Property Address: Date:
THIS SECTION TO BE COMPLETED BY LANDLORD, MANAGER OR AGENT.
Applicant has paid a nonrefundable screening fee of $ 37.00, applied as follows: (The screening fee may not exceed $30.00 adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index.) A CPI inflation calculator is available on the Bureau of Labor Statistics websites, www.bls.gov. The California Department of Consumer Affairs calculates the applicable screening fee amount to be $ 37.57 as of 2006.
$37.00 for credit reports prepared by Trans Union/Equifax;
$ for (other out-of-pocket expenses); and
$ for processing.
The undersigned has read the foregoing and acknowledges receipt of a copy.
The undersigned has received the screening fee indicated above.
Landlord or Manager or Agent Signature Viktor Manrique DRE Lic.# r01224855Date
THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS ® (C.A.R). NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE TRANSACTIONS. IF YOU DESIRE LEGAL OR TAX DEVICE, CONSULT AN APPROPRIATE PROFESSIONAL.
This form is available for use by the entire real estate industry. It is not intended to identify the user as a REALTOR ® REALTOR ® is a registered collective membership mark which may be used only by members if the NATIONAL ASSOCIATION OF REALTORS® who subscribe to its Code of Ethics.