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SECTION I: APPLICATION
Property Name: __________________________________________________
Property Address: ___________________________________________
Size: ____ BR__ _ Other Needs: _______________________ Date: ______________ Time: _________
A. A SEPARATE APPLICATION FORM MUST BE COMPLETED BY EACH APPLICANT OF THE HOUSEHOLD WHO IS 18 OR OVER.
MARRIED COUPLES MAY COMPLETE ONE APPLICATION.
Please provide date of birth for all persons who will be living in the household. Proof of age will be requested if you are applying to live in a designated elderly
development. Acceptable age verifications include a copy of (1) a valid State Driver’s License, (2) a valid State I.D. Card or (3) a Birth Certificate.
Name of Persons to occupy the apartment Sex Relationship Social Security No. or Date of Birth
Provide for each: Name: Last, First, MI.
(M / F) Alien Registration No.
(Required)
Do you anticipate any additions to this household in the next twelve months? ____Yes ____No
Explain: ___________________________________________________________________________________________________
B. HOUSING REFERENCE (List ALL landlords in the past THREE years.) This application is unacceptable if not completed. If
extra space is needed, please attach a separate sheet of paper.
Present Address: __________________________________________________________________________________________
Home Phone: _________________________ Length of Residency: ________________ Rent Per Month: _________________
Landlord Name: __________________________________________ Phone: (Required) ______________________________
Prior Landlord Name: _____________________________________ Phone: (Required) _______________________________
Address Rented: ___________________________________________________________________________________________
Length of Residency: _______________________________________________________Rent Per Month: _________________
Prior Landlord Name: _____________________________________ Phone: (Required) _______________________________
Address Rented: ___________________________________________________________________________________________
Length of Residency: ______________________________________________________ Rent per Month: __________________
C. APPLICANT SIGNATURE CLAUSE
I / We certify that answers given therein are true and complete to the best of my knowledge. I / We authorize investigation of all statements contained in this application
for residency as may be necessary. I / We understand that any misrepresentation may result in the denial of my application. I / We authorize
________________________________, its subsidiaries, and its agents to investigate my credit through any credit bureau or other reasonable means. I / We have read
this application and understand it.
The Rental Application submitted by Applicant will hereby be made a part of the Rental Lease Agreement. Applicant acknowledges that Owner has relied on the
information submitted by Applicant as an inducement to rent the Premises to Applicant. If any presentation on the application is determined to be misleading, incorrect
or untrue, Owner may, at its option, terminate Applicant’s right to occupy the Premises. Owner shall have the right to recover from Applicant any loss or damages
which Owner may suffer because of such misrepresentation.
THIS APPLICATION IS NOT A RENTAL AGREEMENT, CONTRACT OR RENTAL LEASE AGREEMENT. ALL APPLICATIONS ARE SUBJECT TO
THE APPROVAL OF THE OWNER OR MANAGING AGENT.
It is our aim to ensure that this apartment community is a drug free zone. The use, possession, manufacture and/or sale of controlled substances will not be tolerated. By
signing this application form, I verify my support for this policy.
ALL PERSONS DESIGNATED AS APPLICANT OR CO-APPLICANT MUST SIGN BELOW.
______________________________________________________________________________________
APPLICANT SIGNATURE DATE
______________________________________________________________________________________
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SECTION II: CERTIFICATION
You have applied to rent an apartment which is only available to qualified participants in the Section 42 Tax Credit Program. To determine your eligibility, you must
provide the following information on this application. The information will be kept confidential by the Owner or Managing Agent, except as necessary to prove to the
government that you qualify. All adult applicants related by marriage may complete a single form showing total household income and assets. Read each item carefully,
and provide the information requested truthfully and fully. Making a false statement may subject you to criminal penalties. If you have any questions, please consult
with the Property Manager.
SECTION IIA: GENERAL
Please complete every question by circling Y or N. This application will not be processed if not completed in its entirety.
Y N 1. Are you or will you (or any household member) be a full-time student in the next 12 months?
Y N 2. Have you (or any household member) been a full time student for 5 months at anytime this calendar year?
Y N 3. Are any household members temporarily absent? Who? _________________________________________________
Y N 4. Are any household members permanently absent? Who? _________________________________________________
Y N 5. Are you separated but not yet divorced from your spouse?
Y N 6. Will you be receiving Section 8 Assistance? Agency: ______________________________Phone: _______________
Y N 7. Do you own a waterbed?
Y N 8. Do you have the right to legally enter into a lease?
Y N 9. Have you ever filed bankruptcy? Date: ________________________________________ Discharged: ____________
Y N 10. Have you ever been evicted from any residence for any reason?
Y N 11. Have you or any household member been convicted of any felony, drug offense or crime involving violence, fraud or
Dishonesty?
Y N 12. Are you or any household member currently charged with any of the above criminal activities?
Y N 13. Are you or any household member currently subject to a lifetime registration requirement under a state sex offender
registration program?
Y N 14. Do you own any pets? (Restrictions may apply)**Acceptance of this application does not approve a pet.
Y N 15. Do you require a Live-In Care Attendant?
Y N 16. Do you carry Renter’s Insurance?
Comments: _________________________________________________________________________________________________
___________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
SECTION IIB: EMPLOYMENT
Applicant:
Name of Employer: ______________________________________________________Monthly Gross Income: __________________
Address: _______________________________________________________________Contact Person: ________________________
Phone: __________________________________________Fax:________________________________________________________
Other Sources of Income (tips, bonuses, etc.): ______________________________________________________________________
Co-Applicant
Name of Employer: ______________________________________________________Monthly Gross Income: __________________
Address: _______________________________________________________________Contact Person: ________________________
Phone: _________________________________________Fax: ________________________________________________________
Other Sources of Income (tips, bonuses, etc.): ______________________________________________________________________
SECTION IIC:INCOME
Please answer each question. An incomplete application will not be accepted and may cause delays.
Applicant Income Sources: __Employment __Social Security __TANF __Other:_____________ Amount $ __________________
Co-Applicant Income Sources: __Employment __Social Security __TANF __Other: _________ Amount $ __________________
Y N 1. Are any Applicants entitled to receive Alimony? Amount $ ___________
Y N 2. Are any Applicants entitled to receive Child Support? Amount $ ___________ County & State ____________________
Y N 3. If yes, are payments received regularly?
“ In accordance with Federal law and the US Departments of Agriculture policy, this institution is prohibited from discriminating
on the basis of race, color, national origin, sex, age or disability (Not all prohibited bases apply to all programs)
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Ave., S.W. Washington,
D.C. 20250-9410, or call (800) 795-395-3272 (voice), or (202) 720-6382 (TDD).”
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SECTION IIC:INCOME, CONTINUED
Does any Applicant receive:
Y N Pension? Source: __________________________ Amount $ _________________
Y N Veterans Benefits? Amount $ _________________
Y N Unemployment Benefits? Amount $ _________________
Y N Interest Income? Amount $ _________________
Y N Military Pay? (Whether payee is absent from home or not) Amount $ _________________
Y N Severance Pay? Source: ____________________________ Amount $ _________________
Y N Help paying bills from friends, relatives, agencies, etc. Amount $ _________________
Y N Is any Applicant expecting a lump sum payment of any kind? Amount $ _________________
(i.e., insurance settlement, lottery winnings, etc.)
Y N Full Time Student Income Amount $ _________________
TOTAL GROSS MONTHLY INCOME $__________________ X 12 = $_______________________
Y N Do you anticipate any changes in this income in the next 12 months?
SECTION III: ASSETS
All Questions MUST be answered for this application to be considered. If you have more than one bank, please be sure and list each one. If more space is
needed, please attach a separate sheet of paper. Failure to disclose information may lead to denial of your application.
Do you have any of the following?
Y N 1. Checking Account? Where? _________________________ Value $___________________
Where? _________________________ Value $ __________________
Y N 2. Savings Account? Where? _________________________ Value $___________________
Where? _________________________ Value $ __________________
Y N 3. Trust? Where? _________________________ Value $___________________
Y N 4. CD(Certificate of Deposit) Where? _________________________ Value $___________________
Where? _________________________ Value $ ___________________
Y N 5. Mutual Fund? Where? _________________________ Value $___________________
Y N 6. Stocks? Where? _________________________ Value $___________________
Where? _________________________ Value $ ___________________
Y N 7. Savings Bonds? Where? _________________________ Value $____________________
Y N 8. Annuities? Where? _________________________ Value $____________________
Y N 9. Cash on hand? Amount $ _______________________
Y N 10. Life Insurance with a cash value? (This does not include Term Insurance)
Company: ____________________________________________________ Value $__________________
Y N 11. Do you own any Real Estate (residence, farm, vacation home, land, mobile home, or rental property)
Where? ________________________________________________ _____ Value $__________________
Y N 12. Have you disposed of any assets in the last 2 years for less than fair market Value?
What? ______________________________________________________ When $ __________________
I/We, __________________________________, certify that the information and statement provided above are true and
complete to the best of my/our knowledge and belief. I/We consent to release the information and that making false statements
may be grounds for denial of my/our application and may subject me/us to criminal penalties. I/We agree to provide
verification of all income and assets as required by the Owner or its agent. I/We further authorize disclosure of all information
which will verify my/our income and assets. I/We understand applicants must be eligible for the Section 42 Program.
ALL PERSONS DESIGNATED AN APPLICANT OR CO-APPLICANT MUST SIGN BELOW
__________________________________________ ____________________________
APPLICANT SIGNATURE DATE
__________________________________________ ____________________________
CO-APPLICANT SIGNATURE DATE
“ In accordance with Federal law and the US Departments of Agriculture policy, this institution is prohibited from discriminating
on the basis of race, color, national origin, sex, age or disability (Not all prohibited bases apply to all programs)
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Ave., S.W. Washington,
D.C. 20250-9410, or call (800) 795-395-3272 (voice), or (202) 720-6382 (TDD).”
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CO-APPLICANT SIGNATURE DATE
“ In accordance with Federal law and the US Departments of Agriculture policy, this institution is prohibited from discriminating
on the basis of race, color, national origin, sex, age or disability (Not all prohibited bases apply to all programs)
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Ave., S.W. Washington,
D.C. 20250-9410, or call (800) 795-395-3272 (voice), or (202) 720-6382 (TDD).”
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