McLeod Lake Indian Band HOUSING DEPARTMENT Application to Rent Schedule II A. Applicant Information (Please Print Clearly): Last Name Last Name
First or Given Name
Middle Initial
First Name
Middle Initial
B. Address: Apt # City
Street Name
Street, Road, Direction, etc
Province
Postal Code
C. Mailing Address if different from above: Mailing Address City
Province
Postal Code
D. Contact Information: Home Phone E-‐Mail Address
Mobile #
Alternate i.e. message #
E. Household Information: Last Name
First Name
Date of Birth (dd/mm/yyyy)
Age
M or F
Relationship to Applicant
Member of MLIB (Y/N)
F. Housing Request Location:
McLeod Lake:_____ Prince George:_____ Other:____________ No. of Bedrooms:
1:_____ 2:_____ 3:_____ 4:_____ 4 or more:_____ Basement:
Yes:_____ No:_____ Does not matter:_____ G. Residency Information Please list your address(es) for the past 12 months Address From Date
To Date
Name of Landlord
Landlord Phone #
H. CONSENT – For the purpose of determining whether my/our application for tenancy is acceptable, I/we hereby consent to the landlord obtaining credit/personal information reports pertaining to myself/other. Signature of Applicant: Signature of Co-‐Applicant (if applicable):
Date:
Date: