APPLICATION Dagenais Real Estate, Inc. Application For Lot Application for LotApproved by:Date Lot NumberSize of HomePark NameNameSocial Security No.DateDate of BirthEmail AddressDrivers License #Drivers License State*StateName & Ages of ChildrenCurrent AddressPresent Telephone No.Where EmployedOccupationHow Long?Present Landlord:Current AddressNearest Relative/ Emergency Contact:Current AddressFinancial Institution Reference:Accounts Held: Checking SavingsList Automobiles Of All Occupants:Vehicle OneVehicle OneVehicle OneVehicle OneVehicle TwoVehicle twoVehicle TwoVehicle twoVehicle ThreeVehicle ThreeVehicle ThreeVehicle ThreeAdditional Automobiles List InformationList Your Total Income:List Your Total Income:List Three Local Personal References:Reference OneReference TwoReference ThreeHave eviction proceedings ever been filed against you?Do you have (or have you ever had) any garnishments?If you answered yes to either question, please explain:*OUR PARK RULES DO NOT PERMIT PETS. YOU WILL BE EVICTED IF YOU AQUIRE A DOG OR CAT* The undersigned applicant hereby applies to lease or rent your property. We warrant the accuracy of the information provided. The applicant hereby authorizes Dagenais Real Estate to check, without liability, all information listed on this application, including the useof a credit reporting service. The applicant hereby authorizes Dagenais Real Estate to check, without liability, local police department records including any information in regard to complaints from neighbors or other members of applicants jurisdiction, which resulted in a police officer being dispatched to investigate the incident. Applicant claims that all information above is true and understands that falsification of this application will be cause for denial of renting or grounds for evictions should they become a tenant.DATEAPPLICANTIt is against the law to discriminate against tenants on the basis of race, color, religion, national origin, sex, handicap, height, weight, or family status. DAGENAIS REAL ESTATE INC. 1505 North Lincold Road Escanaba MI 49829906-789-9427AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweSubmit