EHRLO HOUSING – APPLICATION FORM
Office: 2910 5th Ave.Telephone: 584-3313
Regina, SASK. 751-5666
S4T 0L3Fax: 584-3317
Property Locations: Lakeshore Village – 1313 23rd Ave.
44 Unit Complex with One and Two bedroom apartments
One bedrooms - $650.00; Two Bedrooms - $675.00
Heat, Water and Laundry included (No Pets)
(Creative Corners Daycare on Site)
Washington Park Place – 1074 Retallack St.
12 Unit Complex with One and Two bedroom apartments
One Bedrooms - $650.00; Two Bedrooms - $675.00
Heat, Water and Laundry included (No Pets)
(Priority is given to single mothers)
Date: ______
- APPLICANT2. CO-APPLICANT
Name: ______
Birthdate: ______
Present Address: ______
______
______
Telephone: (H)______(w)______(cell)______
Please indicate housing preference: ____ Lakeshore Village ____Washington Park Place
One bedroom ____Two bedroom____
(2)
Do you require parking? _____yes _____no
Preferred date of occupancy? ____/____/______
d m y
Reason for leaving present address? ______
______
Have you been provided with, or provided a Notice to Vacate: _____Yes______No
If yes, please indicate date ____/_____/ ______
d my
- FINANCIAL INFORMATION
Source of Income: ______Applicant
______Co-Applicant
Gross Earned Income: ______Applicant
______Co-Applicant
Please see income verification section of this application.
- PRESENT LIVING ACCOMMODATIONS
_____Rent _____Own_____Other, please explain ______
______
Current rent/mortgage amount: ______(per month)
Heat ______
Water/Sewer ______
Electricity______
Name of Present Landlord:______
(3)
Address: ______
______
______
Telephone: ______
Date Tenancy started: ______
Name of Previous Landlord______
Address:______
______
______
Telephone:______
Date Tenancy started:______
Date Vacated: ______
- REFERENCES
Employer Name: ______
Address: ______
Telephone: ______
How long employed: ______
Name of Reference (other than relative):______
Address: ______
Telephone:______
Relationship: ______
(if not employed, please provide another reference)
Name: ______
Address: ______
Telephone:______
Relationship: ______
- DEPENDANT INFORMATION
Name: ______Birthdate: ______
______
______
(4)
- NEXT OF KIN
Name: ______Relationship: ______
Address: ______Telephone: ______
______
______
Income Verification
Verification of ALL income MUST accompany the application, including:
a)Photocopies of ALL your most recent cheque stubs (pay stubs; SAP/TEA payments)
b)A photocopy of your most recent income tax return that has been sent to Revenue Canada
c)If employed, provide a signed letter from your employer stating the GROSS rate of pay, hours per week, and the total earnings in the last 12 month period.
Declaration
I understand this application does not constitute an agreement on the part of Ehrlo Housing to provide me with accommodation.
I hereby authorize Ehrlo Housing to investigate any or all of the statements herein, and any false statements will cancel further consideration of my application.
I accept that this application becomes the property of Ehrlo Housing.
I hereby declare the information provided on this application is true, correct and complete.
Signed: ______Date: ______