Positio Engineer wlgar@cal. . . . .

APPLICANTS REFERENCES
Full Name Alfonso Acosta ... Relationship Brother Phone 3395240 E-mail alfacosta@hotmail.com Fernando Zuiga Full Name Relationship Friend Phone 3365599 Full Name Mary Perea Relationship Brother in law maryperea@yahoo.com

E-

fzunga@hotmail.c om

Phone 6844423 E-mail

AGREEMENT AND AUTHORIZATION The statements above made are true and correct. Applicant authorizes to conduct a credit check and applicant knows that this is a rental application and not a lease agreement.

Date 08/08/2013

Signature Martha Stella Perea Jimenez

Notes: The statements above made are true and correct. I appreciate all the cooperation extended and waiting to meet the requirements and awaiting a positive response.

Attentively, Martha Stella Perea J.