Harmonious living with spacious 2 bedroom units with rents of $700 and $775;

Similar documents
DePaul Housing Management Corporation Franciscan Heights Senior Community TENANT SELECTION PLAN March 28, 2016

a) The appropriate size unit for the applicant's household is available within the Community.

*Applicant Signature: Date:

Umpqua Community Property Management Equal Housing Opportunity

RESIDENTIAL LEASE RENTAL CRITERIA

East Village Growth Partners, LLC Tenant Selection Plan Effective 10/1/14

TENANT SELECTION PLAN Providence Elizabeth House 3201 SW Graham Street, Seattle WA Phone: TRS/TTY: 711

Bay Property Management Inc.

CARRIAGE HILLS APARTMENTS Application For Residency

TENANT SELECTION PROCEDURE

GRIGGS FARM TENANT SELECTION POLICY

Thank you for your interest in the Senior Public Housing program (50+ or older). Enclosed please find:

Spokane Housing Authority Tenant Selection Criteria

TENANT SELECTION PLAN

CHRISTOPHER HOMES OF ARKANSAS PRAC Properties

APARTMENT RENTAL APPLICATION Each co-resident and each occupant over 18 must submit a separate application. Spouses may submit a joint application.

PORT ROYALE I PROPERTY RENTAL CRITERIA

RESIDENT SELECTION PLAN

Physical: 1928 Grand Ave Billings, MT Mailing: PO Box Billings, MT APPLICATION CHECKLIST:

Incomplete applications will not be accepted or processed Review Your Credit Report Obtain Your Housing Reference

APPLICATION FOR OCCUPANCY

FAIRVILLE MANAGEMENT COMPANY, LLC Resident Screening & Selection Policy

APPLICATION FOR RENTAL (Each Co-Applicant must submit a separate application)

DePaul Housing Management Corporation Communities for Seniors Franciscan Heights Senior Community

THE MUNICIPAL HOUSING AGENCY


Thank you for your interest in Lloyd Apartments! We look forward to your visit here. For your convenience, we have attached an Application to Lease.

Affordable Housing Qualification Guidelines

Rental Application. Applicant: Name: Current Address: City, State, Zip Code: Work Phone:

Equal Opportunity Housing

QUALIFYING GUIDELINES

Dear Prospective Resident,

City Limits Apartments 127 E 59 th St. Suite 204 Minneapolis, MN APPLICATION CRITERIA AND CONSIDERATION

SPENCER TRACE APARTMENTS 5142 Wall Triana Hwy, Madison, AL. Phone: (256) Fax: (205) TDD: (800) x799 RENTAL APPLICATION

MEDFORD BETTER HOUSING ASSOCIATION, INC.

Rental Application RENTAL APPLICATION PROCEDURES

WELCOME TO THE PRUITT TEAM AT WEST USA REALTY

Welcome to Sabrina s Place!

BREVARD. Application Processing and Time Frame: Cost:

Alders Point Apartments Winston-Salem, N.C.

Fisher & Company Real Estate Services, Inc Chippewa, St. Louis, MO Office: * Fax:

Rental Application for the Cedar River Tower

We do not charge an application fee.

University Parkway Apartments 500 University Parkway Yakima, WA Ph

RENTAL APPLICATION. 106 Tugger Trail Nicholasville, KY

Applications must be submitted in person or by mail to 3240 Sacramento St., Attn: Hearst Studios, Berkeley, CA

AOA's Applicant Screening Checklist

Sault Ste. Marie Tribe of Chippewa Indians Housing Authority 154 Parkside Drive Kincheloe, MI or

Rainbow Property Management Inc. MOUNTAIN VIEW APARTMENTS - RED LODGE, MT. Westchester Duplex - Billings, MT

201 South Lakeline Blvd, Ste 804, Cedar Park, TX Office * Fax: Online Applicant Qualifying Criteria Page 1 of 6

Real Property Management Professionals of Central FL

APPLICATION TO RENT OR LEASE INSTRUCTIONS. The more information you give, the faster we will be able to finish processing your application.

RENTAL APPLICATION & SCREENING CRITERIA

APPLICATION POLICY MCCORMICK PROPERTY MANAGEMENT AND REALTY, LLC (WE ARE AN EQUAL OPPORTUNITY HOUSING PROVIDER)

Rental Process And Application Disclosure

ADDENDUM A - RENTAL APPLICATION RENTAL QUALIFYING CRITERIA

A merican Proud Realty does business in accordance with the Federal Fair Housing Law and does not discriminate against

If you would like to review the property selection policy please request a copy from the Community Manager.

Waitlist Coming Soon COLUMBIA PARK MANOR SENIOR APARTMENTS Chester Drive, Pittsburg, CA AMENITIES

RESIDENT SELECTION CRITERIA (Available at the Rental Office) Lenzen Gardens

Desired Date of Occupancy: Apt. Size Apt. # RENTAL APPLICATION

TENANT SELECTION CRITERIA

APPLICATION REQUIREMENTS

RPM HOUSTON. LEASING GUIDELINES and CHECKLIST

RESIDENT SELECTION CRITERIA - TAX CREDIT Avenida Espana Gardens

RESIDENT SELECTION PLAN-POLICY

RENTAL PROCESS AND APPLICATION DISCLOSURE

Driver s License # OR ID # CURRENT ADDRESS: CITY: ST: ZIP: COUNTY: OCCUPIED FROM: TO: Monthly Payment $ PREVIOUS ADDRESS: CITY: ST: ZIP:

Application Policies

MAIL TO: SAHA, P.O. BOX 3289, BERKELEY, CA 94703

HOUSEHOLD COMPOSITION:

Wexford Way at Emerald Vista

Page 1 APPLICATION FOR LEASE

PROPERTY MANAGEMENT AGENCY/SUBAGENCY DISCLOSURE

GSH #3700-AH Rev. 12/16 DEAR APPLICANT,

Applications must be submitted in person or by mail to 1531 University Avenue, Attn: Manager s Office, Berkeley, CA

WEST GATEWAY PLACE RESIDENT SELECTION CRITERIA

WAV CONDOMINIUMS, LLC RESIDENT SELECTION CRITERIA

PLEASE READ AND FOLLOW THESE INSTRUCTIONS THE SITE MANAGER CAN ASSIST WITH ANY QUESTIONS CONCERNING YOUR APPLICATION TO THIS COMMUNITY

Westlake Senior (62+) Apartments

APPLICATION FOR OCCUPANCY Eastbrook Apartments Community Name

If you would like to review the property selection policy please request a copy from the Site Manager.

Keystone Property Management 308 SE Greenville Blvd. PO Box 2039 Greenville, NC (fax)

Applications must be submitted in person or by mail to 1109 Oak Street, Suite 511, Attn: Manager s Office, Oakland, CA

Property address: Target Move-In date: / / Resident: Cell Phone : ( ) - Social Security # : - - Date of Birth ; / /

Application Procedure Checklist All documentation and checks must be given to the Long & Foster Listing Agent/PM

2. The average credit score between all applicants must be greater than 550 or it will result in this application being automatically denied.

Spokane Housing Ventures Resident Screening Criteria

1900 Alcatraz Avenue, Berkeley, CA AMENITIES ALCATRAZ APARTMENTS. Head of household must be at least 18 years or older.

Robin Lane Apartments Waitlist Opening Soon!

CONSUMER NOTICE FOR TENANTS THIS IS NOT A CONTRACT

STOUT MANAGEMENT PROPERTY SANDPOINTE APARTMENTS

Waitlist Coming Soon HILLEGASS AVENUE APARTMENTS. Property Address: 2500 Hillegass Avenue, Berkeley, CA 94704

Dear Potential Applicant. Thank you for your interest in Mountain Vista Apartments!

Thank you for choosing to rent with Boulder Housing Partners.

RENTAL APPLICATION INFORMATION

APPLICATION FOR TENANCY

YOUR RENTAL CONNECTION, INC.

SOCIAL SECURITY/ ALIEN REG. # MDHA SAMPLE. ADDRESS: PROPERTY/LANDLORD PHONE: (615)

THE RENTAL APPLICATION PROCESS

Transcription:

TEAKWOOD APARTMENTS. Harmonious living with spacious 2 bedroom units with rents of $700 and $775; amenity filled kitchen, with in unit washer/ dryer hookups, lots of storage; garage PET FRIENDLY! (some restrictions apply) Contact us to see a unit! 605-271-4663

TO ALL APPLICANTS: CHARISMA PROPERTY MANAGEMENT, INC. CONVENTIONAL & RESIDENTIAL HOUSING 4304 TECHNOLOGY DRIVE, SIOUX FALLS, SD 57106 PHONE: (605)271-4663 FAX: (605)271-0278 We would like to thank you for your interest in our apartments. We take pride in our apartments and are pleased with what we have to offer. After you have completed ALL questions and signed the application form, we will put you on our waiting list so your application can be processed for eligibility as follows: 1. Availability of qualifying apartment 2. Income eligibility 3. Date of application (Application is complete, only if ALL questions have been answered and the application is signed and dated) 4. Background Checks (Credit, Criminal and Landlord References) It is your responsibility as the applicant to call our office if you have a change in income, household composition, address or phone number while you are on the waiting list. Please be aware that after 6 months, if we have not heard from you, and you want to remain on the waiting list, you must contact Charisma Property Management, Inc. to confirm your continued interest in remaining on the waiting list. If you do not contact us 6 months after the application was made, your application will be removed from the waiting list. If an apartment becomes available for you and we are not able to get in touch with you by phone or mail, your application will be noted and will be put in our inactive/unavailable file. Instructions: Please read carefully. The following must be provided at the time the housing application is turned in. All incomplete applications will be returned. 1. Complete all questions: If an item does not apply to you, mark N/A on that line. Do not leave it blank. (This includes income, asset and expense questions) 2. Must sign and date the Standards of Occupancy form. Each household member 18 years and older must read, sign and date Standards of Occupancy form. 3. Provide a copy of social security cards for ALL household members over the age of 18. 4. Provide a copy of proof of age for household members 18 years and older. ( Drivers License) 5. Provide four recent pay stubs. 6. Signatures are required by all applicants 18 years and older. 7. $40.00 Non-refundable application fee per adult (person over 18) is required to process the application. Payments can be made by: a. Cashier Check or money order payable to the property on which you are applying for. b. Cash payment will be accepted at the rental office only. c. Credit card ( not applicable for Brakeaway Properties, Whispering Pines & Hegerfeld Properties) PERSONAL OR COMPANY CHECKS WILL NOT BE ACCPETED FOR APPLICATION FEES. ***Please note that the rental application will not be processed if applicant does not sign, date, complete and turn in the above required information. Charisma Property Management, Inc. does not discriminate against any person because of age, race, color, religion, sex, handicap, creed, familial status or national original.

Rental Application Charisma Property Management 4304 Technology Dr. Sioux Falls, SD 57106 Phone: 605.271.4663 Email: www.info@charismaproperties.com APPLICANT/CO-APPLICANT INFORMATION APPLICANT NAMES RELATIONSHIP DATES OF BIRTH (Any person(s) over 18 years of age) SOCIAL SECURITY NUMBERS Telephone Number: Co-Head Telephone Number: Email Address: Co-Head Email Address: Which property are you applying for?: Unit #: I heard about this property from: Does anyone in your household require a handicap-accessible unit? Yes No (Circle One) OTHER OCCUPANTS THAT WILL BE RESIDING WITH YOU OTHER OCCUPANT NAMES RELATIONSHIP DATES OF BIRTH SOCIAL SECURITY NUMBERS Present Address: RESIDENCE HISTORY City: State: Zip: Present Landlord/Mortgage Holder: Dates of Residency: from to Amount of Rent: Reason for moving: Previous Address: City: State: Zip: Present Landlord/Mortgage Holder: Dates of Residency: from to Amount of Rent: Reason for moving: Co- Applicant Present Address: City: State: Zip: Present Landlord/Mortgage Holder: Dates of Residency: from to Amount of Rent: Reason for moving: Co-Applicants Previous Address: City: State: Zip: Present Landlord/Mortgage Holder: Dates of Residency: from to Amount of Rent: Reason for moving:

EMPLOYMENT INFORMATION Employed By: How long: Employers Address: City/State/Zip Salary/Wage Per hr / wk / mo / yr Position Held: Supervisor: Previous Employer: (if at present employer less than six (6) months) Co-Applicant s Employer: How long: Employers Address: City/State/Zip Salary/Wage Per hr / wk / mo / yr Position Held: Supervisor: Previous Employer: (if at present employer less than six (6) months) AUTOMOBILE AND CONTACT INFORMATION Make: Model: Year: Lic. Tag No: Color: Make: Model: Year: Lic. Tag No: Color: Make: Model: Year: Lic. Tag No: Color: Will you have a pet(s)? Yes No (Circle one) If yes, how many? Breed(s) Do you have an Assistance Animal? YES NO (Circle One) In case of Personal Emergency, Notify: Relationship: Address: EMERGENCY INFORMATION City, State, Zip QUESTIONNAIRE Applicant Driver s License Number State Issued Lists all states in which you have lived? Do you have renter s insurance? Yes No It is not required, but strongly encouraged. Has an eviction action ever been filed against you or someone you were living with at the time? Yes No If yes, by whom, when, and for what reason? Have you ever been charged with a crime? Yes No If yes, please explain: List all states in which you have lived in and been charged with a crime? Is any household member subject to a lifetime state sex offender registration program in any state? Have you ever filed bankruptcy? Yes No QUESTIONNAIRE Co-Applicant Driver s License Number State Issued Lists all states in which you have lived? Do you have renter s insurance? Yes No It is not required, but strongly encouraged. Has an eviction action ever been filed against you or someone you were living with at the time? Yes No If yes, by whom, when, and for what reason? Have you ever been charged with a crime? Yes No If yes, please explain: List all states in which you have lived in and been charged with a crime? Is any household member subject to a lifetime state sex offender registration program in any state? Have you ever filed bankruptcy? Yes No

NO RENTAL APPLICATION WILL BE PROCESSED WITHOUT ALL REQUESTED PHONE NUMBERS INCLUDED. I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for residency, as may be necessary. I understand that any misrepresentation may result in the denial of my application. I authorize Charisma Property Management, Inc., its subsidiaries, and its agents to investigate my criminal background, rental and employment history as well as my credit worthiness through any credit bureau or other reasonable means. I also understand that a non-refundable application fee of $40.00 per adult (person 18 or older) is required to process my application. It is Charisma Property Management s aim to ensure that this property is a drug-free zone. Any illegal activity, including the use and sale of controlled substances, will not be tolerated. By signing this application form, I verify my support for this policy. THIS APPLICATION IS NOT A RENTAL AGREEMENT, CONTRACT OR LEASE. ALL APPLICATIONS ARE SUBJECT TO THE APPROVAL OF THE OWNER OR MANAGING AGENT. Please read the above statements PRIOR to signing this application. By signing below, you accept these conditions. Applicant s Signature: Co-Resident s Signature: Date: Date: We encourage and support the nation s and state s affirmative housing program in which there are no barriers to obtain housing because of race, color, sex, national origin, handicap, familial status or creed. Equal Housing Opportunity. I,, real estate licensee, am representing the owner in this transaction. All agents of Charisma Property Management, Inc. represent the owner in this and any other transaction. R.A. Credit Report: Criminal Report: DO NOT WRITE BELOW THIS LINE! Y / N Y / N S.D. Length of time at employment: Time at Address: Amount of Rent: GRG Y / N Position: Resident #1 Number of Late Payments: L.L 6 / 12 Income: hr / wk / mo / yr Problems/Complaints: M.I. Notes: Name of person confirming: Credit Report: Criminal Report: Length of time at employment: Y / N Y / N Would you re-rent to resident? Name of person confirming: Time at Address: Amount of Rent: Number of Late Payments: Resident #2 Position: Problems/Complaints: Income: hr / wk / mo / yr Would you re-rent to resident? Name of person confirming: Name of person confirming: Verified By: Approved Denied Date: We encourage and support the nation s and state s affirmative housing program in which there are no barriers to obtain housing because of race, color, sex, national origin, handicap, familial status or creed. Equal Housing Opportunity.

Standards for Occupancy and Reasons for Disqualifying an Applicant Every application must be completed in its entirety, signed and dated by the head of the household and cohead(s), and all household members 18 years and older, if applicable. All members of the household shall be listed on the application form. Staff will assist any applicant who might have trouble completing the application form. This assistance might take the form of answering questions about the application, helping applicants who might have literacy, vision or language problems and, in general, making it possible for interested parties to apply for housing. The application will be completed to the extent that all factors of eligibility are included and a determination can be made on the apparent eligibility status of an applicant. Applications that are incomplete, have not been signed and dated, or application fees that haven t been paid as required will not be processed. Screening Criteria The screening is completed to provide objective information on the probability that the potential renter will abide by the terms of their lease, pay rent on time, take care of the property and their unit, and permit other residents to peacefully enjoy their homes. The following standards are used in screening eligible applicants: Applicant is 18 years of age or older. a. All applicants shall be at least eighteen (18) years of age. b. An applicant who is eighteen (18) year of age may qualify on his or her own, provided that he or she has verifiable rental references and credit history. Failing to have such references, the applicant would need a parent, guardian or other adult in a position or responsibility to consign, or guarantee the lease and payment of rent. c. HUD regulations for qualifying apply for full time students for tax-credit and subsidized housing. Applicant must be able to fulfill the following debt ratio standards for apartment applying for: Debt ratio qualifications: a. Income 3x rent for market b. Income 2x for tax-credit income guidelines apply c. Subsidized none required, must meet income guidelines Applicant must give written permission for Owner/Agent to verify income source(s), asset and expense information, if applicable, for all qualifying household members 18 years and older. Households are limited to no more than 2 people per bedroom unit. 1 bedroom unit 1-2 persons 2 bedroom unit 2-4 persons 3 bedroom unit 3-6 persons 4 bedroom unit 4-8 persons Previous landlords are contacted and the household members are reviewed to determine if the household members have a history of abiding by the requirements of their lease including: a. Maintaining their living units in reasonable conditions, b. Not damaging their units, c. Demonstrated ability to pay rent and utilities on time, d. Credit references; e. Only keeping pets within the restrictions of their lease, and applicant s ability to comply with terms of lease; 10/28/2014 Revised

f. No history of incidents that could harm or threaten neighbors or infringe on their neighbors rights to peaceful enjoyment of their housing (for example threatening and violent confrontations with neighbors or others and multiple reports of problems such as excess noise that disturbs neighbors). Credit References will be made for all applicants 18 years and older to determine household member s ability to fulfill financial obligations in a timely manner; Acceptable credit history: Written explanation for medical Judgment/Collection under $500 with written explanation Judgment/Collection over $500 requires co-signer No collections from previous landlord Copy of bankruptcy within last 10 years Criminal background reports, rental history reports, and other reports are reviewed for all household members to screen for any household members who: a. Were convicted for felony drug or criminal activity in the previous 15 years, b. Were convicted for misdemeanors criminal activity in the previous 7 years, c. Are currently using illegal drugs or have a pattern of use of illegal drugs, or been convicted for misdemeanor drug related criminal activity, d. Have been involved in the manufacturing or selling of illegal drugs, e. Have been involved in violent or criminal activity that may interfere with the health, safety and right to peaceful enjoyment of the property by other residents, owner, employees, contractors, subcontractors, or agents of the owner, or f. Have a pattern of abuse of alcohol that may interfere with the health, safety and right to peaceful enjoyment of the property by other residents, owner, employees, contractors, subcontractors, or agents of the owner, g. Have been charged for any criminal activity that is still under investigation. h. Have outstanding bench warrants. Rejecting Applicants Applicants may be rejected if: The applicant is income ineligible; (Tax-Credit and Subsidized Properties) The applicant is unable to meet debt ratio requirements; (listed in screening criteria) The applicant s household characteristics are not appropriate for the size or type of units that are available; The applicant does not meet the owner/agent s resident selection criteria; The applicant fails to disclose and document all Social Security Numbers or execute a certification when numbers have not been assigned; (Tax-Credit and Subsidized Properties) The applicant fails to supply current and previous physical or mailing address on the rental application; The applicant fails to supply landlord information on rental application; The applicant fails to provide declaration of citizenship or legal non-citizenship; (Tax-Credit & Subsidized) The applicant was/is unable to fulfill obligations and comply with all terms of the previous/current Lease/Rental Agreement; The applicant has a record of chronic late, underpayment or nonpayment of rightful obligations, including rent and utilities; The applicant has a record of disruptive behavior; The applicant has a record of destruction of property; The applicant has a record of poor living or housekeeping habits; The applicant has Adverse credit history; The applicant has a history of criminal activity involving crimes of physical violence to persons or property, or a record of other criminal acts which may endanger the health, safety or welfare of other residents; 10/28/2014 Revised

The applicant has been evicted for non-material compliance, or other good cause from the current or previous housing; The applicant has a history of activities that would be injurious to the reputation of the property and/or be likely to cause an increase in the rate of hazard insurance on the property; The applicant purposefully falsified, misrepresented or withheld information or submitted inaccurate and/or incomplete information on any application or during the interview related to eligibility, award of preference for admission, allowance, family composition or rent; The applicant has current or recent problems involving chemical or drug dependency resulting in any of the other reasons for non-selection; and/or The applicant refuses to comply with housing program requirements, policies and/or procedures; i.e. failure to sign and submit relevant forms, consents, releases, etc. The applicant fails to supply current and previous physical or mailing address on the rental application. The applicant fails to supply landlord information on rental application. Applicants must be rejected if: Any conviction or adjudication other than an acquittal of a violent crime. Examples of such crimes include: a. Murder/ Manslaughter b. Sex offenses, including forcible rape, child molestation, and aggravated sexual battery c. Arson d. Armed robbery The applicant was convicted for felony drug related criminal activity in the previous 15 years, The applicant was convicted with a felony in the past 15 years. The applicant was convicted for misdemeanor drug related criminal activity in the previous 7 years, The applicant was convicted with three or more misdemeanors and/or gross misdemeanors in the past 5 years other than traffic violations. The applicant has been involved in violent or criminal activity that may interfere with the health, safety and right to peaceful enjoyment of the property by other residents, owner, employees, contractors, subcontractors, or agents of the owner. The applicant has open warrants. Have been charged for any criminal activity that is still under investigation. If property allows pets, the type and size of pet is reviewed (must not be of a type considered dangerous such as a pit bull, trained guard dogs, etc.); the health records for the pet will be reviewed upon request to verify that it has been neutered and has required inoculations; and the behavior history of the pet will be reviewed to determine if there has been a history of being disruptive to neighbors or has caused damage in previous units rented by the applicant. Assistance/service animal inoculations and behavior will be reviewed. If an applicant is not approved, a written explanation of the reason for rejection shall be provided to the applicant. The notice must include information on the applicant s ability to request a review of the rejection of their application as long as they request the review within 14 calendar days of the date of the notice of rejection of their application. Owner/agent will be the final judge of what constitutes adequate and credible documentation/verification/references. If there is any doubt about the truthfulness or reliability of information received, alternative methods will be pursued until owner/agent is satisfied that the documentation obtained is the best available. It is the policy of Charisma Property Management, Inc. to rent without regard to an applicants race, color, religion, sex, handicap, familial status or national origin. Charisma Property Management, Inc. provides an Equal Housing Opportunity. 10/28/2014 Revised

I have read and understand the Charisma Property Management, Inc. Standards for Occupancy and choose to submit a rental application. I understand that my signature on this document is merely an acknowledgement that I was provided with the Standards of Occupancy and does not guarantee that my application will be accepted. Signature Date Signature Date We encourage and support the nation's affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status. 10/28/2014 Revised

RECEIPT FOR APARTMENT HOLDING FEE Applicant(s) hereby tender an application deposit in the sum of $ to Owner/Agent to rent. If the application to rent is approved, they agree to sign the Rental Agreement on or before. Applicants acknowledge and understand that after they are notified by Owner/Agent that their application to rent has been approved, the application deposit will be retained by Owner/Agent if the applicants do not sign the Rental Agreement as discussed above. If applicant(s) withdraw the rental application before they are notified by Owner/Agent that their application has been approved to rent, a $50 processing fee, per applicant, will be deducted from the deposit and the balance of the deposit will be returned to the applicant. Should Charisma Property Management, Inc. deny my application, the application deposit will be returned. Residents Initials Applicant Applicant Date Date Owner/Agent Date 4304 Technology Drive, Sioux Falls, SD 57106 PH: 605-271-4663 FX: 605-271-0278 www.charismaproperties.com

EXHIBIT K EMPLOYMENT VERIFICATION THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT TO: (Name & address of employer) Date: RE: Applicant/Tenant Name Social Security Number Unit # (if assigned) I hereby authorize release of my employment information. Signature of Applicant/Tenant Date The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The inf ormation provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated. Project Owner/Management Agent Return Form To: THIS SECTION TO BE COMPLETED BY EMPLOYER Employee Name: Job Title: Presently Employed: Yes Date First Employed No Last Day of Employment Current Wages/Salary: $ (circle one) hourly weekly bi-weekly semi-monthly monthly yearly other Average # of regular hours per week: Year-to-date earnings: $ through / / Overtime Rate: $ per hour Average # of overtime hours per week: Shift Differential Rate: $ per hour Average # of shift differential hours per week: Commissions, bonuses, tips, other: $ (circle one) hourly weekly bi-weekly semi-monthly monthly yearly other List any anticipated change in the employee's rate of pay within the next 12 months: Effective date: If the employee's work is seasonal or sporadic, please indicate the layoff period(s): Additional remarks: Employer's Signature Employer's Printed Name Date Employer [Company] Name and Address Phone # Fax # E-mail NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction AM-411 Page 1 of 1 1-2-03

LANDLORD REFERENCE NAME OF LANDLORD: DATE: COMPANY/RELATIONSHIP: TELEPHONE #: PROPERTY ADDRESS: PROPERTY APPLYING FOR: APPLICANT: LEASING AGENT TO BE COMPLETED BY THE LANDLORD/OWNER REPRESENTATIVE Dates of residency: From to Lease Length: 1. Did the resident pay their rent on time? Yes / No # Time Late if any: days 2. How much rent was paid each month by this resident? 3. Did you receive a security deposit? How Much? $ 4. Did the resident, their guests, or their family damage the apartment or property? Yes / No Did they pay for the damages? Yes / No Amount of damages? 5. Were the police ever called a result of disturbance? Yes / No Date of Call Comments: 6. Were there problems with neighbors? Yes / No If yes, comments: 7. Were there problems with pest infestation? Yes / No If yes, comments: 8. Does the resident have pets or other potential problems that may be important for a landlord to know? Yes / No If yes, comments: 9. Did the resident violate the lease agreement in any way? Yes / No If yes, in what way? 10. Did the resident give you proper notice for vacating? 11. Would you re-rent to this resident? Yes / No If no, comments: Signature of Verifier Date Verified We encourage and support the nation s and state s affirmative housing program in which there are no barriers to obtaining Housing because of race, color, religion, sex, national origin, handicap, familial status or creed. Equal Housing Opportunity