Fillable Bv Application App 1

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Bv Application App 1

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App 1-TC
Page 1 of 4
G:\Multi\Forms\Occupancy\Tax Credit Apps Prop Specific\111219.doc
Revised 05/2019
FOR OFFICE USE ONLY:
Date: Requested Bedroom Size: Special Needs:
Time: Date Occupancy Desired: Gross Annual Income $_________________
Tax Credit Unit Type: [ ] Market [ ] 60% [ ] 50% [ ] 40% [ ] 30%
Resident Manager Signature: _____________________________ Unit # - Add on to Existing Household__________
THE HOUSING COMPANY RESIDENTIAL APPLICATION FORM
Name of Apartment Complex:
Applicant Name: (Last, First, Middle Initial)
Telephone: ( ) Cell Phone: ( )
Current Mailing Address:
City: State: Zip:
How did you hear about this apartment community? [ ] Flyers or Brochures; [ ] Newspaper; [ ] Yellow Pages;
[ ] Website; [ ] Drive By; [ ] Housing Assistance Listing; [ ] Resident Referral (Name of Resident________________________)
Do you have a housing voucher? (If yes, supporting documentation required) ........................................... [ ]YES [ ] NO
Are you on a Waiting List to receive a housing voucher? (If yes, supporting documentation required) .... [ ]YES [ ] NO
Were you referred to us by another agency? [ ]YES [ ] NO If yes, which one?
Are you a veteran of the US Armed Forces? (optional) ........................................ [ ]YES [ ] NO [ ] Decline to Answer
Do you have an animal that will be moving with you? ................................................................................. [ ]YES [ ] NO
A.HOUSEHOLD COMPOSITION – Please list all names of those who will occupy the unit, even on a part-time basis
Name (Last, First, Middle Initial)
Relationship to
Applicant
Date of Birth
Social Security #
Full-
Time
Student*
Yes or No
Full-time student is defined as any individual who attends full-time (for a minimum of five months per
calendar year), an educational organization which normally maintains a regular faculty and curriculum. (This
includes kindergarten and elementary school children.)
Tax Credit Revised February, 2015
Certification of Student Status
Head of Household Name
Unit Number
Students include individuals attending public or private elementary schools, middle or junior high schools, senior high schools,
colleges, universities, technical, trade or mechanical schools. Students do not include individuals participating in on-the-job
training or correspondence courses.
Please choose one option below that best describes your household:
The household contains no occupants who are students (full-time or part-time).=
The household contains at least one occupant who is not a student and has not been and will not be a student for five
months or more out of the current calendar year (months need not be consecutive).
List non-student here:
The household contains all students, but is qualified because at least one occupant is a part-time student. Verification of
part-time status is required.
List part-time student here:
The household contains all full-time students for five months or more out of the current and/or upcoming calendar year
(months need not be consecutive). If yes, you must answer all five questions below.
Yes
No
Are the students married and entitled to file a joint tax return? (attach an affidavit or tax return)
Are all adult members single parents with child(ren), and not a dependent of someone else, and the child(ren)
is/are not dependent(s) of someone other than the parent(s)?
Is at least one student receiving Temporary Assistance to Needy Families (TANF)?
Does at least one student participate in a program receiving assistance under the Job Training Partnership Act,
Workforce Investment Act, or under other similar federal, state, or local laws? (attach verification of participation)
Does the household consist of at least one student who was previously under foster care? (provide verification of
participation)
Signatures:
Under penalties of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge
and belief. I/we agree to notify management immediately of any changes in this household’s student status. I/we understand that providing
false representations constitutes an act of fraud. False, misleading, or incomplete information may result in the termination of the lease
agreement.
This form must be signed by each household member age 18 and older.
Resident Signature Date
Resident Signature Date
Resident Signature Date
Resident Signature Date
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Bv Application App 1

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Completed 28 August 2021

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