PEACEABLE HOUSE RENTAL APPLICATION 61 E. Parker St., Scranton, PA 18509 ___ Upstairs One Bedroom Unit
___ Downstairs One Bedroom Unit
Date: Head of Household First and Last Name: How many in the household (list names, relationships, and ages):
Current Address:
Phone Number(s): Date of Birth:
SSN:
Present Landlord or Management Name, Address, phone: Monthly Rent: Dates of Current Occupancy: +++++++++++ SPECIAL NEEDS/SITUATION STATED: The intent of the Peaceable House is to help those most in need of affordable housing. Please share the specifics of your situation, including your special needs and a detailed listing of regular income and expenses. Use however many sheets you need and attach it to this rental application. This information will be kept confidential to the church council and its appointed Peaceable House committee.
How many pets do you have?: What is the lease length that you prefer for the rental?
Signature:
Date: