Items one through twelve below are required of a landlord/agent by the State of Wisconsin and all items are required by the City of Madison prior to entering into a rental agreement with a tenant and/or prior to accepting earnest money or a security deposit. Other governmental jurisdictions may have additional laws and regulations that apply.

TENANT/APPLICANT ACKNOWLEDGES HAVING BEEN ADVISED:

1. that the landlord shall have up to 21 calendar days from acceptance of the earnest money deposit to approve or deny the rental application. [134.05(2)3]
2. that applicant agrees to pay landlord the landlord's actual cost, up to $20.00, of obtaining a consumer credit report from a consumer credit reporting agency that compiles and maintains files on consumers on a nationwide basis. [134.05(4)]
3. a receipt for money collected has been given tenant. (See Below)
4. that not more than 30 days after the start of the tenancy, tenant may request, in writing, that landlord provide tenant with a list of physical damages or defects, and photographic evidence, if any, charged to the previous tenant's security deposit. [134.06(1)(a)2]
5. that copies of the proposed lease and rules and regulations of the landlord were made available to tenant for inspection.
6. of the name and address of the person authorized to receive rent, manage and maintain the premises who can readily be contacted and an owner or agent with an address within the state authorized to receive and receipt for notices and demands and at which service of process can be made in person. (See Below)
7. tenant has seven days after the beginning of tenancy to inspect the dwelling unit and notify landlord of any damages or defects existing prior to the beginning of tenancy.
8. of utility charges not included in the rent. (See Below)
9. of the following uncorrected building and housing code violations, for which the landlord has received notice from code enforcement authorities and which affect the entire premises (in the City of Madison) or, only the dwelling unit and common areas (State of WI). N/A
10. that the premises contain the following conditions adversely affecting habitability: N/A
11. landlord promises to repair, clean, or improve the premises as follows by the completion dates noted: N/A
12. security deposits may be withheld only for tenant damage, waste or neglect of the premises or the nonpayment of rent, utility services or mobile home parking fees for which the landlord becomes liable and other reasons specifically and separately negotiated and agreed to by the tenant in writing other than in form provision.

THE FOLLOWING DISCLOSURES APPLY TO THE CITY OF MADISON ONLY

13. that a copy of notice of eligibility for rent abatement, if any, which affects the rental unit or common areas has been provided to the tenant.
14. that the occupancy limit imposed upon the dwelling unit by 27.06 of the City of Madison General Ordinance is , however, occupancy is restricted to those persons named in the application and rental agreement.
15. that the definition of a "family" pursuant to 28.03(2), Madison General Ordinances, is as follows: "A family is an individual or two or more persons related by blood, marriage, or legal adoption living together as a single housekeeping unit in a dwelling unit, including foster children, and not more than four (4) roomers except where such dwelling unit is owner occupied. For the purpose of this section, 'children' means natural children, grandchildren, legally adopted children, stepchildren, foster children, or a ward as determined in a legal guardianship proceeding. Up to two (2) personal attendants who provide services for family members or roomers who, because of advanced age or a physical or mental disability, need assistance with activities or daily living shall be considered part of the 'family.' Such services may include personal care, housekeeping, meal preparation, laundry or companionship."
16. that the zoning district in which the unit is located is
17. that the off-street parking requirements of the dwelling unit pursuant to 28.11 Madison Ordinance is except in the "central area" as per section 28.07(1)(g) of the Madison Ordinances.
18. that disclosure of an Applicant’s Social Security Number is voluntary, and housing may not be denied based solely on the applicant’s decision to withhold their Social Security Number.

Property Name:

Primary Address:

Apartment # if Known:

Number of Bedrooms:

Utilities Included in Rent: No Utilities are Included

Prefered Move-in Date:

Number of Persons Living With You:
0 1 2 3 4 5

Number of Dogs:
0 1 2

Number of Cats:
0 1 2 3

May Vary Depending on FMI Application Approval Guidelines

By checking this box I certify that I have read the above statement and agree to its terms.

At the time the lease is signed, the applicant agrees to pay the balance of the security deposit. If the applicant refuses to sign the lease after the application has been approved, actual charges incurred will be deducted from the deposit and the balance, if any, refunded. Additional amounts due to loss of rent & advertising costs may be due.

This application is subject to the approval of the landlord or agent. False, inaccurate or incomplete information may result in the rejection of this application, or grounds for termination of the tenancy.

The applicant consents to a routine inquiry of references and credit agencies, and authorizes his or her employer to divulge salary & wage information. The inquiry will provide applicable information concerning the applicant's credit worthiness and reliability. At applicant's request, landlord will advise if a credit report is requested and the name and address of the credit reporting agency. Applicant acknowledges receipt of a copy of this application with disclosures below as part thereof which may be applicable.

I, the applicant have read and acknowledge the above conditions and additional disclosures on the back of this form.