STANDARD RENTAL APPLICATIONTodays Date 5/2/2012 Prospective Address 95 Lincoln Ave

Tenant Ralph Cueva Social Security #079-82-9519 Home Phone (347)602-2334 Date of Birth 6/10/1991 Driver's License #_____________________Present Address 40-14 10 ST APT 2A How Long? 3 years City Long Island City State NY Zip Code 11101 Previous Address NONE

Current Landlord's Name NONE, I do not have one Phone_______________Why are you leaving? I am going over to Pennsylvania for an Internship.

Employer's Name Media Services Union College Phone Address 807 Union ST, Schenectady NY 12308 Position Technician How Long? 3 Years Your Superior Jermaine Wells

Monthly take-home pay $3,000 Sources Working for General Electric

Character Reference Kelli Johnson (not a family member) Phone(870) 723-5078

Cotenant Corey Wicks Social Security #________________________Date of Birth____________________ Home Phone ______________________________Relation to tenant_______________ Driver's License #_______________________Present Address_________________________________ How Long? _____________Previous Address

Current Landlord's Name___________________________ Phone________________Why are you leaving?____________________________________________________

Employer's Name_______________________________Phone______________________Address_______________________________________Position___________________How long?___________________Your Superior_______________________________

Monthly take-home pay_____________ Sources___________________________

Character Reference ___________________________________________________(not a family member) Phone__________________________________

Total number of occupants 2

Do you have any pets? NO How many?________ Type____________

List all motor vehicles, including RVs, to be kept at the dwelling unit. Include make, model, year, and license plate number for each.

Vehicle #1 NONE License__________________Vehicle #2____________________________ License__________________

Please list any outstanding loan balances and monthly payment:

1.NONE 2._________________________________________________________________________

3._________________________________________________________________________

STANDARD RENTAL APPLICATION (continued)

In an emergency contact Rafael Cueva Phone (646)260-5456

Address 40-14 10 ST APT 2A Long Island City NY 11101

Have you ever been evicted from any tenancy? [] yes [X] noHave you ever willfully and intentionally refused to pay rent when due? [ ] yes [X] noDo you know of anything, which may interrupt income or ability to pay rent? [ ] yes [X] no

I hereby certify that the answers I have given in this application are true and correct and hereby authorize E.C.R.M. Inc. to obtain a credit report to verify the information contained here. I understand that any false answers or statements made by me will be sufficient grounds for eviction and loss of any security deposit. I further authorize the landlord or his agent to verify the above information including but not limited to contacting creditors, both listed herein or not, and present or former landlords.

Dated May 2,2012

Tenant Ralph Cueva

Cotenant________________________________________________________

Discrimination

It is against the law to discriminate against tenants on the basis of race, religion, national origin, age, or neighborhood racial makeup.