Dear Prospective Tenant: Thank you for your interest in our new affordable housing opportunity in the heart of Newburgh s historic east end. These units are conveniently located to transportation, hospitals, schools, restaurants and attractions. RUPCO has beautifully restored a total of 44 units: (1) studio apartment, (25) 1-bedroom apartments, (9) 2-bedroom apartments and (9) 3-bedroom apartments in the historic East End District. The project includes (1) 2-bedroom unit fully adapted and move-in ready for visually and/or hearing impaired residents and (3) units, to include (1) 1-bedroom, (1) 2-bedroom and (1) 3-bedroom that will be fully adapted, accessible and move-in ready for mobility impaired residents. Twelve (12) of the units will be preferenced for tenants involved in artistic or literary endeavors in accordance with the HERA Act of 2008. Amenities include: Community room On-site laundry facility Police substation This property is a smoke-free community. No pets allowed. Please type or write legibly and provide us with all of the information reuested on the application. If a uestion on the application does not apply to you, please write N/A. Applications that are incomplete or not legible will be sent back for correcting. Applications can be returned to Safe Harbors of the Hudson through U.S. Postal service, hand delivered, faxed or emailed. Safe Harbors of the Hudson Attn: Leasing Office 111 Broadway Newburgh, NY 12550 Fax #: (845) 784-1112 Email: nrivera@safe-harbors.org Eligibility is based on the Federal Low Income Housing Tax Credit Guidelines. Income restrictions apply (see attachment). With limited exceptions, full-time students are not eligible for residency. Please inuire with lease staff. All applications will be reviewed for eligibility. Applicants will be notified of their status by mail. At the time of interviews, Safe Harbors will review your financial, credit, criminal background, housing and employment histories. Please be aware that acceptance for our housing is based on all of these criteria. At no time in the application process are you guaranteed an apartment until you have signed a lease. A felony charge could affect eligibility for residency. If you have any uestions, please contact Safe Harbors Leasing Office (845) 562-6940 Ext 141. Good luck in your housing search! Sincerely, Safe Harbors of the Hudson
East End Apartments c/o Safe Harbors of the Hudson 111 Broadway Newburgh, NY 12550 Leasing Office: (845) 784-1150 Fax: (845) 784-1112 Application for Occupancy For Safe Harbors of the Hudson Office Use Only: Date Received: Application #: East End Apartments is a Smoke-Free Community This application is to be completed by the head of household. All uestions must be answered. If any uestions are left blank, the application will be returned. If a uestion does not apply, please write N/A. Head of household and all adult family members must sign the last page. Head of Household Full Name: Street Address / Apartment Number: City, State Zip Code Home Phone: Secondary Phone: Email Address: ( ) ( ) Check which size units you would like to be considered for: One Bedroom Three Bedroom Two Bedroom Other (specify) Preferences: Veteran Artist Are you reuesting a unit with special accommodations for any member of your household due to the following disabilities. Mobility Visual Hearing Housing Status Complete each category as applicable, or write N/A Current Landlord Name / Address: Current Managing Agent Name / Address: Check the size of your current residence: Studio Three Bedroom One Bedroom Four Bedroom Two Bedroom Other (specify) How long have you lived at this address? Years / Months Landlord Phone: ( ) Managing Agent Phone: ( ) Is the lease in your name? Yes No Are you sharing your apartment? Yes No Total monthly rent for your apartment Your portion of the monthly rent $ $ Does your current rent include utilities? Yes No Average monthly utility expense Is your landlord a relative? $ Yes No Do you pay your own rent? Yes No If no, who does? Reason for wanting to move: Do you currently have a portable Section 8 voucher? Yes No Are you currently without a regular nighttime residence? Yes No Previous Landlord Name / Address: Previous Managing Agent Name / Address: Previous monthly rent: $ Reason for moving: Please list all states in which you previously resided: Current rent subsidized through Section 8? Yes No Current relocation due to violent/unsafe conditions? Yes No Landlord Phone: ( ) Managing Agent Phone: ( )
Household Information List all persons who will occupy the apartment, including yourself and persons anticipated to join the household (ie. unborn child/children of expectant household members, children to be adopted, live-in aides, etc.) Household Member Full name: Relationship to Sex (Male, Female, Date of Birth: Last 4 digits of SSN: Head of Household: Decline to answer) Head of Household Please list all household members who have served in the U.S. military: Income from Employment List all current full-time and part-time employment income for all household members. (Include self-employment gross earnings and net taxable income.) If you do not currently receive income from employment, please write N/A. See next page for non-employment sources of income. Household Member Full name: Occupation Employer Name/Address/Phone: Start Date: Gross Earnings (Before Deductions and Taxes) Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly
Income from Other Sources List any and all other income sources not previously reported, including but not limited to: Social Security, S.S.I., AFDC/TANF, pension, disability compensation, Armed Forces regular and special pay, unemployment compensation, alimony, child support, annuities, dividends, income from rental property, recurring monetary contributions, etc. If you do not have any sources of additional income, please write N/A. Household Member Full name: Type of Income: Income Amount: Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Weekly Monthly Yearly Assets Complete each category as applicable, or write N/A. Checking Account Additional Checking Account Savings Account Money Market Account Certificate of Deposit Account 401K /Other Retirement Account
Do you receive income in the form of a pre-paid debit card (ie. Direct Express, EBT, etc.)? Yes No Do you own any stocks/bonds? Yes No Current Balance as of Last Statement Date: If yes, what is the current value? Do you own any savings bonds? Yes No If yes, what is the current value? Do you own any real estate? Yes No If yes, what is the current value? Have you ever owned any real estate? Yes No If yes, when? When was it sold? For how much? Has any adult member sold, given away, or otherwise disposed of any assets for less than their fair market value during the past two years? Yes No If yes, list each asset and the amount received for each asset: Type of Asset: Amount $ Type of Asset: Amount $ Type of Asset: Amount $ Student Status List all household members that are currently enrolled in an educational program, or write N/A Full Name of Student: School Name / Address / Phone Enrollment Status:
Program Information Complete each category as applicable, or write N/A Do you presently reside in a development where your rent is based upon your income? Yes No How did you hear about our development? If yes, explain: Why are you applying to our development? Were you or any member of your household ever convicted of a felony? Yes No If yes, when? Were you or any member of your household ever evicted? Yes No If yes, when? If yes, was the eviction from federally assisted housing for drug-related criminal activity? Yes No Has anyone in your household been convicted of violating any drug-related laws? Yes No If yes, when? Is anyone in your household currently engaged in the use of illegal drugs? Yes No Is anyone in your household engaged in a pattern of alcohol abuse that could interfere with others health, safety and right to peaceful enjoyment? Yes No Is any member of your household subject to a state sex offender lifetime registration reuirement? Yes No By signing, you authorize us to contact any references listed and to obtain consumer reports, which may include credit, rental payment history and criminal background information about you and any occupants in the premises in order to verify the above information. Signature of Head of Household Date WARNING; MISLEADING WILLFULL FALSE STATEMENTS OR MISREPRESENTATIONS OF THIS APPLICATION WILL BE GROUNDS FOR REJECTION OF THIS APPLICATION. AN INCOMPLETE APPLICATION WILL BE RETURNED TO THE APPLICANT FOR FULL COMPLETION (ONLY ONCE). I DECLARE THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. Signature of Head of Household Signature of Applicant Over Age 18 Signature of Applicant Over Age 18 Date Date Date
Demographic Data The following information is reuired only to determine program utilization for statistical purposes. This information will not affect the processing of this application. Gender: Male Female Decline to Answer Ethnicity: Hispanic or Latino Non Hispanic or Latino Race: American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Attention Please do not submit more than one application per household or copies of an application. The filing of this application in no way guarantees you an apartment. Positively no pets, large appliances or waterbeds are permitted without the owner s prior written approval and signed agreement. We do not insure your personal property; we encourage you to purchase renter s insurance for your personal belongings. Application Revised 10/2017