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  • Household Information

  • List ALL household members that are applying to live in this apartment with you.

  • First NameMiddle InitialLast NameRelationship to Head of HouseholdM/FSS NumberBirthdate: Month, Day, Year 
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  • 5. Have you or any one else named on this application (if Yes, please explain below):
  • If “YES” was answered to any of the above questions, please explain below.
  • Question NumberExplanation 
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  • Housing References

    List the past THREE years of housing references.
  • Landlord Name/AddressLandlord's Phone NumberYour AddressOwn/RentDates: From - To 
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  • Personal Reference

    List a personal reference other than a relative:
  • NameAddressPhoneRelationshipYears Known 
  • Vehicle Identification:

    List vehicle information for all vehicles that are owned or operated by any household member.
  • Licence Plate #State IssuedMake/Model/Year 
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  • Emergency Contact:

    List someone in the area that is not already on the application.
  • NameAddressPhoneRelationshipYears Known 
  • Income Information

    Income is counted for anyone 18 or older (unless legally emancipated). However, if the income is unearned income such as a grant, it is counted for all household members including minors.

    Include all income anticipated for the next 12 months.
    Do YOU or ANYONE in your household receive OR expect to receive income from:

  • 6. Employment wages or salaries? (Include overtime, tips, bonuses, commissions and payments received in cash.)
  • Yes or NoHousehold MemberName of CompanyAmount 
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  • 7. Self-employment? (Include overtime, tips, bonuses, commissions and payments received in cash.)
  • Yes or NoHousehold MemberName of CompanyAmount 
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  • 8. Income from any of the following:
  • (We must count court-ordered support whether or not it is received unless legal action has been taken to remedy. We must also count support that is not court-ordered rather received directly from payor.)
  • If “YES” was answered to “d” above, please complete 1, 2 & 3 below. If No, continue to question “e”.
    1. Household Member Receiving SupportPayorAmount 
  • For all those that apply, fill in Name of Agency, Name of Court, Name of Person, or if "Other" then Explain.
    Child Support Enforcement AgencyCourt of LawDirectly from IndividualOther 
  • If Yes, obtain court papers. Explanation:
  • (This includes anyone supplementing your income or paying any of your bills.)
  • If “YES” was answered to any of the above questions (6-9), please complete the information below.
    Question No.Household MemberSource of Benefit/PayorAmount 
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  • Asset Information

    Include all assets held and the income derived from the asset. INCLUDE ALL ASSETS HELD BY ALL HOUSEHOLD MEMBERS INCLUDING MINORS.

    Do YOU or ANYONE in your household hold:

  • (This includes your personal residence, mobile homes, vacant land, farms, vacation homes or commercial property.)
  • (This includes paintings, coin or stamp collections, artwork, collector or show cars, and antiques. This does not include your personal belongings such as your car, furniture or clothing.)
  • If Yes, to any of the above 10 a-i, complete below. If No, continue to question 11.

    Question No.Household MemberSource of Benefit/PayorAmount 
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  • Applicant Status

    The following questions pertain to specific eligibility requirements of the Housing Credit Program.

  • Household Member(s):
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  • Name of Attendant:Relationship (if any): 
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  • Expected Date:Name of Agency:Contact Person: 
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  • Please provide the following information for statistical purposes only.
  • Signature

    I/We understand that Kingsbury’s Twin Towers is relying on this information to prove my household’s eligibility for the Housing Programs at Kingsbury’s Twin Towers. I/We certify that all information and answers to the above questions are true and complete to the best of my knowledge. I/We consent to release the necessary information to determine my eligibility. I/We understand that providing false information or making false statements may be grounds for denial of my application. I/We also understand that such action may result in penalties.

    I/ We authorize my/our consent to have Kingsbury’s Twin Towers verify the information contained in this application for purposes of proving my/our eligibility for occupancy. I/We will provide all necessary information including names, addresses, phone numbers, and account numbers where applicable and any other information required for expediting this process. I/We understand that my occupancy is contingent on meeting Kingsbury’s Twin Towers resident selection criteria.

    The information contained in the application must be completed in full. Please type "N/A" in the areas which may not pertain to the particular situation surrounding the people moving into this community. Further, I/We understand that I/We have a household that is comprised solely of full time students, unless I/We meet one of the exceptions. Should it subsequently be determined that our household is comprised solely of fulltime students, I/We understand that I/We are responsible for the payment of the non- Tax Credit rent. I/We understand that my rental history, criminal and credit background will be checked on an annual basis.
  • All ADULT household members must sign below:

    Electronic SignatureDate 
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