LOW INCOME HOUSING TAX CREDIT RENTAL APPLICATION

All co-applicants, age 18 or older, including spouse, should complete a separate application.

We are pleased to consider your family as future residents of our rental community. The information you provide below will assist us in determining your eligibility. All information will be kept confidential. Failure to provide the required information will prevent us from considering your application. Misrepresentation of information is punishable by law. Please answer all questions. Write N/A if a particular question is not applicable. Do no leave any questions blank or unanswered. THANK YOU!

HOUSEHOLD COMPOSITION AND STATUS:

List the Head of Household (applicant) and all other persons who wi ll be living in your unit. State the relationship of each family member to the Head. Choose only one member to be Head of Household. List all members you anticipate to live with you at least 50% of the time in the next 12 months including anyone who is not cur rently a household member but is anticipated to become one in the next 12 months. Include any temporally absent family members.

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

Add additional household member 1

Add another member of household

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

Add additional household member 2

Add another member of household

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

Add additional household member 3

Add another member of household

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

Add additional household member 4

Add another member of household

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

Add additional household member 5

Add another member of household

Household Member’s

Full Name (first and last)

Relationship to Head

Date of Birth

Marital Status

Social Security Number

Student

Student Status

Phone

*A household member should be considered a full-time (FT) or part-time (PT) student if he/she has attended school in the current calendar year, is currently attending, OR plans to attend school in the next 12 months. Please include all school-age children, even if home-schooled as FT students.

1. COMPLETE THE FOLLOWING SECTION ONLY IF ALL HOUSEHOLD MEMBERS ARE FULL TIME STUDENTS:

a. Is at least one student receiving assistance under Title IV of the Social Security Act? (AFDC/TANF)

b. Does at least one student participate in a program receiving assistance under the Training Act, Workforce Investment Act or under other similar federal, state, or local laws?

c. Are the full-time students married and entitled to file a joint tax return?

d. Is the household comprised entirely of a single parent with child(ren) and the parent is not a dependent of another individual and the child(ren) are not dependents of someone other than a parent?

e. Was at least one student previously under the care and placement responsibility of the State agency responsible for administering foster care?

If you are divorced or separated, please provide date effective:

(If divorced, please provide a full copy of divorce decree.)

Do you expect any changes in the household in the next 12 months?

Please describe an explanation of changes, and state when this change is expected to occur.

(If adding a new member, this person should be listed as a household member on page 1 of this application.)

Are any household members under age 18 claiming emancipation (yourself included)? Yes or No If yes, please provide documentation to validate emancipation.

CURRENT EMPLOYMENT INFORMATION:

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title

Date of Hire

Monthly Gross Wage: $

Supervisor

ADDITIONAL CURRENT EMPLOYER INFORMATION: (complete if you currently have more than one job):

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title

Date of Hire

Monthly Gross Wage: $

Supervisor

PREVIOUS EMPLOYMENT INFORMATION:

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Title

Date of Hire

Monthly Gross Wage: $

Supervisor

OTHER INCOME INFORMATION:

Identify each source of income currently received or anticipated to be received in the next 12 months.

Adoption Assistance