Criminal background and eviction will be check within the past 5 years.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Criminal background and eviction will be check within the past 5 years."

Transcription

1 Housing Authority of the City of Fort Lauderdale (HACFL) Telephone: (954) Submit your application to: HACFL- Affordable Housing Division 500 West Sunrise Boulevard Fort Lauderdale, FL The following documents will need to be provided with your completed application & fee*: Valid Picture ID for all adult members (Drivers License, government issued ID) Birth Certificate for all members Social Security Cards for all members Marriage / Divorce certificate (if applicable) Income received for all members (1 months) Assets all members (6 months), if applicable- bank statement, Life Insurance, IRA, etc THERE IS A NON-REFUNDABLE APPLICATION FEE OF 25.00* PER ADULT (18 YEARS & OLDER), PAYABLE IN MONEY ORDER ONLY TO: HOUSING AUTHORITY OF THE CITY OF FORT LAUDERDALE (HACFL) IN ORDER TO HOLD A UNIT, YOU MUST PROVIDE HALF (½) OF THE SECURITY DEPOSIT (1 MONTH RENT) IN MONEY ORDER TO: HOUSING AUTHORITY OF THE CITY OF FORT LAUDERDALE (HACFL) NO PET(S) ALLOWED. Your total monthly gross income must be twice (2x) the rent amount Criminal background and eviction will be check within the past 5 years.

2 The Housing Authority of the City of Fort Lauderdale, Florida Affordable Housing Division Application: Initial Renewal If this is an initial application, address of unit applying for: Head of Household Information Home Phone: Current Address: Work Phone: City, State, Zip: Cell Phone: Address: MAIDEN NAME, NICKNAME OR ALIAS (if applicable): LEGAL NAME Last, First, Middle Initial Social Security Number Household Information Date of Birth Relationship To Head HEAD Sex M/F Marital Status Race (see # Below) Ethnicity (see # Below) RACE: (1) Black (2) White (3) American Indian/Alaskan Native (4) Asian or Pacific Islander (5) Multi Racial ETHNICITY: (1) Hispanic (2) Non- Hispanic Current Landlord name, address and phone number: Rental History Have you or any household member ever been evicted? Yes No If yes, how many times and when: Name of Landlord(s): Are you or any household member now living or have ever lived in Public Housing, received Section 8 assistance or any other form of government assistance? Yes No If yes, where and what agency: Do you owe them money? Yes No If yes, how much: Are you related to anyone currently employed by The Housing Authority of the City of Fort Lauderdale or any of its affiliates, including the Affordable Housing Division? Yes No If yes, who are you related to and what is the relationship:

3 Criminal History Have you or any member of your household ever engaged in, been cited, arrested, indicted, convicted, placed on probation/parole, had an adjudication withheld, had charges dropped or nolle prossed in connection with any criminal activity? Yes No If yes, who: When? What was the charge? What was the outcome? Are you or any member of your household required to register as a sex offender or predator? Yes No If yes, who? What was the charge: When? What city and state did the offense occur: Emergency Contact Telephone: Relationship: Beneficiary Telephone: Relationship: THE RESIDENT DESIGNATES THE ABOVE ADULT PERSON AS THE RESIDENT'S BENEFICIARY TO BE RESPONSIBLE FOR REMOVAL OF THE RESIDENT'S PERSONAL PROPERTY IN THE EVENT OF DEATH OR INCAPACITY OF RESIDENT. RESIDENT FURTHER DESIGNATES HIS/HER BENEFICIARY TO BE THE RECIPIENT OF ANY FUNDS DUE TO RESIDENT IN THE EVENT OF RESIDENT'S DEATH OR INCAPACITY. THIS EMERGENCY CONTACT BENEFICIARY NOTICE SUPERCEDES ANY AND ALL PRE-EXISTING EMERGENCY CONTACT BENEFICIARY NOTICES. Household Income Please provide one (1) month of income receiving now and/or expect to receive in the next twelve (12) months for all members of your household. Proof of income such as: Employment Retirement Fund Unemployment Social Security Workmen s Compensation TANF / Food Stamps Self Employment Verification Child Support Tax Return with W-2 attached for the past 2 years Alimony Veterans Benefits Annuity Payments Contribution / Money received from: (i.e. gifts, family members, friends, etc.) Notarized letter ONLY Member Name Type of Income Agency / Contributor Name Income Household Expenses Please provide twelve (12) months of your most recent expenses paid out of pocket. Proof of expenses such as: (Only applicable for Project Based Units) Childcare Prescriptions/Medications Doctor/Dental Hospital Adult care / Nurse Aide Supplemental Insurance Insurance Other Member Name Type of Expense Agency Name Expenses

4 Household Assets Please provide your most recent asset statement. Proof of assets such as: Checking Account Life Insurance Policy Money Market IRA/ Retirement Pension Savings Account Trust Stocks / Bonds / CD Other Member Name Type of Asset Agency Name Value or Balance Vehicle Information Member Name Year, Make, Model Tag Number Vehicle Payment Insurance Payment If you or anyone in your family is a person with disabilities, and you require a specific accommodation in order to fully utilize our program and services, please contact the Affordable Housing Manager at 500 West Sunrise Boulevard, Fort Lauderdale, FL or By signing below I understand that there is a non-refundable initial application fee per adult. I further understand that any security deposit given to The Housing Authority of the City of Fort Lauderdale will only be refunded if denied. If I decide to cancel after being approved, security deposit paid will NOT be refunded. I hereby authorize The Housing Authority of the City of Fort Lauderdale to perform background checks, including, but not limited to, income verification, criminal background, and eviction record for the purposes of determining my suitability and eligibility as an initial or continuing tenant. I understand and agree that any initial or renewal lease agreement entered into by the parties is conditional upon the receipt of cleared background checks, income verifications, and eviction records. Said checks and verifications will be performed after this Application has been completed. The Housing Authority of the City of Fort Lauderdale reserves the right to terminate any lease if the background checks are not approved or the income verifications do not meet eligibility requirements. Tenant will be given a 7-Day Notice to Cure the Non Compliance if their background check(s) are not approved. Tenant s lease will be terminated in the event they are unable to cure the noncompliance. WARNING: Title 18, Section 1001 of the United States Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department or agency of the United States. I/we read and understand all questions asked of me and certify that all information given is true. I/we further understand any false information given will result in denial of my application. Stamp date/time received: Revised 7/26/13

5 Authorization for the Release of Information Organization requesting release of Information (Name, Address, Telephone, & Date): The Housing Authority of the City of Fort Lauderdale Affordable Housing Division 500 West Sunrise Blvd Ft. Lauderdale, FL (954) Purpose The Housing Authority of the City of Fort Lauderdale may use this authorization and the information obtained with it, to administer and enforce program rules and policies. Authorization I authorize the release of any information (including documentation and other materials) pertinent to eligibility for or participation under any of the following program: Affordable Housing Program I authorize the above named organization to obtain information about me or my family that is pertinent to eligibility for participation in assisted housing programs. I authorize the Housing Authority of City of Fort Lauderdale to obtain information on wages or unemployment compensation from State Employment Securities Agencies. Information Covered Inquiries may be made about: Child Care Expenses Credit History Criminal Activity Family Composition Employment, Income, Pension, and Assets Federal, State, Tribal, or Local Benefits Handicapped Assistance Expenses Identity and Marital Status Medical Expenses Social Security Numbers Residences and Rental History Individuals Or Organizations That May Release Information Any individual or organization including any governmental organization may be asked to release information. For example, information may be requested from: Banks and Other Financial Institutions Courts Law Enforcement Agencies Credit Bureaus Employers, Past and Present Landlords Providers of: Alimony Child Care Child Support Credit Handicapped Assistance Medical Care Pensions/Annuities Schools and Colleges U. S. Social Security Administration U. S. Department of Veterans Affairs Utility Companies Welfare Agencies Conditions I agree that photocopies of this authorization may be used for the purposes stated above. If I do not sign this authorization, I also understand that my housing assistance may be denied or terminated. Signature, Original of the is retained Head of Household by the requesting organization. Date Print, Name of Head of Household HOUSING AUTHORITY OF CITY OF Signature, Spouse/Co-Head FORT LAUDERDALE Date Print, Name of Spouse/Co-Head Signature, Other Adult Member of the Household Date Print, Other Adult Member of the Household Signature, Other Adult Member of the Household Date Print, Other Adult Member of the Household

APPLICATION FOR ADMISSION TO RIVERWALK PLACE. If you need assistance with filling out this application, please contact the office of RiverWalk Place.

APPLICATION FOR ADMISSION TO RIVERWALK PLACE. If you need assistance with filling out this application, please contact the office of RiverWalk Place. RIVERWALK PLACE 431 E. EAGLE FLATS PARKWAY--APPLETON, WISCONSIN 54915 Phone: (920) 733-5046 Fax: 882-9427 TDD: 731-2406 Office Hours: Mon-Thurs 8am-4pm, Fri. 7:30am-3:30pm APPLICATION FOR ADMISSION TO

More information

We Do Business in Accordance to the Federal Fair Housing Law

We Do Business in Accordance to the Federal Fair Housing Law PLEASE COMPLETE IN FULL Housing Authority of the City of Fort Myers Public Housing Application SOUTHWARD VILLAGE APTS. 3040 Franklin Street, Fort Myers, FL 33916 Telephone (239) 332-6635 Fax (239) 344-3273

More information

Thank you for requesting an application for an apartment. Enclosed, please find an application package.

Thank you for requesting an application for an apartment. Enclosed, please find an application package. Dear Applicant, Thank you for requesting an application for an apartment. Enclosed, please find an application package. Please read the application carefully, complete every section, and date where indicated.

More information

IMPORTANT! PLEASE READ THIS ENTIRE NOTICE

IMPORTANT! PLEASE READ THIS ENTIRE NOTICE IMPORTANT! PLEASE READ THIS ENTIRE NOTICE Completed Applications May Be Returned by email to: apply@ccmanagers.com by Fax to 212-348-3670 or by Mail. Do NOT return page 1 & 2 with your application YOU

More information

Brook Haven 7781 Crystal Brook Circle * Brooksville, FL 34601 Office (352) 397-4340 Fax (813) 925-4287 RENTAL APPLICATION

Brook Haven 7781 Crystal Brook Circle * Brooksville, FL 34601 Office (352) 397-4340 Fax (813) 925-4287 RENTAL APPLICATION Brook Haven 7781 Crystal Brook Circle * Brooksville, FL 34601 Office (352) 397-4340 Fax (813) 925-4287 RENTAL APPLICATION Desired Community Name Desired Move-in Date / /20 Desired Apartment Size (check

More information

Please note: We are accepting applications for 1-4 bedroom apartments only.

Please note: We are accepting applications for 1-4 bedroom apartments only. Page 1 Gardens at SouthBay Preliminary Application 6720 S. Louis Ave, Tampa, FL 33616 PLEASE RETURN APPLICATION MONDAY THURSDAY 9AM 6PM POR FAVOR DE REGRESAR LA APLICACIÓN DE LUNES A JUEVES DE 9AM A 6PM

More information

phone fax

phone fax 480-898-0228 phone 480-898-9007 fax www.affordablerental.org Save the Family's Transitional Program was designed to promote self-sufficiency and stabilize family lifestyles with the community through intensive

More information

Madsen Properties, Inc.

Madsen Properties, Inc. Madsen Properties, Inc. 27128 State Highway 78, Suite 1 Battle Lake, MN 56515 218-864-5400 1-800-728-5401 Dear Applicant, Thank you for your interest in our affordable apartments. The application you downloaded

More information

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU.

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU. Dear Applicant: Thank you for your recent inquiry of occupancy at a Carabetta Management Company apartment community. Due to the nature of Federal Assistance provided for these properties, we are required

More information

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU.

PLEASE SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD EVEN IF YOU ARE INTERESTED IN MORE THAN ONE (1) PROPERTY. THANK YOU. Dear Applicant: Thank you for your recent inquiry of occupancy at a Carabetta Management Company apartment community. Due to the nature of Federal Assistance provided for these properties, we are required

More information

Application for Housing

Application for Housing Application for Housing HELP Philadelphia IV consists of sixty 1-BEDROOM units. Applicant Information Last Name First Name MI Street Address Apt. # City State Zip Code Social Security# Home Phone: Date

More information

RENTAL HOUSING APPLICATION

RENTAL HOUSING APPLICATION OFFICE USE ONLY: Property: Date/Time: 901 30th Street Paso Robles, CA 93446 Phone: (805) 238-4015 Fax (805) 238-4036 Bdrm size: Waitlist No: Hhld Size: AMI: % Applicant RENTAL HOUSING APPLICATION M / F

More information

PALM LAKE VILLAGE. Application Fee is $25.00 Please make money order/cashier check payable to P.L.V.H.C.

PALM LAKE VILLAGE. Application Fee is $25.00 Please make money order/cashier check payable to P.L.V.H.C. PALM LAKE VILLAGE 1515 County Road One Dunedin, Florida 34698 (727) 733-8880 Monday through Friday 8:00 am to 5:00 pm (Office closed last Friday of each month for in-service day) Application Fee is $25.00

More information

Key Real Estate Advisors, Inc.

Key Real Estate Advisors, Inc. 10231 Metro Pkwy, Suite 2 Fort Myers, Florida 33966 Office (239) 454-3749 Fax: (239) 425-0701 www.keyrealestateadvisors.com AGENT - APPLICATION CHECK LIST LEASING AGENT: Name: Phone: Email: Property Address:

More information

Applicant Name: Last MI First Co-Applicant Name: Last MI First Current Address: City: State: Zip Code: Tel #:

Applicant Name: Last MI First Co-Applicant Name: Last MI First Current Address: City: State: Zip Code: Tel #: PROPERTY NAME: Denver Apartments Iowa Housing Associates / Time Received: For Office Use Only TAX CREDIT RURAL DEVELOPMENT APPLICATION FOR HOUSING Equal Housing Opportunity Bedroom Size Requested: Bdrm

More information

APPLICATION & RESIDENT SELECTION INFORMATION

APPLICATION & RESIDENT SELECTION INFORMATION Professional Property Managers 4110 Eaton Avenue, Suite C, Caldwell, ID 83607 APPLICATION & RESIDENT SELECTION INFORMATION Note to applicant: This page is for you to retain in reference to our resident

More information

APPLICATION DEADLINE: JUNE 10, 2016

APPLICATION DEADLINE: JUNE 10, 2016 APPLICATION DEADLINE: JUNE 10, 2016 Affordable Rental Housing for Seniors 55+ Grace Terrace in Mt. Vernon One Bedroom + 1 Bathroom Apartments Available Located at 125 S. Fifth Avenue, Mt. Vernon, New York

More information

Menorah Plaza, Menorah West, and Harry & Jeanette Weinberg Apartments

Menorah Plaza, Menorah West, and Harry & Jeanette Weinberg Apartments Menorah Plaza, Menorah West, and Harry & Jeanette Weinberg Apartments Date Time Method Initials APPLICATION Menorah Plaza, Menorah West, and Weinberg Apartments do not discriminate against applicants based

More information

Sample Rental Housing

Sample Rental Housing Sample Rental Housing Application for Residency Property Name: : _ Household Information: Complete the following information for each household member that will occupy the unit at time of move-in: Name

More information

HOUSING ASSISTANCE PROGRAMS

HOUSING ASSISTANCE PROGRAMS Marion County Board of County Commissioners Community Services 2631 SE Third St. Ocala, FL 34471 Phone: 352-671-8770 Fax: 352-671-8769 HOUSING ASSISTANCE PROGRAMS LOAN APPLICATION State Housing Initiatives

More information

AFFORDABLE HOUSING APPLICATION

AFFORDABLE HOUSING APPLICATION For Office-Use-Check all that apply TAX CREDIT *BOND *HUD *OTHER *Requires Addendum Property: Marketing Source: Apartment # Unit Type: Move-in Date App Fee Lease Term Rental Rate Security Deposit Telephone#

More information

AFFORDABLE RENTAL HOUSING OPPORTUNITY

AFFORDABLE RENTAL HOUSING OPPORTUNITY AFFORDABLE RENTAL HOUSING OPPORTUNITY SELECTION BY LOTTERY -, & 3 BEDROOM APARTMENTS 44 Merrimack Street, Haverhill, MA 0830 78.794.000 (TTY 7) LiveHarborPlace.com Discover Harbor Place on the Merrimack.

More information

STAGE COACH RESIDENCES 70 STAGE COACH ROAD, CENTERVILLE

STAGE COACH RESIDENCES 70 STAGE COACH ROAD, CENTERVILLE STAGE COACH RESIDENCES 70 STAGE COACH ROAD, CENTERVILLE Thank you for your interest in the Stage Coach Residences (12) apartments that are available for rental to low and moderate income households. Six

More information

Pre-Application for Waiting List Section 8 Housing Choice Voucher (HCV) Program

Pre-Application for Waiting List Section 8 Housing Choice Voucher (HCV) Program Pre-Application for Waiting List Section 8 Housing Choice Voucher (HCV) Program Please designate which county you are applying for (can change county when pulled from the waiting list): Clatsop County

More information

PLEASE USE BLUE INK APPLICATION FOR HOUSING

PLEASE USE BLUE INK APPLICATION FOR HOUSING PLEASE USE BLUE INK APPLICATION FOR HOUSING DEVELOPMENT NAME Renaissance II, Smith Hill Vision, Smith Hill Vision II DEVELOPMENT NUMBER 525 / 514 DEVELOPMENT ADDRESS 47 Goddard Street 1 st Flr. Providence,

More information

Date Received: Time Received: Application taken by:

Date Received: Time Received: Application taken by: Received: Time Received: Application taken by: APPLICATION FOR HOUSING Low-Income Housing Tax Credit Property This is an application for housing at: Whitney Young Manor, LP 358 Nepperhan Avenue, Management

More information

The Housing Choice Voucher Program (Section 8) waiting list is open for applicants who qualify for the following preference(s)

The Housing Choice Voucher Program (Section 8) waiting list is open for applicants who qualify for the following preference(s) The Housing Choice Voucher Program (Section 8) waiting list is open for applicants who qualify for the following preference(s) 1. Families with an adult member who is employed full-time for the past 12

More information

BELLHINGHAM HILL FAMILY HOMES APPLICATION FOR HOUSING

BELLHINGHAM HILL FAMILY HOMES APPLICATION FOR HOUSING BELLHINGHAM HILL FAMILY HOMES APPLICATION FOR HOUSING 55 Library Street and 158-164 Shawmut Street, Chelsea, MA Opening Summer 2014 Thank you for your interest in Bellingham Hill Family Homes! Please read

More information

Making our Communities a better place to live

Making our Communities a better place to live RPM MANAGEMENT, LLC Making our Communities a better place to live 77 Park Street * Montclair, NJ 07042 * PHONE :(973) 744-5410 * FAX: (973) 744-6455 Dear Prospective Resident, Thank you for your interest

More information

HURRICANE IKE INTAKE APPLICATION

HURRICANE IKE INTAKE APPLICATION HURRICANE IKE INTAKE APPLICATION INSTRUCTIONS FOR APPLICATION STEP 1: Read the instructions for this application and the Frequently Asked Questions (FAQ). They contain important information about documents

More information

Kane County Foreclosure Redevelopment Program. Home Buyer Application

Kane County Foreclosure Redevelopment Program. Home Buyer Application Kane County Foreclosure Redevelopment Program Home Buyer Application To apply to purchase a home that was redeveloped under the Kane County Foreclosure Redevelopment Program Please follow these three easy

More information

AFFORDABLE HOUSING UNITS FOR RENT

AFFORDABLE HOUSING UNITS FOR RENT AFFORDABLE HOUSING UNITS FOR RENT Via 57 West is pleased to announce that applications are now being accepted for 142 affordable rental apartments. This project is being financed by NYS Homes and Community

More information

Capital Area Housing Partnership, Inc. (CAHP) Income and Asset Checklist

Capital Area Housing Partnership, Inc. (CAHP) Income and Asset Checklist Capital Area Housing Partnership, Inc. (CAHP) Income and Asset Checklist EQUAL HOUSING OPPORTUNITY Complete a separate form for each household member who is age 18 or older, and be prepared to provide

More information

APPLICATION FOR APARTMENT

APPLICATION FOR APARTMENT APPLICATION FOR APARTMENT INSTRUCTIONS: 1. SUBMIT ONLY ONE APPLICATION PER HOUSEHOLD. Applications are selected randomly through a lottery. You will be disqualified if more than one application is received

More information

First Name: M/I: Last Name: Social Security Number: Date of Birth: Home Phone Number: Address:

First Name: M/I: Last Name: Social Security Number: Date of Birth: Home Phone Number:  Address: Rental Application Applicant Information : Unit Number: Monthly Rent: Move in : Leasing Agent: First Name: M/I: Last Name: Social Security Number: of Birth: Home Phone Number: Email Address: Other Occupants

More information

RENTAL APPLICATION USDA/HUD PROPERTIES ONLY

RENTAL APPLICATION USDA/HUD PROPERTIES ONLY Updated 09/15/2014 This institution is an equal opportunity provider and employer Instructions for completing the application: RENTAL APPLICATION USDA/HUD PROPERTIES ONLY (Please return the application

More information

EMERGENCY FINANCIAL ASSISTANCE APPLICATION PACKET

EMERGENCY FINANCIAL ASSISTANCE APPLICATION PACKET LAKE COUNTY VETERANS SERVICE OFFICE An Office of the Lake County Government 105 Main Street, (Lake County Administration Building), Painesville, OH 44077 (440) 350-2904 or (440) 350-2567 EMERGENCY FINANCIAL

More information

Queset Commons 11 Roosevelt Circle Easton, MA First Come First Serve Rental Application

Queset Commons 11 Roosevelt Circle Easton, MA First Come First Serve Rental Application 11 Roosevelt Circle Easton, MA First Come First Serve Rental Application TO SCHEDULE A SHOWING CONTACT: Jaclyn Cracknell at 508-205-3241. Attached is the information regarding the affordable rental units

More information

It is our mission to provide excellence in quality and service

It is our mission to provide excellence in quality and service It is our mission to provide excellence in quality and service Date: Patient Name: MRN: For your convenience, enclosed is a Financial Assistance Application. The application is for bills acquired for services

More information

5620 Arapahoe Avenue Suite 212, Boulder, CO Phone: Fax:

5620 Arapahoe Avenue Suite 212, Boulder, CO Phone: Fax: Welcome to Thistle Communities. We offer a variety of rental homes ranging in size from studios to4 bedrooms throughout Boulder. Thistle is a not-for-profit organization committed to providing quality

More information

City of Odessa Community Development Home of Your Own/Homeownership Assistance Programs

City of Odessa Community Development Home of Your Own/Homeownership Assistance Programs City of Odessa Community Development Home of Your Own/Homeownership Assistance Programs The following items must be submitted with your application before we can proceed with processing. All portions of

More information

Sample Rental Housing Tenant Application Form

Sample Rental Housing Tenant Application Form Sample Rental Housing Tenant Application Form About this Tool Description: This resource provides an example of a tenant application form. Rental applications provide important information about prospective

More information

First-Time Homebuyers Training Assistance Program Application

First-Time Homebuyers Training Assistance Program Application Dear Prospective First Time Home Buyer: Thank you for your recent inquiry regarding the City of Kenner Department of Community Development s First Time Home Buyers Training Assistance Program. The purpose

More information

AFFORDABLE HOUSING APPLICATION

AFFORDABLE HOUSING APPLICATION AFFORDABLE HOUSING APPLICATION PLEASE FILL OUT THIS APPLICATION COMPLETELY. ALL BLANKS MUST BE FILLED IN BEFORE THE APPLICATION W I L L B E C O N S I D E R E D C O M P L E T E A N D C A N B E PROCESSED

More information

APPLICATION COVER LETTER

APPLICATION COVER LETTER APPLICATION COVER LETTER RE: 66 FLATBUSH APTS Dear Prospective Applicant: Enclosed is an application for the above-referenced building, which participates in a governmentally assisted affordable housing

More information

LOW INCOME PUBLIC HOUSING COMMUNITY SELECTION FORM. Applicant s Full Name. Applicant s Social Security Number - - Applicant s Current Address

LOW INCOME PUBLIC HOUSING COMMUNITY SELECTION FORM. Applicant s Full Name. Applicant s Social Security Number - - Applicant s Current Address LOW INCOME PUBLIC HOUSING COMMUNITY SELECTION FORM Applicant s Full Name Applicant s Social Security Number - - Applicant s Current Address City State Zip Code Please check up to three (3) box(s) for the

More information

CS MELROSE SITE B LLC LA TERRAZA. RE: La Terraza - 3100 Third Avenue, Bronx, New York 10451

CS MELROSE SITE B LLC LA TERRAZA. RE: La Terraza - 3100 Third Avenue, Bronx, New York 10451 CS MELROSE SITE B LLC LA TERRAZA RE: La Terraza - 3100 Third Avenue, Bronx, New York 10451 Thank you for contacting us. As per your request, enclosed is an application for the above-referenced apartment

More information

HEAD Of HOUSEHOLD M / F. ID or Driver s License Number: State: Please provide a copy of license / ID. Relationship S.S. M / F M / F.

HEAD Of HOUSEHOLD M / F. ID or Driver s License Number: State: Please provide a copy of license / ID. Relationship S.S. M / F M / F. Property: 1. Name (first, middle initial, last) Applicants (Do not provide Social Security numbers for minors) HEAD Of HOUSEHOLD S.S. Number Date of Birth 2. Name (first, middle initial, last) Relationship

More information

Brookview Apartments. Applicant Leasing Checklist

Brookview Apartments. Applicant Leasing Checklist P a g e 1 Brookview Apartments 1940 W University Drive Mesa, AZ 85201 (480)962-6222 EACH APPLICANT 18 AND OLDER MUST COMPLETE A SPERATE APPLICATION. AN APPLICATION FEE OF $25.00 PER APPLICANT IN THE FORM

More information

Dear Resident, Sincerely, Neighborhood Services Staff. Rehabilitation Program. Purchase/Workforce Program. Completed Application Form

Dear Resident, Sincerely, Neighborhood Services Staff. Rehabilitation Program. Purchase/Workforce Program. Completed Application Form City of Delray Beach Neighborhood Services Division Dear Resident, Thank you for your interest in the City of Delray Beach Neighborhood Services Programs. We are required to document your eligibility for

More information

CITY OF LONGVIEW TECHNICAL JOB TRAINING SCHOLARSHIP GRANT APPLICATION INSTRUCTIONS

CITY OF LONGVIEW TECHNICAL JOB TRAINING SCHOLARSHIP GRANT APPLICATION INSTRUCTIONS CITY OF LONGVIEW TECHNICAL JOB TRAINING SCHOLARSHIP GRANT APPLICATION INSTRUCTIONS You are applying for a technical job training scholarship grant from the city of Longview. The grant is federally funded

More information

Mariner s Watch Apartments

Mariner s Watch Apartments Mariner s Watch Apartments 440 Mariners Way Norfolk, VA. 23503 (7547) 587-6447 Office (757) 587-5724 Fax RESIDENT SELECTION CRITERIA APPLICATIONS: All Applicants must meet the criteria for acceptance set

More information

Iowa Department of Human Services Application for Food Assistance

Iowa Department of Human Services Application for Food Assistance What is Food Assistance? Iowa Department of Human Services Application for Food Assistance Food Assistance is a program to help buy food for good health. How Do I Get Food Assistance? Step 1. Fill out

More information

SOMERVILLE HOUSING AUTHORITY 30 Memorial Road, Somerville, Massachusetts 02145 Telephone (617) 625-1152 TDD (617) 628-8889

SOMERVILLE HOUSING AUTHORITY 30 Memorial Road, Somerville, Massachusetts 02145 Telephone (617) 625-1152 TDD (617) 628-8889 SOMERVILLE HOUSING AUTHORITY 30 Memorial Road, Somerville, Massachusetts 02145 Telephone (617) 625-1152 TDD (617) 628-8889 PRELIMINARY APPLICATION FOR FEDERAL-AIDED HOUSING PLEASE PRINT Federal Control

More information

Who can apply? Documentation Requested. For more information please contact: Susan Hernandez Homeless Services Technician

Who can apply? Documentation Requested. For more information please contact: Susan Hernandez Homeless Services Technician SECURITY DEPOSIT ASSISTANCE PROGRAM UNDER THE HOUSING AUTHORITY OF THE COUNTY OF RIVERSIDE SECURITY DEPOSIT ASSISTANCE PROGRAM, PAYMENT WILL BE PROVIDED FOR THE SECURITY DEPOSIT NOT TO EXCEED 50% OF THE

More information

ATLANTA TAMPA MIAMI JAX

ATLANTA TAMPA MIAMI JAX RENTAL CRITERIA WE DO BUSINESS IN ACCORDANCE WITH THE FEDERAL FAIR HOUSING LAW. It is illegal to discriminate against any person because of RACE, COLOR, RELIGION, SEX, HANICAP, FAMILIAL STATUS, OR NATIONAL

More information

AFFORDABLE HOUSING RENTAL APPLICATION

AFFORDABLE HOUSING RENTAL APPLICATION Please call Sally with any questions @ 207-333-6420 AFFORDABLE HOUSING RENTAL APPLICATION This Affordable Housing Rental Application is the first step in seeking to rent an apartment owned and/or managed

More information

APPLICATION FOR HOUSING REHABILITATION ASSISTANCE

APPLICATION FOR HOUSING REHABILITATION ASSISTANCE City of St. Petersburg HOUSING & COMMUNITY DEVELOPMENT DEPARTMENT (727) 893-7247 One Fourth Street North, Ninth Floor Municipal Services Building St. Petersburg, Florida 33701 COMPLETION OF THIS APPLICATION

More information

Rental Process and Application Disclosure

Rental Process and Application Disclosure Rental Process and Application Disclosure WE ARE PLEDGED TO THE LETTER AND SPIRIT OF U.S. POLICY FOR THE ACHIEVEMENT OF EQUAL HOUSING OPPORTUNITY THROUGHOUT THE NATION. WE ENCOURAGE AND SUPPORT A PROGRAM

More information

Page 1 GUARANTOR APPLICATION FOR LEASE

Page 1 GUARANTOR APPLICATION FOR LEASE Page 1 GUARANTOR APPLICATION FOR LEASE WILLIAMSBURG PROPERTY MANAGEMENT, INC. 811 RICHMOND ROAD/WILLIAMSBURG, VA 23185 (757)229-8292 - PH (757)229-2943 - FAX E-MAIL: wpm@wpminconline.com The property will

More information

CRITERIA FOR RESIDENCY AT APARTMENTS RESIDENT SCREENING AND SELECTION PROCESS

CRITERIA FOR RESIDENCY AT APARTMENTS RESIDENT SCREENING AND SELECTION PROCESS OR CRITERIA FOR RESIDENCY AT APARTMENTS RESIDENT SCREENING AND SELECTION PROCESS I. OCCUPANCY POLICY 1. Occupancy is based on the number of bedrooms in a unit. A bedroom is defined as a space within a

More information

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs

Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs Application for Mississippi Medicaid Aged, Blind and Disabled Medicaid Programs This application is used for an individual, couple or child to apply for Medicaid due to age or disability. Please read each

More information

WAITING LIST REQUESTS

WAITING LIST REQUESTS Please complete this form and the attachments and forward to the Leasing Department at the address provided. WAITING LIST REQUESTS NAME: If I qualify, I wish to be placed on the following waiting lists:

More information

Application for Legal Assistance

Application for Legal Assistance Application for Legal Assistance 1. What kind of problem do you need help with? Divorce Child Custody Guardianship Bankruptcy Tax Landlord/Tenant Will / Estate Planning Other 2. Applicant Information Your

More information

Provide a match of a 2:1 ratio (for every one dollar the participant saves, it will be matched with two dollars)

Provide a match of a 2:1 ratio (for every one dollar the participant saves, it will be matched with two dollars) Program Overview The Back On Track Matched Savings Accounts program is administered by United Way of the Bluegrass in partnership with local/regional community agencies. An Individual Development Account

More information

3165 Waialae Avenue, Suite 200, Honolulu, Hawaii 96816 Ph: (808) 735-9099 e-fax: (781) 295-3427

3165 Waialae Avenue, Suite 200, Honolulu, Hawaii 96816 Ph: (808) 735-9099 e-fax: (781) 295-3427 3165 Waialae Avenue, Suite 200, Honolulu, Hawaii 96816 Ph: (808) 735-9099 e-fax: (781) 295-3427 APPLICATION FOR RENTAL HOUSING NA LEI HULU KUPUNA ELDERLY HOUSING (2/2015) 610 Cooke Street, Honolulu, HI

More information

BlackRoc Property Management

BlackRoc Property Management BlackRoc Property Management 15825 S. 46 th Street, Suite 128 Phoenix, AZ 85048 Phone: (480) 940-1366 Fax: (480) 422-8752 Email: Residents@BlackRocpm.com Rental Application for Occupancy $40 per applicant

More information

LEASE APPLICATION RESIDENCY INFORMATION

LEASE APPLICATION RESIDENCY INFORMATION Full Name LEASE APPLICATION Date Apt. # Source Amount $ Move In Lease Term Social Security Number RESIDENCY INFORMATION Present Address Phone Length of Residency Own Rent Monthly Payment Landlord s Name

More information

Rental Qualifications

Rental Qualifications 807 E. Broad Street Columbus, Oh 43205 p. 614-228-6700 f. 614-228-1617 Email: info@beaconman.com Rental Qualifications Website: www.beaconman.com *A completed application for each resident 18 years of

More information

CITY OF VICTORVILLE. APPLICATION Administered by Neighborhood Partnership Housing Services, Inc.

CITY OF VICTORVILLE. APPLICATION Administered by Neighborhood Partnership Housing Services, Inc. CITY OF VICTORVILLE OWNER OCCUPIED HOME REPAIR LOAN APPLICATION Administered by Neighborhood Partnership Housing Services, Inc. Submit completed application and all requested information to: NPHS, Inc.

More information

Venetia Gardens South Condominium Association

Venetia Gardens South Condominium Association Request for Approval - Purchase ALL of the following information must be submitted to the Board of Directors for consideration BEFORE APPROVAL IS GRANTED for the sale of your property. A $100.00 non-refundable

More information

Tooele County HOMEOWNER HOUSING REHAB LOAN APPLICATION

Tooele County HOMEOWNER HOUSING REHAB LOAN APPLICATION ELIGIBILITY Income Eligibility: This program is available to households with a maximum of 80 percent of the median family income for Tooele County. If your household income is greater than the limits,

More information

APPLICATION COVER LETTER

APPLICATION COVER LETTER APPLICATION COVER LETTER RE: BAM SOUTH APTS Dear Prospective Applicant: Enclosed is an application for the above-referenced building, which participates in a governmentally assisted affordable housing

More information

Non-Custodial Parent Form. Last Name First Name M.I. SS# or AU Student ID#

Non-Custodial Parent Form. Last Name First Name M.I. SS# or AU Student ID# Alfred University Student (print) Non-Custodial Parent Form Student Financial Aid Office Alfred University One Saxon Drive Alfred, NY 14802 607 871 2159 fax: 607 871 2252 www.alfred.edu Last Name First

More information

FINANCIAL ASSISTANCE APPLICATION: COVER LETTER

FINANCIAL ASSISTANCE APPLICATION: COVER LETTER FINANCIAL ASSISTANCE APPLICATION: COVER LETTER Thank you for choosing Children s of Alabama to provide for the healthcare needs of your child. Please find attached the forms you must complete in order

More information

COVENANT PLACE #8 MILLSTONE CAMPUS DR, SUITE 2000 ST. LOUIS, MO ATTN: ADMISSIONS

COVENANT PLACE #8 MILLSTONE CAMPUS DR, SUITE 2000 ST. LOUIS, MO ATTN: ADMISSIONS ELIGIBILITY QUESTIONNAIRE Dear Interested Person, Community Housing Management Corporation Covenant House/CHAI Apts. 8 Millstone Campus Drive Ste. 2000 St. Louis, MO 63146 314-432-1610 phone 314-432-4058

More information

NEWLY RENOVATED LARGE & SPACIOUS APARTMENTS FOR RENT

NEWLY RENOVATED LARGE & SPACIOUS APARTMENTS FOR RENT NEWLY RENOVATED LARGE & SPACIOUS APARTMENTS FOR RENT BRONX PRO - UAC 3 Apartments is pleased to announce that applications are now being accepted for 170 affordable housing rental apartments now under

More information

450-458 Gouverneur Place Apartments WESTHAB, INC. (Property Management) 8 BASHFORD ST, YONKERS, N.Y. 10701 HOUSING APPLICATION

450-458 Gouverneur Place Apartments WESTHAB, INC. (Property Management) 8 BASHFORD ST, YONKERS, N.Y. 10701 HOUSING APPLICATION Mail to: 450-458 Gouverneur Place Apartments WESTHAB, INC. (Property Management) 8 BASHFORD ST, YONKERS, N.Y. 10701 HOUSING APPLICATION Agency Use Only Date Received Application # Approved YES NO 1) LAST

More information

DARKO AFFORDABLE HOUSING SOLUTIONS, LLC 125 E Broadway, P.O. BOX 1161 ANADARKO, OK Phone: FAX:

DARKO AFFORDABLE HOUSING SOLUTIONS, LLC 125 E Broadway, P.O. BOX 1161 ANADARKO, OK Phone: FAX: DARKO AFFORDABLE HOUSING SOLUTIONS, LLC 125 E Broadway, P.O. BOX 1161 ANADARKO, OK 73005 Phone: 405-247-1110 FAX: 405-247-4955 STORM SHELTER ASSISTANCE PROGRAM APPLICATION The DAHS Storm Shelter Assistance

More information

TAX DEFERRAL INFORMATION AND INSTRUCTION SHEET

TAX DEFERRAL INFORMATION AND INSTRUCTION SHEET CECIL COUNTY, MARYLAND OFFICE OF FINANCE 200 CHESAPEAKE BLVD, STE. 1100 ELKTON, MARYLAND 21921 TAX DEFERRAL INFORMATION AND INSTRUCTION SHEET The Annotated Code of Maryland, Tax-Property Article 10-204

More information

APPLICATION TO RENT 1519 Locust Street Chico, CA 95928

APPLICATION TO RENT 1519 Locust Street Chico, CA 95928 APPLICATION TO RENT 1519 Locust Street Chico, CA 95928 (All sections must be completed) Individual application required from each occupant 18 years of age or older Last First Middle Social Security Number

More information

General Information or Things You May Need to Know About Section 8

General Information or Things You May Need to Know About Section 8 General Information or Things You May Need to Know About Section 8 What is Section 8? What is a Waiting List? This is a federally funded program to help low income families pay their rent. Generally, families

More information

WEDCO. Amount Requested Purpose. Repayment Source

WEDCO. Amount Requested Purpose. Repayment Source WEDCO Wentworth Economic Development Corporation, Inc. 7 Center Street, PO Box 641, Wolfeboro, NH 03894 Phone: 569-4216 Fax: 569-3317 Website: www.wedco NH.org Small Business Loan Application All information

More information

SITKA APARTMENTS - Request to be added to Waiting List

SITKA APARTMENTS - Request to be added to Waiting List SITKA APARTMENTS - Request to be added to Waiting List Name(s) (list all who will live in apt.): Current Street Address: City, State, Zip Code: Contact information (phone # or e-mail): # of BRs and MFI

More information

P E N N S Y L V A N I A

P E N N S Y L V A N I A P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles If you have a disability and need this form in large print or another format, please call our helpline

More information

H O M E FOR HOMEOWNERS IN DISTRICT 3

H O M E FOR HOMEOWNERS IN DISTRICT 3 H O M E R E H A B L O A N P R O G R A M FOR HOMEOWNERS IN DISTRICT 3 Are You Having Problems with Your Plumbing? Do You Need a New Roof? Are Your Windows Old and Seeping Air? How About Other Over Looked

More information

RIVER HOUSE TENANT, LLC - RENTAL APPLICATION

RIVER HOUSE TENANT, LLC - RENTAL APPLICATION RIVER HOUSE TENANT, LLC - RENTAL APPLICATION River House Tenant, LLC does business in accordance with the Fair Housing Amendments Act of 1988 and the Virginia Fair Housing Law, which specifies that it

More information

AFFORDABLE RENTAL OPPORTUNITY Eastham, MA 3 Bedroom-Single Family Home COMPLETE APPLICATION DUE: FEBRUARY 16 TH, 3:00 PM

AFFORDABLE RENTAL OPPORTUNITY Eastham, MA 3 Bedroom-Single Family Home COMPLETE APPLICATION DUE: FEBRUARY 16 TH, 3:00 PM AFFORDABLE RENTAL OPPORTUNITY Eastham, MA 3 Bedroom-Single Family Home COMPLETE APPLICATION DUE: FEBRUARY 16 TH, 3:00 PM Be sure to read the directions for completing the application very carefully! Do

More information

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance NEW JERSEY HOME ENERGY PROGRAMS Home Energy Assistance Universal Service Fund Weatherization Assistance Home Energy Assistance (HEA)/Universal Service Fund (USF) and Weatherization Application Home Energy

More information

Applicant Name: Last MI First Co-Applicant Name: Last MI First Current Address: City: State: Zip Code: Tel #:

Applicant Name: Last MI First Co-Applicant Name: Last MI First Current Address: City: State: Zip Code: Tel #: PROPERTY NAME: Denver Apartments Iowa Housing Associates / Time Received: For Office Use Only TAX CREDIT RURAL DEVELOPMENT APPLICATION FOR HOUSING Equal Housing Opportunity Bedroom Size Requested: 1 Bdrm

More information

Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program

Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program Hallandale Beach Community Redevelopment Agency First Time Homebuyers Program Program Overview Under the First Time Homebuyer Program, the Hallandale Beach CRA will provide up to $50,000 in assistance

More information

NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE OFFICE OF REAL PROPERTY TAX SERVICES

NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE OFFICE OF REAL PROPERTY TAX SERVICES NEW YORK STATE DEPARTMENT OF TAXATION & FINANCE OFFICE OF REAL PROPERTY TAX SERVICES RP-459-c (9/09) APPLICATION FOR PARTIAL TAX EXEMPTION FOR REAL PROPERTY OF PERSONS WITH DISABILITIES AND LIMITED INCOMES

More information

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance

NEW JERSEY HOME ENERGY PROGRAMS. Home Energy Assistance Universal Service Fund Weatherization Assistance NEW JERSEY HOME ENERGY PROGRAMS Home Energy Assistance Universal Service Fund Weatherization Assistance Home Energy Assistance (HEA)/Universal Service Fund (USF) and Weatherization Application Home Energy

More information

Ginger Tuttle, REALTOR Riverstone Residential Properties Invitation Homes Phone: 786-473-4288 Fax: 786-219-3304 Email: ginger.riverstone@gmail.

Ginger Tuttle, REALTOR Riverstone Residential Properties Invitation Homes Phone: 786-473-4288 Fax: 786-219-3304 Email: ginger.riverstone@gmail. Ginger Tuttle, REALTOR Riverstone Residential Properties Invitation Homes Phone: 786-473-4288 Fax: 786-219-3304 Email: ginger.riverstone@gmail.com Application Process 1. Complete an APPLICATION FOR EACH

More information

CHANGE REPORT FORM HEAD OF HOUSEHOLD S EMAIL. Mark all that apply

CHANGE REPORT FORM HEAD OF HOUSEHOLD S EMAIL. Mark all that apply Stamp(COCHA office use only) CHANGE REPORT FORM INFORMATION Pre Application F : NAME SOCIAL SECURITY NUMBER PHONE NUMBER ADDRESS HEAD OF HOUSEHOLD S EMAIL Mark all that apply I am a waiting list applicant

More information

APPLICATION FOR HOUSING Low-Income Tax Credit Property

APPLICATION FOR HOUSING Low-Income Tax Credit Property APPLICATION FOR HOUSING Low-Income Tax Credit Property For Office Use Only: Date/Time Received PLEASE PRINT CLEARLY This is an application for housing at: Please complete this application and return to:

More information

5. Upon submission of Application Fee(s) and Security Deposit, we will run a credit check on all adult household members.

5. Upon submission of Application Fee(s) and Security Deposit, we will run a credit check on all adult household members. Thank you for your interest in Avalon Berkeley! Enclosed is information regarding the Avalon Berkeley Open Enrollment period for the affordable housing program: Information on the documentation requirements

More information

CHARIS PROPERTY MANAGEMENT

CHARIS PROPERTY MANAGEMENT CHARIS PROPERTY MANAGEMENT CRIMINAL BACKGROUND CHECKS WILL BE PERFORMED ON ALL APPLICANTS. CONVICTION OF THE FOLLOWING CRIMES WILL MOST OFTEN CONSTITUTE THE AUTOMATIC REJECTION OF TENANCY: murder sale

More information

Board of County Commissioners, Broward County, Florida HUMAN SERVICES DEPARTMENT FAMILY SUCCESS ADMINISTRATION DIVISION

Board of County Commissioners, Broward County, Florida HUMAN SERVICES DEPARTMENT FAMILY SUCCESS ADMINISTRATION DIVISION Board of County Commissioners, Broward County, Florida HUMAN SERVICES DEPARTMENT FAMILY SUCCESS ADMINISTRATION DIVISION BROWARD COUNTY COMMUNITY ACTION AGENCY 2015 LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

More information

PLEASE READ BEFORE COMPLETING APPLICATION ANY QUESTIONS SHOULD BE ASKED PRIOR TO COMPLETING THE APPLICATION

PLEASE READ BEFORE COMPLETING APPLICATION ANY QUESTIONS SHOULD BE ASKED PRIOR TO COMPLETING THE APPLICATION PLEASE READ BEFORE COMPLETING APPLICATION ANY QUESTIONS SHOULD BE ASKED PRIOR TO COMPLETING THE APPLICATION 1. Application and application fee of $25.00 cash (if applicant and co-applicant $50.00) is submitted

More information