Date Application Received/Renewed / Time / Owner Agent Initials
Program Type: / Income Status (Preference) Code:
(must match Waiting List at all times) / VL / L / M
Accessible Unit Desired? / Yes / No / Federal Preference received? / Yes / No
Waiting List Bedroom Size Requested: / Studio / 1 / 2 / 3 / 4
RENTAL APPLICATION INSTRUCTIONS
Thank you for taking the time to visit our Apartment Community. We hope we can call you “Neighbor” soon! We trust that the instructions listed below will help you complete your application in an easier more efficient manner. If you have any questions or require further assistance in completing this application please do not hesitate to ask for our assistance.
IF you are disabled or have difficulty completing this application, please advise us of your needs now or call us to schedule assistance. Appropriate assistance will be provided in a confidential manner and setting.
To schedule assistance, please call the apartment community office weekdays between the hours of 8:00 A.M. and 5:00 P.M. at ______. This line is not equipped for the hearing impaired. Therefore, please call the TDD and TTY numbers listed below in the 504 NON-DISCRIMINATION ON THE BASIS OF DISABLITY STATUS NOTICE.
504 NON-DISCRIMINATION ON THE BASIS OF DISABILITY STATUS NOTICE
§ It is the intention of Management to take reasonable, affirmative steps to increase access and opportunities for disabled individuals in all programs, services and administrative operations.
§ This Apartment Community does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, it’s federally assisted programs and activities.
§ The person named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988).
Jack MacGillivray, Monarch Properties, Inc.
1720 Louisiana Blvd, Suite 402, Albuquerque, NM 87110
Phone (505) 260-4800 Fax (505) 265-2995
National: TDD 1 (202) 720-6362
New Mexico: TTY 1 (800) 659-8331. Voice 1 (800) 659-1779 or “711”
Oklahoma: TTY 1 (800) 722-0353 Voice 1 (800) 676-3777 or “711”
Texas: TTY 1 (800) 735-2989. Voice 1 (800) 735-2988 or “711”
This institution is an equal opportunity provider and employer.
APPLICANT· Please answer all questions. Answer “NO” for questions that are not applicable.
· All adult household members must present a Picture I.D. (i.e. Driver’s License, state I/D, etc.)
· Proof of Social Security number or explanation for not having a Social Security number for all household members; Individual Tax Payer Identification Number (ITIN), Alien Registration Card, as applicable. Proof of birth date for all household members.
· Completed applications will be placed on our Waiting List based on date and time received. Applicants will be notified in writing at the address they have provided. Management will contact you as your name nears the top of the Waiting List. An appointment will be set at your convenience to complete the final phase of the application process, at which time final eligibility for housing and program compliance will be determined.
· Applications placed on the Waiting List will automatically expire in six months from the date and time received. To remain on the Waiting List you must contact our office at least every six months so that we can review and update your application. If any of the household information listed on this application changes before the six-month time frame has expired, it is your responsibility to notify Management in person, by telephone or in writing immediately. We must be able to contact you regarding your Waiting List status and eligibility.
OPTIONS FOR APPLICANTS WITH DISABILITIES
We provide affordable housing to applicants that qualify for Federal rental assistance programs and meet all conditions of our “Resident Selection Plan”. The “Plan” is located at the apartment community office for your reference. We are not permitted to discriminate against applicants on the basis of their race, color, creed, sex, national origin, religion, sexual orientation, gender identity, familial status (includes marital status), or disability condition. In addition, we have a legal obligation to provide “Reasonable Accommodations” to applicants if they or any household members have a disability. Compliance actions may include reasonable accommodations as well as structural modifications to the unit or premises.
A reasonable accommodation is some modification or change that can be made to the policies or procedures that will assist an otherwise eligible applicant with a disability to take advantage of the program. Examples of reasonable accommodations and structural modifications include:
· Making alterations to a unit so it could be used by a household with a wheel chair;
· Installing strobe light smoke detectors in an apartment for a household with a hearing impaired member;
· Permitting a household to have a seeing eye dog to assist a vision impaired household member in a community where dogs are not usually permitted;
· Make a sign language interpreter available to a hearing impaired applicant during the interview; or
· Permitting an outside agency to assist an applicant with a disability to meet the property’s screening criteria.
An applicant household that has a member with a disability must still be able to meet essential obligations of tenancy. They must be able and willing to pay rent, to care for their apartment, to report required information to Management, to avoid disturbing their neighbors, etc. However, there is no requirement that they be able to do these things without assistance.
I/We have read and understand the Options for Applicants with Disabilities. All adults must initial on the line provided.
Please Initial: ______
REASONABLE ACCOMODATION
If you or a member of your household has a disability and you believe you might need or want a reasonable accommodation, you may request it at any time during the application process or after admission to the property. This is up to you. If you prefer not to discuss your situation with Management, that is your right. Please check one below:
Yes, I wish to request reasonable accommodation. (Manager: complete Forms RS-9 and RS-10)
No, reasonable accommodations are not needed.
I wish not to discuss the situation with Management. Please Initial: ______
EMERGENCY CONTACT(S)
Name: Telephone: Relationship:
Address: / City: / State: / Zip Code:
Name: Telephone: Relationship:
Address: / City: / State: / Zip Code:
In the event that I/we cannot be reached directly the above named person(s) May May Not be contacted regarding the status of my/our application. Please initial______
INFORMATION FOR ADULT STUDENTS
If you and/or any adult member of your household applying for an apartment is or will be a full-time or part-time student you and/or they will be required to complete additional form(s) and supply the required documentation. Please check one below and initial where indicated as applicable to the household:
Yes, there is/are ____ full-time and/or ____part-time student(s) in the household.
No, adult (age 18 or older) in the household is a full-time or part-time student. Please Initial: ______
GENERAL INFORMATION
Bedroom Size Requested: (check one) Studio 1 2 3 4
Does your household have a pet(s)? / No Yes, list number and type:
Does your household have an Assistive or Companion animal(s)? / No Yes, list number and type:
Does your household have any vehicles? / Make / Model / Year / License Plate / Color
How did you hear about us? Advertisement Friend/Family Other:______
HOUSEHOLD COMPOSITION
Please list yourself and all household members who will reside with you. (Also include those who are temporarily absent.) HUD requires that ALL household members, regardless of age, must declare their citizenship or immigration status.
Also include those who are temporarily absent:
NAME(S) / RELATION TO HEAD OF HOUSE / AGE /
SEX
/ DATE OF BIRTH / U.S.A. CitizenYes or No / SOCIAL SECURITY, ITIN, Alien Registration NUMBER
Head of House
HOUSEHOLD INCOME
List all sources of income for ALL household members below including but not limited to: Employment, Social Security, Supplemental Security Insurance (SSI), Self-Employment, Military/National Guard Pay, VA Benefits, Pensions, Annuities, Student Scholarships/Grants, Unemployment/Worker’s Comp Benefits, TANF, General Assistance, Child Support, Family Support, Alimony, other sources including cash.
Household Member Name / Type of Income / Monthly
Amount / Source
$
$
$
$
$
$
$
$
Do you anticipate any changes in this income in the next 12 months? / Yes No
If YES please list:
HOUSEHOLD ASSETS
List ALL assets for ALL household members including children and those owned jointly with another person(s) who will not be living in your household. Assets include ,but are not limited to, Checking (draft), Savings (share), Direct Deposit Accounts (Money cards), Cash on Hand, IRA, KEOGH, Inheritances, Trusts (revocable and irrevocable), Burial Policies, Certificates of Deposit, Money Market, Stocks, Bonds, Whole Life Insurance, Term Life Insurance, etc.
Household Member Name
/Type of Account
/Source Name
/Value
$$
$
$
$
$
1. Do you own any real estate/land/buildings/mobile homes? Yes No
If YES, type of property: / Location:
Full market value on most recent tax bill? / $ / Mortgage or outstanding loan(s) balance owed? / $
2. Have you or any household members’ sold/disposed of any land or buildings in the last two years? Yes No
If YES, type of property? / Market value when sold/disposed? / $
Date of disposition? / Amount sold/disposed for? / $
HOUSEHOLD ASSETS: continued
3. Have you disposed of any other assets in the last two years? (Example: gave
away money to relatives, set up irrevocable trusts accounts.) Yes No
If YES, describe asset: / Date of disposition? / Amount disposed? / $
4. Do you have any other assets not listed above (excluding personal property)? Yes No
If YES, list: / $ / $
RESIDENTIAL HISTORY
Are you currently receiving government rental assistance from HUD, USDA-RD, Public Housing voucher, etc. at your current place of residence? / Yes No
If yes, please provide the housing provider name, address and telephone number:
Please provide TWO (2) most current years of housing history starting with your current address. All dates must be consecutive, without any lapses in time.
CURRENT RESIDENCY INFORMATION
Dates of Residency: From (m/d/y) _____ /______/______To: Current
Adult occupants at this address:
Do you have an executed lease agreement at this address? Yes No
Current
Address: / City: / State: / Zip
Code:
Housing Provider’s Relationship:
Name: / Telephone:
Address: / City: / State: / Zip
Code:
PREVIOUS RESIDENCY INFORMATION
Dates of Residency: From (m/d/y) / / To / /
Adult occupants at this address:
Prior
Address: / City: / State: / Zip
Code:
Housing Provider’s Relationship:
Name: / Telephone:
Address: / City: / State: / Zip
Code:
PREVIOUS RESIDENCY INFORMATION
Dates of Residency: From (m/d/y) / / To / /
Adult occupants at this address:
Prior
Address: / City: / State: / Zip
Code:
Housing Provider’s Relationship:
Name: / Telephone:
Address: / City: / State: / Zip
Code:
If these addresses do not cover a two-year history for each adult, please add additional addresses and contact information on the last page of this “Application for Residency.
RESIDENTIAL HISTORY: continued
1. Have you or any household member ever been evicted or otherwise removed from rental housing? / Yes No
If YES, explain circumstances, outcome and present status:
2. Have you or any household member ever engaged in drug-related criminal activity, such as use, possession, distribution, trafficking, or manufacture of an illegal drug? / Yes No
If YES, explain circumstances, outcome and present status:
3. Have you or any household member ever engaged in, been arrested, and/or convicted of any other
criminal activity? / Yes No
If YES, explain circumstances, outcome and present status:
4. Are you or any member of your household including minors subject to a lifetime sex offender registration requirement? / Yes No
If YES, explain circumstances, outcome and present status:
5. Are you or any household member currently serving in any branch of the armed services? / Yes No
If YES, what branch?
6. Is your household currently displaced due to a Federally declared disaster? / Yes No
If YES, provide verification:
CONTACT INFORMATION
List Information for all household members 18 years of age or older, including emancipated minors
Name(s) / Phone Number(s) / E-mail / List all States where this member has resided
READ THE SECTION BELOW BEFORE CERTIFYING AND SIGNING PAGE 6
PENALTIES FOR MISUSING THIS FORM:
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government, HUD, RHS, Section 42, the PHA and any owner (or any employee of HUD, RHS, Section 42, the PHA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person, who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against the officer or employee of HUD, RHS, Section 42, the PHA or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at 208 (a) (6), (7) and (8). Violation of these provisions are cited as violations of 42 U.S.C. 408 (a) (6), (7) and (8).
CERTIFICATION BY ALL ADULT HOUSEHOLD MEMBERS
I/We have read, and understand, the information in this application in particular the information contained in the instructions and I/we agree to comply with such information.
I/We have been notified that the “Resident Selection Plan”, which summarizes the procedures for processing applications, is available in the apartment community’s Management Office; and that my/our application will be processed according to the “Resident Selection Plan”.