PRELIMINARY RENTAL APPLICATION EQUAL HOUSING OPPORTUNITY Sandalwood 253 Sandalwood Drive Leechburg, PA 1.5656 724,845.7358 I hereby apply for a rental housing living unit in this housing complex, and for rental assistance, if I am eligible and if it is available. I certify that this will be my permanent residence and I will not maintain a separate subsidized rental unit in a different location. I understand that this application will allow me to be placed on the Waiting List and it is my responsibility to contact t'he Property every o months in order to keep my place on the waiting list. PRELIMINARY INFORMATION PERTAINING TO APPLICANT(S) Appli cant ' s Name : Co-Applicant's Name: Others Living in the Unit: Name Name Name SS# SS# SS# SS# SS# Age : Age : Age: Age: Age: Present Address: Telephone Number: Annual Family Income: $ Source(s) of Income: Are you a U. S. citizen? Yes/No Are you a student under the age of 24? Yes/No Do you request consideration for an income adjustment based on a /disability? Yes/No Do you need special accommodations or modifications to the living unit based on a disability? Yes/No SIGNED: (Owner or Agent) (Applicant) (Date Received) (Co-Applicant) The information solicited on this application is requested by the apartment owner in order to assure the Federal Government, acting through HUD, that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, marital status, age, and handicap are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner (or managing agent) is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname. HEAD OF HOUSEHOLD (check as appropriate) Ethnicity Marital Status American Indian / Alaskan Native Hispanic or Latino Asian Not Hispanic or Latino Black or African American Native Hawaiian or Other Pacific Islander White Other Married Separated Unmarried Male Female (FOR MANAGEMENT USE ONLY) Eligibility Determination: Date: Eligible Unit size (s) : (Attach copy of Notification Letter) 2 bdr. 3 bdr. 4 bdr. BBUf'l l|Page
4
Embed
PRELIMINARY RENTAL APPLICATION Sandalwood PA 1 app_0269.pdfPRELIMINARY RENTAL APPLICATION EQUAL HOUSING OPPORTUNITY Sandalwood 253 Sandalwood Drive Leechburg, PA 1.5656 724,845.7358
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
PRELIMINARY RENTAL APPLICATION
EQUAL HOUSINGOPPORTUNITY
Sandalwood253 Sandalwood DriveLeechburg, PA 1.5656724,845.7358
I hereby apply for a rental housing living unit in this housing complex, and for rental assistance, if I ameligible and if it is available. I certify that this will be my permanent residence and I will not maintaina separate subsidized rental unit in a different location. I understand that this application will allow me tobe placed on the Waiting List and it is my responsibility to contact t'he Property every o months in order tokeep my place on the waiting list.
PRELIMINARY INFORMATION PERTAINING TO APPLICANT(S)
Appl i cant ' s Name :
Co-Applicant's Name:
Others Living in the Unit:
Name
Name
Name
SS#
SS#
SS#
SS#
SS#
Age :
Age :
Age:
Age:
Age:
Present Address:
Telephone Number: Annual Family Income: $
Source(s) of Income:
Are you a U. S. citizen? Yes/No
Are you a student under the age of 24? Yes/No
Do you request consideration for an income adjustment based on a /disability? Yes/No
Do you need special accommodations or modifications to the living unit based on a disability? Yes/No
SIGNED:
(Owner or Agent) (Applicant)
(Date Received) (Co-Applicant)
The information solicited on this application is requested by the apartment owner in order to assure theFederal Government, acting through HUD, that Federal Laws prohibiting discriminationagainst tenant applicants on the basis of race, color, national origin, religion, sex, marital status, age,and handicap are complied with. You are not required to furnish this information, but are encouraged to doso. This information will not be used in evaluating your application or to discriminate against you in anyway. However, if you choose not to furnish it, the owner (or managing agent) is required to note the race,ethnicity and sex of individual applicants on the basis of visual observation or surname.
HEAD OF HOUSEHOLD(check as appropriate)
Ethnicity Marital Status
American Indian / Alaskan Native Hispanic or LatinoAsian Not Hispanic or LatinoBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther