Fillable 4d Aordable Housing Program-Rent Roll Page 1 of (City of Golden Valley)

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4d Aordable Housing Program-Rent Roll Page 1 of (City of Golden Valley)

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4d Aordable Housing Program-Rent Roll Page 1 of 2
In the table below, please list any units you wish to enroll in the Low Income Rental Classification (4d) Tax Program as well
as their type, current rent, and the date of the last rate increase on that unit. At least 20 percent of the property’s total units
must be aordable to a household making 60 percent or less of the Area Median Income (AMI). Maximum rents at the 60
percent AMI level as well as an example rent roll are provided on the reverse of this sheet.
Number of total rental units at property: _______________
Number of designated aordable units: _______________
Property Address
Property Identification
Number (PIN)
Unit
Number**
Unit Type
Current
Rent
Date Of
Last Rent
Increase
Physical Development Department-Planning | 7800 Golden Valley Road, Golden Valley, MN 55427
763-593-8095 | FAX: 763-593-8109 | TTY: 763-593-3968 | www.goldenvalleymn.gov
1/16/2020
continued
asdf
**Please list the actual unit number for units you wish to classify as 4d. Preferential 4d status only applies to these units.
Example Rent Roll
Property Address
Property Identification
Number (PIN)
Unit
Number**
Unit Type
Current
Rent
Date Of
Last Rent
Increase
105 5th Ave S 23-029-24-34-0053 1 1 BR $690 12/1/18
105 5th Ave S 23-029-24-34-0053 2 2 BR $800 5/1/17
105 5th Ave S 23-029-24-34-0053 3 Studio $500 5/1/17
105 5th Ave S 23-029-24-34-0053 4 Studio $650 5/1/17
105 5th Ave S 23-029-24-34-0053 5 1 BR $600 12/1/18
105 5th Ave S 23-029-24-34-0053 6 1 BR $650 12/1/18
105 5th Ave S 23-029-24-34-0053 7 1 BR $680 12/1/18
105 5th Ave S 23-029-24-34-0053 8 Studio $600 5/1/17
105 5th Ave S 23-029-24-34-0053 9 1 BR $600 12/1/18
105 5th Ave S 23-029-24-34-0053 10 1 BR $800 12/1/18
105 5th Ave S 23-029-24-34-0053 11 1 BR $690 12/1/18
Monthly Rent Limits
60% AMI Maximu Rent Limits, 2019
Studio/E/0 1 BR 2 BR 3 BR 4 BR 5 BR
$1,050 $1,125 $1,350 $1,560 $1,740 $1,920
Data Practices Advisory
The City of Golden Valley will use the data you supply in this application to assess your qualifications for the Golden Valley 4d
Aordable Housing Program. If you provide the requested data, some or all of the data will become public under the Minnesota
Government Data Practices Act (MGDPA). This data is not legally required, but the City will not be able to process or approve your
application without it. Pursuant to Minn. Stat. § 13.59, the following information is private or non-public information when provided for
the purpose of determining eligibility of a property for class 4d: individual income information and lease information. The data you
supply may be shared upon court order or provided to the state or legislative auditor.
4d Aordable Housing Program-Rent Roll Page 2 of 2
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY:
763-593-3968) to make a request. Examples of alternate formats may include large print, electronic,
Braille, audiocassette, etc.
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Completed 3 August 2020

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