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Picture Book Park, West Bloomfield, NY

Location: 1925 Factory Hollow Road, West Bloomfield, NY 14585

Rent: City Water, Sewer, Garbage Collection & Lawn Maintenance Included. (Gas/Electric not included.)

Text Box: General Information
Yearly Leases
Underground Natural Gas
City Water
Quiet – Neighborly Community! A beautiful, quaint community surrounded by trees in a very private setting.

Directions: From Lima or (I – 390 Exit 10) – Take Routes 5 & 20 (East)… Just after you cross over Honeoye Creek, Factory Hollow Road will be on your Right. Make a Right onto Factory Hollow Road. Take your first Left into Picture Book Park (Section I). Note: Honeoye Creek is the dividing line between Livingston & Ontario Counties.

From East Bloomfield or Canandaigua – Take Routes 5 & 20 (West)… to West Bloomfield. You will pass our office Burke Manufactured Homes, Inc. (on your left)….keep going down the hill (past Picture Book Pkwy – Section II). Make a Left onto Factory Hollow Road. Take your first Left into Picture Book Park (Section I).

Application For Residency

Instructions: Please complete all sections listed below and on the back. Any questions that do not apply, place N/A in the space provided. Thank you for your interest. Please mail this form to Indian Valley Dev. Corp., PO Box 180, West Bloomfield, NY 14585, fax it to (585) 624-3557 or e-mail to maralee@burkehomes.com.

Site Number Desired_______ Desirable Date of Occupancy________________

______ Renting

Applicants Full Name________________________________

Social Security Number__________________

Co-Applicants Full Name______________________________

Social Security Number__________________

Other Residents:

1.___________________________ 4.____________________________

2.___________________________

3.___________________________

Applicants Present Address_________________________________ Town/City_________________ State________ Zip Code _____________. Home Phone ___________________.

Name of Landlord or Mortgagor_______________________ Phone Number___________________

Length of Time at Address___________ Reason for Moving_________________________________

Monthly Payment $________

Applicants Previous Address_______________________________ Town/City__________________

State________ Zip Code ______________. Length of Time at Address_________________

Name of Landlord or Mortgagor_______________________________

Reason for Moving___________________________ Monthly Payment $___________

Co-Applicants Present Address_______________________________ Town/City_________________

State________ Zip Code _____________. Home Phone ____________________.

Name of Landlord or Mortgagor_______________________ Phone Number____________________

Length of Time at Address___________ Reason for Moving__________________________________

Monthly Payment $________

Applicants Employer_______________________________ Phone Number ____________________

Address_________________________ Town/City_________________ State_____ Zip Code_______

Length of Time____________ Position______________________ Supervisor___________________

Previous Employer________________________________ Phone Number _____________________

Length of Time____________ Position______________________

Co-Applicants Employer___________________________ Phone Number______________________

Address_________________________ Town/City_________________ State_____ Zip Code_______

Length of Time____________ Position______________________ Supervisor___________________

Previous Employer________________________________ Phone Number ______________________

Length of Time____________ Position______________________

Applicants Bank Reference____________________________Address__________________________________

Town/City________________ State______ Zip Code _________.

Applicants Credit Reference_______________________ Date Started________________

Address____________________ Town/City____________________ State______ Zip Code _______.

Co-Applicants Credit Reference____________________ Date Started________________

Address____________________ Town/City____________________ State______ Zip Code _______.

Applicants Loans

Institution_____________________ Address___________________ Town/City__________________

State______ Zip Code _______. Monthly Payment $_____________ Balance $______________

Co-Applicants Loans

Institution_____________________ Address___________________ Town/City__________________

State______ Zip Code _______. Monthly Payment $_____________ Balance $______________

Applicants Yearly Income (Gross) $_______________ (Net) $_______________

Co-Applicants Yearly Income (Gross) $_______________ (Net) $_______________

Yearly Household Income $_____________ Comments___________________________________________

Have you ever filed bankruptcy?_____________ If so, when & why?_____________________________

Do you have any judgments against you?______________ if so, when & why?________________________

Automobile(s)/Boat/RV/Camper/Motorcycle:

Make___________________ Year_________ Color__________ License #_____________________

In case of emergency please contact:___________________________________________________

Relationship___________________ Phone Number _____________________

Address______________________ Town/City_______________ State________ Zip Code_________

I certify that the above information is correct and I understand that this application may be revoked if any information furnished upon this application is found to be incorrect. I authorize you to contact any references listed on this application. I also understand that by law Indian Valley Development Corporation has up to 30 days from the time this application is returned to their office to review with their Board of Directors my application and make a final decision on whether or not community residency approval will be granted at this time.

Applicant Signature_____________________________ Date___________________

Co-Applicant Signature ____________________________Date___________________

For Office Use Only

Date of application___________ Application received by___________________

Reference Verification Application: approved not approved

Present address ____ ____ Employment _____ ____ Date of appr./disappr.______________

Previous address ___ ____ Loans/Credit ____ ____ Signature__________________________

Bank (checking) _______ Credit Check_____ ____ Site #______ Date of Occupancy______________

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