Fillable Dear Online Applicant, Thank you for your interest

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Dear Online Applicant,
Thank you for your interest in Blue Ledge Co-op. We are anxious to get the paperwork
and approvals completed so we can welcome you to our co-op community.
Here’s the information needed for your application; it includes:
1. Applicatio
n*
2. “Document Package for Applicant’s/Tenants Consent to Release of
Information” (Please print an extra copy for your personal use.)
3. Income Eligibility Fact Sheet
4. Supplemental & Optional Contact Information (Attachment A)
5. Race and Ethnic Data Reporting Form
*If this is for co-applicants, two applications and two packets of certification forms need to be downloaded;
each person must complete their own.
Please complete the application and release forms and then return them to:
CSI Support & Development
Attn: Certification Department
110 Florence Street, Suite 204
Malden, MA 02148
There’s a lot of paperwork, but please don’t be discouraged! If you have any questions
about the materials, assistance is just a phone call away. Please call 617-544-1160
or
stop by the CSI Support and Development office where a staff member will be happy to
assist you in completing the paperwork.
Your eligibility for this building will require you to meet the income limits and provide
social security information. In addition to eligibility requirements, our screening includes
an interview, landlord and/or credit and background checks.
After your application is completed you will be placed on the waitlist as of the date and
time it is received. When your name comes up towards the top of the waitlist a financial
packet will be mailed out to you. This financial packet will need to be completed in a
timely manner in order for the application process to proceed.
If you would like to set up an appointment to tour the building, please call the Leasing
office at 617-323-6419
.
We are hoping that you join our cooperative community of
People Working Together to Help Each Other.
Questions Concerning this Notice
CSI Support & Development is dedicated to providing decent, and affordable housing to our residents. If you
have any questions about this notice, please contact the management office.
If
you are disabled and wish to request a reasonable accommodation or if you have difficulty understanding
English, please request our assistance and we will ensure that you are provided with meaningful access based
on your individual needs.
This is an important notice. Please have it translated. (English)
Esto es un aviso importante. Por favor téngalo traducido. (Spanish)
Ceci est un avis important. Le faire traduire, s'il vous plait. (French)
这是一个重要的通知。请翻譯這分文件。(Chinese)
이것은 매우 중요한 통지 입니다. 꼭 번역하시기 바랍니다. (Korean)
Это очень важное сообщение . Переведите пожалуйста. (Russian)
Acesta este un mesaj important. Vâ rugâm sâ apelaţi la cineva sâ vi-l traducâ. (Romanian)
Jest to ważna informacja. Proszę mieć to przetłumaczone. (Polish)
هﺎﺑﺗﻧا! هذھ ﺔﻘﯾﺛوﻟا ﺔﻣﮭﻣ. ءﺎﺟرﻟا ﺎﮭﺗﻣﺟرﺗ (Arabic)
Ky është një njoftim i rëndësishëm. Ju lutemi ta përktheni këtë (Albanian)
Your response to this letter does not preclude you from exercising other avenues available if you believe that
you are being discriminated against on the basis of race, color, religion, sex, national origin, familial status,
handicap, or any other state or locally protected classes.
Notification of Non-Discrimination Based on Disability
CSI Support & Development does not discriminate on the basis of disability status in the admission or access
to, or treatment or employment in, its federally assisted programs and activities. We have a 504 coordinator
designated to coordinate compliance with the nondiscrimination requirements contained in the Department
of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2,
1988): CSI Support & Development, Attn: 504 Coordinator, 8425 E. 12 Mile Road, Warren, MI 48093, 586-753-
9002, TDD 800-348-7011
BL Page 1 of 6
APPLICATION
BLUE LEDGE CO-OP APARTMENTS
Thank you for your interest in residing in one of CSI Support & Development’s properties. We look forward
to processing your application. Please answer all questions on this application. Enter “None” or N/A for
those questions which do not apply to you. Applications will not be considered unless they are fully
completed. Please print.
This application is for one person. A separate application must be completed if a second person will
occupy the apartment. Check our website at www.csi.coop or speak to a specialist at 800-225-3151
(TTD 800-348-7011) for waitlist status information. Do not hesitate to contact us with any questions about
our application process, a friendly CSI staff member is just a phone call away.
APPLICANT INFORMATION
LAST NAME FIRST NAME M.I.
CURRENT ADDRESS
_______________________________________
Street Address Apt. No.
_______________________________________
City State Zip Code
TELEPHONE NUMBER AND AREA CODE
( ) .
E-mail:
_______________________________________
Income limits may apply: 1 Person 2 Person Please note: Income limits subject to change by HUD.
$44,800 p/yr. $51,200 p/yr. Estimate of your anticipated annual income: ___________
HOUSING COMPOSITION
If you are the head of household (HOH), please complete this section which provides information
about other household members. You must indicate one of the HUD approved relationship codes for
each household member. If you are not the HOH, please skip this section.
1. Will anyone else live in the unit with you?
If yes, please provide the following information and note that all adults must
complete their own application:
Yes No
Other household member’s full name
Foster adult/child
Live-in aide (Live-in aides must be approved before move in)
None of the above
FOR OFFICE USE ONLY
Online/Phone/ Walk in Applicant
Date & Time Received:
Processed By:
BL Page 2 of 6
HOUSING INFORMATION
2. Will this unit be your only place of residency?
Yes No
3. This building may have a limited number of units with f
eatures specially designed
for mobility impaired individuals. (e.g., lower kitchen cabinets and counters,
wheelchair accessible doorways.) Do you require such a unit?
Yes No
4. Do you require a unit that has been adapted for the hearing/visual impaired?
Yes No
5. Are you enlisted in the U.S. military or are you a veteran of the U.S. military?
Yes No
6. Are you a student enrolled in an institute of higher education?
Yes No
7. Blue Ledge Co-op is gradually transforming into a 100% smoke free co-op.
While no one is allowed to smoke in any common area of the building there
are approximately 2 members who are still permitted to smoke in their own
apartments. All new members as of July 1, 2013 are not allowed to smoke
inside their own apartment. Do you acknowledge that you are aware of this
smoke free policy?
Yes No
8. The Controlled Substances Act prohibits all forms of marijuana use, therefore, the
use of medical or recreational marijuana is illegal under federal law even if it is
permitted under state law and is not allowed on any CSI property because of
federal funds received. Do you acknowledge that you are aware of this zero-
tolerance marijuana use policy, and agree that you, your guests, and service
providers hired by you will abide by this policy?
Yes No
9. Do you understand that failure to comply with the smoking and marijuana policies
may result in termination of tenancy?
Yes No
10. The management and property staff do not provide, nor has the authority to
provide, any personal care or
personal supervision services. All care and
supervision services must be provided by the resident or aides supervised by the
resident or the resident’s representative(s). Neither CSI nor the co-
op provide
assistance with personal activities of daily livin
g. Are you able to meet all the
obligations of tenancy with or without assistance from outside the building?
Yes No
11. Legally, do you need permission of another person (i.e. court appointed guardian)
to make leasing or financial decisions? If yes, please provide her/his contact
information:
Name:__________________________ Phone number: (_____)_______________
Yes No
BL Page 3 of 6
BACKGROUND INFORMATION
LANDLORD INFORMATION
12. Have you ever used a different name (or names) from the name given in this
application?
If yes, please provide name(s):
Yes No
13. Have you ever been convicted of a crime?
If yes, indicate if the conviction(s) was a felony, misdemeanor, or check both if you
have been convicted of both:
Felony, what year(s)? Misdemeanor, what year(s)?
Yes No
14. Are you currently using illegal drugs or have you ever been convicted of illegal
manufacturing or distribution of illegal drugs?
Yes No
15. Are you or is any member of the household required to register with any state
lifetime sex offender or other sex offender registry?
Yes No
16. Please indicate each state where you have lived: This disclosure is mandatory under HUD rules
and criminal screening will be reviewed in each state listed and via national criminal screening/sex
offender databases. Failure to provide a complete and accurate list will result in the rejection of
the application.
AL AK AZ AR CA CO CT DE FL GA HI ID IL
IN IA KS KY LA ME MD MA MI MN MS MO MT
NE NV NH NJ NM NY NC ND OH OK OR PA RI
SC SD TN TX UT VT VA WA WV WI WY Washington D.C
17.
Are you currently receiving housing assistance from HUD or a Public Housing
Agency?
Yes No
18.
Have you ever been evicted from a federally funded housing program for a lease
violation including drug use or failure to report a crime? If yes, when?
Yes No
19.
Have you ever been evicted from a
property managed by CSI Support &
Development for lease violations?
Yes No
20.
Are you currently homeless?
If yes, please skip questions about your present
landlord and answer questions related to your prior landlords.
Yes No
21. Are you currently renting? If not, please explain your current living arrangements:
Yes No
BL Page 4 of 6
22. We require information on where you have lived for the past five years. Please provide this information
and give the name, address, phone number of your landlords, and the dates you lived there. (Use an
additional sheet if you need more space.)
Dates
From - To
Address of Your
Location
Name and Address
of Landlord
Telephone Number
of Landlord
Indicate which Apply
Own Pay Rent
Live with family or friends
Other-explain:
Do you currently have
outstanding balances
overdue to this landlord?
Yes No
Have you been evicted, or is
this landlord attempting to
evict you or another person
living with you for lease
violations? Yes No
Own Pay Rent
Live with family or friends
Other-explain:
Do you currently have
outstanding balances
overdue to this landlord?
Yes No
Were you or any member of
your household evicted from
this property for lease
violations? Yes No
Own Pay Rent
Live with family or friends
Other-explain:
Do you currently have
outstanding balances
overdue to this landlord?
Yes No
Were you or any member of
your household evicted from
this property for lease
violations? Yes No
23.
How did you hear about this co-op apartment?
(example: newspaper or community center?)
BL Page 5 of 6
PETS & ASSISTANCE/COMPANION ANIMALS
Please review the Rules for Animal Ownership. They are available upon request. The presence of any
animal must be approved before the animal is allowed to be kept in the unit. Please note that only one
four-legged, warm-blooded, under 20 lbs., domesticated animal is allowed per apartment as a pet.
Accommodations can be made for assistance animals. Pets and assistance animals must be approved
before they are allowed to live in the unit. Please contact us at 617-544-1160, for further information.
PARKING
APPLICANT SIGNATURE AND CERTIFICATION
I understand the information in this application will be used to determine eligibility for a unit and that this information
will be checked. I understand that any false information may make me ineligible for a unit.
I certify that all information given in this application and in the attachments: application’s information is true,
complete and accurate. I understand that if any of this information is false, misleading or incomplete, management
may decline my application or, if move-in has occurred, terminate my Lease Agreement.
I understand that under the Federal Fair Credit Reporting Act, I have the right to make a written request to the
company, within a reasonable time, for the disclosure of the name and address of the consumer reporting agency
and the third party reporting agency, so that I may obtain a complete disclosure of the nature and scope of the
investigation.
This authorization is limited to use regarding this facility.
I understand that it is a criminal offense, punishable by a $10,000 fine or 10 years imprisonment or both, to make
willful statement or misrepresentation to any Department or Agency of the United States as to any matter within its
jurisdiction.
During the application process, if your address and/or phone number is to change, it is your responsibility to provide
us with the new address and/or phone number.
If you are interested in reviewing our Tenant Selection Plan, you may request a copy by calling us at 617-544-1160
or emailing us at seniorhousingma@csi.coop
.
This facility is committed to serving all eligible and qualified individuals regardless of disability. If you need a
reasonable accommodation to reside or continue to reside in this facility and have an equal opportunity to participate
in the project, you should bring that fact to the management's attention. The management will try to work with you
to reach an accommodation in keeping with the fundamental nature of the project and within the budgetary and
administrative limits of the facility.
24. Do you plan to keep an animal in your apartment?
Yes No
25. If yes, please provide the following information:
ANIMAL TYPE
(dog, cat, turtle, etc.)
BREED
(if applicable)
WEIGHT
26. This building may have a limited number of parking spaces.
Do you require a parking space?
Yes No
BL Page 6 of 6
Notification of Non-Discrimination Based on Disability: CSI Support & Development does not discriminate on the
basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs
and activities. We have a 504 coordinator designated to coordinate compliance with the nondiscrimination
requirements contained in the Department of Housing and Urban Development’s regulations implementing Section
504 (24 CFR, part 8 dated June 2, 1988): CSI Support & Development, Attn: Corporate Controller, 8425 E. 12 Mile
Road, Warren, MI 48093, 586-753-9002, TDD 800-348-7011
Penalties for Misusing Form: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for
knowingly and willingly making false or fraudulent statements to any department of the United States Government,
HUD, the PHA and any owner (or any employee of HUD, the PHA or the owner) may be subject to penalties for
unauthorized disclosures or improper uses of information collected based on the consent form. Use of the
information collected based on this verification form is restricted to the purposes cited above. Any person who
knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant
or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected
by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be
appropriate, against the officer or employee of HUD, the PHA or the owner responsible for the unauthorized
disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social
Security Act at 208 (a) (6), (7) and (8). Violation of these provisions are cited as violations of 42 U.S.C. 408 (a) (6),
(7) and (8).
__________________________________________________________ ________________________
SIGNATURE DATE
AUTHORIZATION TO RELEASE INFORMATION
I am applying for an apartment at Blue Ledge Co-op. My signature below authorizes credit reporting
agencies and/or landlord references and law enforcement agencies to release all pertinent information
requested.
Applicant’s Name (please print) ________________________________________________________
Applicant’s Signature ________________________________________________________________
Date of Birth _______________________________________________________________________
Applicant’s Social Security Number ______________________________________________________
All Social Security Numbers Used by Applicant ____________________________________________
If you have no social security number, you claim you are exempt because:
You are an ineligible non-citizen
You were 62 as of 1/31/10 and receiving HUD housing assistance as of 1/31/10
Date _____________________________________________________________________________
PLEASE RETURN THIS APPLICATION TO: CSI Support & Development
Attn: Leasing Department
110 Florence Street, Suite 204
Malden, MA 02148
Application-MA- BL-PRAC
Rev 4/1/20
O
MB Control # 2502-0581
Exp. (
02/28/2019)
Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants
SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING
This form is to be provided to each applicant for federally assisted housing
I
nstructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any
issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update,
remove, or change the information you provide on this form at any time. You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.
Applicant Name:
Mailing Address:
Telephone No: Cell Phone No:
Name of Additional Contact Person or Organization:
Address:
Telephone No: Cell Phone No:
E-Mail Address (if applicable):
Relationship to Applicant:
Reason for Contact: (Check all that apply)
Emergency
Unable to contact you
Termination of rental assistance
Eviction from unit
Late payment of rent
Assist with Recertification Process
Change in lease terms
Change in house rules
Other: ______________________________
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.
Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.
Legal Notification: Section 644 of the Housing and Community Development Act of 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered the option of providing information regarding an additional contact person or
organization. By accepting the applicant’s application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.
Check this box if you choose not to provide the contact information.
Signature of Applicant
Date
The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Section 644 of the Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers
participating in HUD’s assisted housing programs to provide any individual or family applying for occupancy in HUD-assisted housing with the option to include in the application for occupancy the name,
address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such
information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with
resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.
Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud,
waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the
collection displays a currently valid OMB control number.
P
rivacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)
click to sign
signature
click to edit
U.S. Depart
ment of Housing and Urban Development
Document Package for
Applicant's/Tenant's Consent
to the
Release Of Information
This Package contains the following documents:
1.HUD-9887/A Fact Sheet describing the necessary verifications
2.Form HUD-9887
(to be signed by the Applicant or
Tenant)
3.Form HUD-9887
-A (to be signed by the Applicant or Tenant and Housing Owner)
4.Relev
ant Verifications (to be signed by the Applicant or Tena
nt)
Each
household must receive a copy of the 9887/A Fact Sheet, form HUD-9887, and form HUD-9887-A.
Attachment to forms HUD-9887 & 9887-A (02/2007)
HUD-9887/A Fact Sheet
Verification of Information Provided by
Applicants and Tenants of Assisted Housing
What Verification Involves
To receive housing assistance, applicants and tenants who are at least 18
years of age and each family head, spouse, or co-head regardless of age
must provide the owner or management agent (O/A) or public housing agency
(PHA) with certain information specified by the U.S. Department of Housing
and Urban Development (HUD).
To make sur
e that the assistance is used properly, Federal laws require
that the information you provide be verified. This information is verified in two
ways:
1. HU
D, O/As, and PHAs may verify the information you provide by
checking with the records kept by certain public agencies (e.g.,
Social Security Administration (SSA), State agency that keeps wage
and unemployment compensation claim information, and the
Department of Health and Human Services’ (HHS) National Directory
of Ne
w Hires (NDNH) database that stores wage, new hires, and
unemployment compensation). HUD (only) may verify informa
tion
covered in
your tax returns from the U.S. Internal Revenue Se
rvice
(IRS).
You give your consent to the release of this information by
signing form HUD-9887. Only HUD, O/As, and PHAs can receive
information authorized by this form
.
2.
The O/A must verify the information that is used to determine your
eligibility and the amount of rent you pay. You give your consent to
the
release of this information b
y signing the form HUD-9887, the form
HUD-9887-A, and the individual verification and consent forms t
hat
appl
y to you. Federal laws limit the kinds of information the O/A can
receive about you. The amount of income you receive helps to
determine the amount of rent you will pay. The O/A will verify all of the
sources of income that you report. There are certain allowances that
reduce the incom
e used in determining tenant re
nts.
E
xample: Mrs. Anderson is 62 years old. Her age qualifies her
for a
medical allow
ance. Her annual income will be adjusted because of
this allowance. Because Mrs. Anderson’s medical expenses will
help determine the amount of rent she pays, the O/A is required to
verify any medical expenses that she reports.
Example: Mr. Harris does not qualify for the medical allowance
because he is not at least 62 years of age and he is not
handicapped or disabled. Because he is not eligible for the medical
allowance, the amount of his medical expenses does not change
the amount of rent he pays. Therefore, the O/A cannot ask Mr.
Harris anything about his medical expenses and cannot verify with
a third party about any medical expenses he has.
Customer Protections
Information received by HUD is protected by the Federal Privacy Act.
Information received by the O/A or the PHA is subject to State privacy
laws. Employees of HUD, the O/A, and the PHA are subject to
penalties for using these consent forms improperly. You do not have to
sign the form HUD-9887, the form HUD-9887-A, or the individual
verification consent forms when they are given to you at your
certification or recertification interview. You may take them home with
you to read or to discuss with a third party of your choice. The O/A will
give you another date when you can return to sign these forms.
If you cannot re
ad and/or sign a consent form due to a disability, the
O/A shall make a reasonable accommodation in accordance with
Section 504 of the Rehabilitation Act of 1973. Such accommodations
may include: home visits when the applicant's or tenant's disability
prevents him/her from coming to the office to complete the forms; the
applicant or tenant authorizing another person to sign on his/her
behalf; and for persons with visual impairments, accommodations may
include providing the forms in large script or braille or providing
readers.
If an adult mem
ber of your household, due to e
xtenuating circumstances, is
unable to sign the form HUD-988
7 or the individual verification forms on time,
the O/A may document the file as to the reason for the delay and the specific
plans to obtain the proper signature as soon as possible.
The O/A must
tell you, or a third party which you choose, of the
findings made
as a result of the O/A verifications authorized by
your
consent. The O/A must give you the opportunity to contest such
findings in accordance with HUD Handbook 4350.3 Rev. 1. However, for
information received under the form HUD-9887 or form HUD-9887-A, HUD, the
O/A, or the PHA, may inform you of these findings.
O/As must kee
p tenant files in a location that ensures confidentiality.
An
y employee
of the O/A who fails to keep tenant information
confidential is subject to the enforcement provisions of the State Privacy Act
and is subject to enforcement actions by HUD. Also, any applicant or tenant
affected by negligent disclosure or improper use of information may bring civil
action for damages, and seek other relief, as may be appropriate, against the
employee.
HUD-9
887/A requires the O/A to give each household a copy of the Fact
Sheet, and form
s HUD-9887, HUD-9887-A along w
ith appropriate individual
consent forms. The package you will receive will include the
following documents:
1.HUD-9887/A Fact Sheet:
Describes the requirement to
verify
information provided by individuals who apply for
housing assistance. This
fact sheet also
describes consumer protections under the ve
rification
process.
2.
Form HUD-9887: Allow
s the release of information betwe
en
government agencies.
3.Form HUD-9887-A: Describ
es the requirement of third party
verification along w
ith consumer protections.
4.Individual verification consents: Used to
verify the re
levant
information provided by applicants/tenants to determine their eligibility and
level of benefits.
Conse
quences for Not Signing the Consent Forms
If you fail to sign the form HUD-9887, the form HUD-9887-A, or the
individual verification forms, this may result in
your assistance being
denied (for applicants) or your assistance being terminated (for tenants). See
further explanation on the forms HUD-9887 and 9887-A.
If
you are an applicant and are denied assistance for this reason, the O/A
must notif
y you of the
reason for your rejection and give you an
opportunity to appeal the decision.
If y
ou are a tenant and your assistance is terminated for this reason,
the O/A must follow the procedures set out in the Lease. This includes
the opportunit
y for you to meet with the O/A.
Programs Covered by this Fact Sheet
Rental Assistance Program (RAP)
Rent Supplement
Section 8 Housing Assistance Payments Programs (administered by the
Office of Housing)
Section 202
Sections 202 and 811 PRAC
Section 202/162 PAC
Section 221(d)(3) Below Market Interest Rate
Section 236
HOPE 2 Home Ownership of Multifamily Units
O/As must give a copy of this HUD Fact Sheet to each household. See the Instructions on form HUD-9887-A.
Attachment to forms HUD-9887 & 9887-A (02/2007)
Notice and Consent for the Release of Information
to the U.S. Department of Housing and Urban Development (HUD) and to
an Owner and Management Agent (O/A), and to a Public Housing
Agency (PHA)
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
HUD Office requesting release of information
(Owner should provide the full address of the
HUD Field Office, Attention: Director, Multifamily
Division.):
O/A requesting release of
information (Owner should provide the full
name and address of the Owner.):
PHA requesting release of information (Owner should
provide the full name and address of the PHA and the title of
the director or administrator. If there is no PHA Owner or
PHA contract administrator for this project, mark an X
through this entire box.):
Notice To Tenant: Do not sign this form if the space above for organizations requesting release of information is left blank. You do not have to sign
this form when it is given to you. You may take the form home with you to read or discuss with a third party of your choice and return to sign the
consent on a date you have worked out with the housing owner/manager.
Au
thority: Section 217 of the Consolidated Appropriations Act of 2004
(Pub L. 108-199). This law is found at 42 U.S.C.653(J). This law authorizes
HHS to disclose to the Department of Housing and Urban Development
(HUD) information in the NDNH portion of the “Location and Collection
System of Records” for the purposes of verifying employment and income of
individuals participating in specified programs and, after removal of personal
identifiers, to conduct analyses of the employment and income reporting of
these individuals. Information may be disclosed by the Secretary of HUD to a
private owner, a management agent, and a contract administrator in the
administration of rental housing assistance.
Section 904 of the Stewart B. McKinney Homeless Assistance Amendments
Act of 1988, as amended by section 903 of the Housing and Community
Development Act of 1992 and section 3003 of the Omnibus Budget
Reconciliation Act of 1993. This law is found at 42 U.S.C. 3544.This law
requires you to sign a consent form authorizing: (1) HUD and the PHA to
request wage and unemployment compensation claim information from the
state agency responsible for keeping that information; and (2) HUD, O/A, and
the PHA responsible for determining eligibility to verity salary and wage
information pertinent to the applicant’s or participant’s eligibility or level of
benefits; (3) HUD to request certain tax return information from the U.S.
Social Security Administration (SSA) and the U.S. Inte
rnal Revenue Service (IRS).
Purpose: In sign
ing this consent form, you are authorizing HUD, the above-
named O/A, and the PHA to request income information from the government
agencies listed on the form. HUD, the O/A, and the PHA need this
information to verify your household’s income to ensure that you are eligible
for assisted housing benefits and that these benefits are set at the correct
level. HUD, the O/A, and the PHA may participate in computer matching
programs with these sources to verify your eligibility and level of benefits.
This form also authorizes HUD, the O/A, and th
e PHA to seek wage, new
hire
(W-4), and unemployment claim information from current or former employers
to verify information obtained through computer matching.
Uses of Information to be Obtained:
HUD is required to protect the income
information it obtains in accordance with the Privacy Act of 1974,
5 U.S.C. 552a. The O/A and the PHA is also required to protect the income
information it obtains in accordance with an
y applicable State privacy law.
After receiving the information covered by this notice of consent, HUD, the
O/A, and the PHA may inform you that your eligibility for, or level of, assistance
is uncertain and needs to be verified and nothing else.
HUD,
O/A, and PHA employees may be subject to penalties for unauthorized
disclosures or im
proper uses of the income information that is obtained based
on the consent form.
Who Must Sign the Consent Form: Each member of your
household who
is
at least 18 years of age and each family head, spouse or co-head, regardless of
age, must sign the consent form at the initial certification
and at each
recertification. Additional signatures must be obtained from new adult
members when they join the household or when members of the household
become 18 years of age.
Persons who apply for or receive assistance under the following programs are
required to sign this consent form:
Rental Assistance Program (RAP)
Rent Supplement
Section 8 Housing Assistance Payments Programs (administered by the
Office of Housing)
Section 202; Sections 202 and 811 PRAC; Section 202/162 PAC Section
221(d)(3) Below Market Interest Rate
Section 236
HOPE 2 Homeownership of Multifamily Units
Failure to Sign Consent Form: Y
our failure to sign the consent form ma
y
result in the denial of assistance or termination of assisted housing benefits. If
an applicant is denied assistance for this reason, the owner must follow the
notification procedures in Handbook 4350.3 Rev. 1. If a tenant is denied
assistance for this reason, the owner or managing agent must follow the
procedures set out in the lease.
________________________________________________________________________________________________________________________________
Consent: I consent to allow HUD, the O/A, or the PHA to request and obtain income information from the federal and state agencies
listed on the back of this form for the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs.
Signatures: Additional Signatures, if needed:
Head of Household Date Other Family Members 18 and Over Date
Spouse Date Other
Family Members 18 and Ov
er Date
Other
Family Members 18 and Over Date Other Family Members 18 and Over Date
Other
Family Members 18 and Over Date Other Family Members 18 and Over Date
Original is retained on file at the project site ref. Handbooks 4350.3 Rev-1, 4571.1, 4571/2 & form HUD-9887 (02/2007)
4571.3 and HOPE II Notice of Program Guidelines
Roslindale Senior Housing
110 Florence Street, Suite 204
Malden, MA 02148
U.S. Dept. of Hsg. & Urban Development
Thomas P. O'Neill Jr., Fed Bldg.
10 Causeway Street, Boston, MA 02222
Agencies To Provide Information
State Wage Information Collection Agencies. (HUD and
PHA). This consent is limited to wages and unemployment
compensation you have received during period(s) within the last 5
years when you have received assisted housing benefits.
U.S. Social Security Administration (HUD only). This consent is
limited to the wage and self employment information from your
current form W-2.
National Directory of New Hires contained in the Department of
Health and Human Services’ system of records. This consent is
limited to wages and unemployment compensation you have
received during period(s) within the last 5 years when you have
received assisted housing benefits.
U.S. Internal Revenue Service (HUD only). This consent is limited
to information covered in your current tax return.
This consent is limited to the following information that may
appear on your current tax return:
1099-S Statement for Recipients of Proceeds from Real Estate
Transactions
1099-B Statement for Recipients of Proceeds from Real Estate
Brokers and Barters Exchange Transactions
1099-A Information Return for Acquisition or Abandonment of
Secured Property
1099-G Statement for Recipients of Certain Government
Payments
1099-DIV Statement for Recipients of Dividends and Distributions
1099 INT Statement for Recipients of Interest Income
1099-MISC Statement for Recipients of Miscellaneous
Income
1099-OID Statement for Recipients of Original Issue Discount
1099-PATR Statement for Recipients of Taxable Distributions
Received from Cooperatives
1099-R Statement for Recipients of Retirement Plans W2-G
Statement of Gambling Winnings
1065-K1 Partners Share of Income, Credits, Deductions,
etc.
1041-K1 Beneficiary’s Share of Income, Credits, Deductions, etc.
1120S-K1 Shareholder’s Share of Undistributed Taxable Income,
Credits, Deductions, etc.
I understand that income information obtained from these sources
w
ill be used to verif
y information that I provide in determining initial
or continued eligibility for assisted housing programs and the level
of benefits.
No action can be taken to terminate, deny, suspend, or reduce the
assistanc
e your
household receives based on information obtained
about you under this consent until the HUD Office, Office of
Inspector General (OIG) or the PHA (whichever is applicable) and
the O/A have independently verified: 1) the amount of the income,
wages, or unemployment compensation involved, 2) whether you
actually have (or had) access to such income, wages, or benefits
for your own use, and 3) the period or periods when, or with
respect to which you actually received such income, wages, or
benefits. A photocopy of the signed consent may be used to
request a third party to verify any information received under this
consent (e.g., employer).
HUD, the O/A, or the PHA shall inform you, or
a third party w
hich
you designate, of the findings made on the basis of information
verified under this consent and shall give you an opportunity to
contest such findings in accordance with Handbook 4350.3 Rev. 1.
If a member of the household who is required to sign the consent
form is un
able to sign the
form on time due to extenuating
circumstances, the O/A may document the file as to the reason for
the delay and the specific plans to obtain the proper signature as
soon as possible.
This consent form expires 15 months after signed.
Privacy Act Statement. The Department of Housing and Urban Development (HUD) is authorized to collect this information by the U.S.
Housing Act of 1937, as amended (42 U.S.C. 1437 et. seq.); the Housing and Urban-Rural Recovery Act of 1983 (P.L. 98-181); the Housing
and Community Development Technical Amendments of 1984 (P.L. 98-479); and by the Housing and Community Development Act of 1987
(42 U.S.C. 3543). The information is being collected by HUD to determine an applicant’s eligibility, the recommended unit size, and the
amount the tenant(s) must pay toward rent and utilities. HUD uses this information to assist in managing certain HUD properties, to protect
the Government’s financial interest, and to verify the accuracy of the information furnished. HUD, the owner or management agent (O/A), or
a public housing agency (PHA) may conduct a computer match to verify the information you provide. This information may be released to
appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors. However,
the information will not be otherwise disclosed or released outside of HUD, except as permitted or required by law. You must provide all of
the information requested. Failure to provide any information may result in a delay or rejection of your eligibility approval.
Penalties for Misusing this Consent:
HUD, the O/A, and any PHA (or any employee of HUD, the O/A, or the PHA) may be subject to penalties for unauthorized disclosures or
improper uses of information collected based on the consent form.
Use of the information collected based on the form HUD 9887 is restricted to the purposes cited on the form HUD 9887. Any person who
knowingly or willfully requests, obtains, or discloses any information under false pretenses concerning an applicant or tenant may be subject
to a misdemeanor and fined not more than $5,000.
Any applicant or tenant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be
appropriate, against the officer or employee of HUD, the Owner or the PHA responsible for the unauthorized disclosure or improper use.
Original is retained on file at the project site ref. Handbooks 4350.3 Rev-1, 4571.1, 4571.2 & form HUD-9887 (02/2007)
4571.3 and HOPE II Notice of Program Guidelines
Applicant's/Tenant's Consent to the
Release of Information
Verification by Owners of Information
Supplied by Individuals Who Apply for Housing Assistance
Instructions to Owners
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
1. Give the documents listed below to the applicants/tenants to sign.
Staple or clip them together in one package in the order listed.
a. The HUD-9887/A Fact Sheet.
b. Form HUD-9887.
c. Form HUD-9887-A.
d . Relevant verifications (HUD Handbook 4350.3 Rev. 1).
2. Verbally inform applicants and tenants that
a. They may take these forms home with them to read or to
discuss with a third party of their choice and to return to sign
them on a date they have worked out with you, and
b. If they have a disability that prevents them from reading and/
or signing any consent, that you, the Owner, are required to
provide reasonable accommodations.
3. Owners are required to give each household a copy of the
HUD9887/A Fact Sheet, form HUD-9887, and form HUD-9887-A
after obtaining the required applicants/tenants signature(s). Also,
owners must give the applicants/tenants a copy of the signed
individual verification forms upon their request.
Instructions to Applicants and Tenants
This Form HUD-9887-A contains customer information and
protections concerning the HUD-required verifications that Owners
must perform.
1. Read this material which explains:
• HUD’s requirements concerning the release of information,
and
• Other customer protections.
2. Sign on the last page that:
• you have read this form, or
• the Owner or a third party of your choice has explained it to you,
and
• you consent to the release of information for the purposes and
uses described.
Authority for Requiring Applicant's/Tenant's Consent to the
Release of Information
Section 904 of the Stewart B. McKinney Homeless Assistance
Amendments Act of 1988, as amended by section 903 of the Housing
and Community Development Act of 1992. This law is found at 42 U.S.C.
3544.
In part, this law requires you to sign a consent form authorizing the
Owner to
request current or previous employers to verify salary and wage
information pertinent to your eligibility or level of benefits.
In addition, HUD regulations (24 CFR 5.659, Family Information and
Verification) require as a condition of receiving housing assistance that
you must sign a HUD-approved release and consent authorizing any
depository or private source of income to furnish such information that is
necessary in determining your eligibility or level of benefits. This includes
Purpose of Requiring Consent to the Release of Information
In signing this consent form, you are authorizing the Owner of the
housing project to which you are applying for assistance to request
information from a third party about you. HUD requires the housing
owner to verify all of the information you provide that affects your
eligibility and level of benefits to ensure that you are eligible for
assisted housing benefits and that these benefits are set at the
correct levels. Upon the request of the HUD office or the PHA (as
Contract Administrator), the housing Owner may provide HUD or the
PHA with the information you have submitted and the information
the Owner receives under this consent.
Uses of Information to be Obtained
The individual listed on the verification form may request and
receive the info
rmation requested by the verification, subject to the
limitations of this form. HUD is required to protect the income
information it obtains in accordance with the Privacy Act of 1974, 5
U.S.C. 552a. The Owner and the PHA are also required to protect
the income information they obtain in accordance with any
applicable state privacy law. Should the Owner receive information
from a third party that is inconsistent with the information you have
provided, the Owner is required to notify you in writing identifying the
information believed to be incorrect. If this should occur, you will
have the opportunity to meet with the Owner to discuss any
discrepancies.
Who Must Sign the Consent Form
Each member of your household who is at least 18 years of age, and
each family head, spouse or co-head, regardless of age
must sign the
relevant consent forms at the initial certification, at each
recertification and at each interim certification, if applicable. In
addition, when new adult members join the household and when
members of the household become 18 years of age they must also
sign the relevant consent forms.
Persons who apply for or receive assistance under the following
programs must sign the relevant consent for
ms:
Rental Assistance Progr
am (RAP)
Rent Supplement
Section 8 Housing Assistance Payments Programs (administered by
the Office of Housing)
Section 202
Sections 202 and 811 PRAC
Section 202/162 PAC
Section 221(d)(3) Below Market Interest Rate
Section 236
HOPE 2 Home Ownership of Multifamily Units
information that you have provided which will affect the amount of rent you
pay. The information includes income and assets, such as salary, welfare
benefits, and interest earned on savings accounts. They also include certain
adjustments to your income, such as the allowances for dependents and for
households whose heads or spouses are elderly handicapped, or disabled;
and allowances for child care expenses, medical expenses, and handicap
assistance expenses.
O
riginal is retained on file at the project site
ref. Hand
books 4350.3 Rev-1, 4571.1, 4571.2 & 4571.3 form HUD-9887-A (02/2007)
and HOPE II Notice of Program Guidelines
Failure to Sign the Consent Form
Failure to sign any required consent form may result in the denial of
assistance or termination of assisted housing benefits. If an
applicant is denied assistance for this reason, the O/A must follow
the notification procedures in Handbook 4350.3 Rev. 1. If a tenant
is denied assistance for this reason, the O/A must follow the
procedures set out in the lease.
Conditions
No action can be taken to terminate, deny, suspend or reduce the
assistance your household receives based on information obtained
about you under this consent until the O/A has independently 1)
verified the information you have provided with respect to your
eligibility and level of benefits and 2) with respect to income
(including both earned and unearned income), the O/A has verified
whether you actually have (or had) access to such income for
your
own use, and verified the period or periods when, or with respect
to which
you actually received such income, wages, or benefits.
A photocopy of the signed consent may be used to request the
information authorized by your signature on the individual consent
forms. This would occur if the O/A does not have another
individual verification consent with an original signature and the
O/A is required to send out another request for verification (for
example, the third party fails to respond). If this happens, the O/A
may attach a photocopy of this consent to a photocopy of the
individual verification form that you sign. To avoid the use of
photocopies, the O/A and the individual may agree to sign more
than one consent for each type of verification that is needed.
The O/A shall inform you, or a third party which you designate,
of the findings made on the basis of information verified under this
consent and shall give you an opportunity to contest such findings
in accordance with Handbook 4350.3 Rev. 1.
The O/A must provide you with information obtained under this
consent in accordance with State privacy laws.
If a member of the household who is required to sign the consent
forms is unable to sign the required forms on time, due to extenuating circum-
Penalties for Misusing this Consent:
stances, the O/A may document the file as to the reason for the delay and
the specific plans
to obtain the proper signature as soon as possible.
Individual consents to the release of information expire 15 months
after they are signed. The O/A may use these individual consent
forms during the 120 days preceding the certification period. The
O/A may also use these forms during the certification period, but
only in cases where the O/A receives information indicating that
the information you have provided may be incorrect. Other uses are
prohibited.
The O/A may not make inquiries into information that is older than 12
months unless he/she has received
inconsistent information and has
reason to believe that the information that you have supplied is
incorrect. If this occurs, the O/A may obtain information within the last
5 years when you have received assistance.
I have read and understand this information on the purposes
and uses of information
that is verified and consent to the
release of information for these purposes and uses.
_______________________________________________________
Name of Applicant or Tenant (Print)
_______________________________________________________
Signature of Applicant or Tenant & Date
I have read and understand the purpose of this consent and its
uses and I understand that misuse of this consent can lead to
personal penalties to me.
_______________________________________________________
Name of Project Owner or his/her representative
_______________________________________________________
Title
_______________________________________________________
Signature & Date
cc:Applicant/Tenant
Owner file
HUD, the O/A, and any PHA (or any employee of HUD, the O/A, or the PHA) may be subject to penalties for unauthorized disclosures or improper
uses of information collected based on the consent form.
Use of the information collected based on the form HUD 9887-A is restricted to the purposes cited on the form HUD 9887-A. Any person who
knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or tenant may be subject to a
misdemeanor and fined not more than $5,000.
Any applicant or tenant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be
appropriate, against the officer or employee of HUD, the O/A or the PHA responsible for the unauthorized disclosure or improper use.
Original is retained on file at the project site ref. Handbooks 4350.3 Rev. 1, 4571.1, 4571.2 & 4571.3 form HUD-9887-A (02/2007)
and HOPE II Notice of Program Guidelines
APPLYING FOR HUD
HOUSING
ASSISTANCE?
THINK ABOUT THIS…
IS FRAUD WORTH IT?
Do You Realize…
If you co
mmit fraud to obtain assisted housing from HUD, you could be:
• Evicted from your ap
artment or house.
• R
equired to repay all overpaid rental assistance you received.
• Fined up to
$10,000.
• Imprison
ed for up to five ye
ars.
• Prohibited from receiving future assistance.
• Subject to St
ate and local government penalti
es.
Do You Know…
You
are committing fraud if you sign a form knowing that you provided false or misleading
information.
The information you provide on housing assistance application and recertification forms
will
be checked. The local housing agency, HUD, or the Office of Inspector General will
check the income and asset information you provide with other Federal, State, or local
governments and with private agencies. Certifying false information is fraud.
So Be Careful!
When you fi
ll out your application and yearly recertification for assisted housing from
HUD make sure your answers to the questions are accurate and honest. You must
include:
All sources of income and changes in income you or any members of your household
receive, such as wages, welfare payments, social security and veterans’ benefits,
pensions, retirement, etc.
Any money you receive on behalf of your children, such as child support, AFDC
payments, social security for children, etc.
HUD-1141
form
(12/2005)
Any increase in income, such as wages from a new job or an expected pay raise or
bonus.
All assets, such as bank accounts, savings bonds, certificates of deposit, stocks, real
estate, etc., that are owned by you or any member of your household.
All income from assets, such as interest from savings and checking accounts, stock
dividends, etc.
Any business or asset (your home) that you sold in the last two years at less than full
value.
The names of everyone, adults or children, relatives and non-relatives, who are living
with you and make up your household.
(Important Notice for Hurricane Katrina and Hurricane Rita Evacuees: HUD’s
reporting requirements may be temporarily waived or suspended because of your
circumstances. Contact the local housing agency before you complete the housing
assistance application.)
Ask Questions
If you don’t understand
something on the application or recertification forms, always ask
questions. It’s better to be safe than sorry.
Watch Out for Housing Assistance Scams!
• Don’t pay money to h
ave someone fill out housing assistance application
and
recertifi
catio
n forms for you.
• Don’t pay money to
move up on a
waiting list.
• Don’t pay for anythin
g that is not covered by your
lease.
• Get a receipt for any money you pay.
• Get a written explanation if you are required to pay for anything other th
an rent
(maint
enance or utility
charges).
Report Fraud
If you kno
w of anyone who provided false information on a HUD housing assistance
application or recertification or if anyone tells you to provide false information, report that
person to the HUD Office of Inspector General Hotline. You can call the Hotline toll-free
Monday through Friday, from 10:00 a.m. to 4:30 p.m., Eastern Time, at 1-800-347-3735.
You can fax information to (202) 708-4829 or e-mail it to Hotline@hudoig.gov
. You can
write the Hotline at:
HUD OIG Hotline, GFI
451 7
th
Street, SW
Washington, DC 20410
December 2005
form
(12/2005)
HUD-1141
CSI Support & Development
Section 202 Income Eligibility Fact Sheet
Admiral’s Tower
Each resident (or couple) will pay 30% of his/her monthly income for rent. "Income" includes social
security, pension, S.S.I., wages, interest, dividends, etc. This means that everyone's rent will be somewhat
different. Each member's charges will be computed individually. There will be a choice of a security
deposit equal to one month's rent or a membership fee in Cooperative Services of $100.
Eligibility:
Qualified applicants are eligible to live in this housing program subject to the following income limits:
Eligibility income limits as of 4/1/2020 Date
Boston Area
1 Person 44,800 (26,850) Annually
2 Persons 51,200 (30,700) Annually
Amounts in parenthesis indicate extremely low-income limits. 40% of the move-ins over
the course of each year must fall into this category.
Applicants must also qualify for at least $1.00 of subsidy in order to qualify financially.
This means that 30% of your income must be at least $1.00 less than the current market rent
for your apartment.
Market rent for Admiral’s Tower Co-op Apts. is $1,091 (studio); $1,336 (one bedroom).
You Must Declare The Following Assets:
Checking, savings, stocks, bonds, mutual funds, value of equity in real estate property, and other capital
investments, anything owned wholly or in part by you.
If total assets are less than $5,000, we calculate the projected income earned based on the current rate of
interest.
If total assets exceed $5,000, we base the earnings on a percentage of the total assets, or actual income
earned -whichever is higher.
Do Not Declare the Following Assets:
Value of necessary personal property, such as furniture, automobiles, etc.
Reminder:
HUD requires that all property and assets be accounted for at market value for a period of two years from
date of disposition.
Rev. 3/31/2020
Notification of Non-Discrimination Based on Disability
CSI Support & Development does not discriminate on the basis of disability status in the admission or access
to, or treatment or employment in, its federally assisted programs and activities. We have a 504 coordinator
designated to coordinate compliance with the nondiscrimination requirements contained in the Department
of Housing and Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2,
1988): CSI Support & Development, Attn: 504 Coordinator, 8425 E. 12 Mile Road, Warren, MI 48093, 586-753-
9002, TDD 800-348-7011
form HUD-27061-H (9/2003)
1
R
ace and Ethnic Data U.S. Department of Housing OMB Approval No. 2502-0204
Reporting Form and Urban Development (Exp. 06/30/2017)
Office of Housing
Name of Property Project No. Address of Property
Name of Owner/Managing Agent Type of Assistance or Program Title:
Name of Head of Household Name of Household Member
Da
te (mm/dd/yyyy):
Ethnic Categories*
Select
One
Hispanic or Latino
Not-Hispanic or Latino
Racial Categories*
Select
All that
Apply
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
*
Definitions of these categories may be found on the reverse side.
Signature Date
P
ublic reporting burden for this collection is estimated to average 10 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This
information is required to obtain benefits and voluntary. HUD may not collect this information, and you are not required to complete this form,
unless it displays a currently valid OMB control number.
This information is authorized by the U.S. Housing Act of 1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing
and Community Development Technical Amendments of 1984. This information is needed to be incompliance with OMB-mandated changes to
Ethnicity and Race categories for recording the 50059 Data Requirements to HUD. Owners/agents must offer the opportunity to the head and co-
head of each household to “self certify’ during the application interview or lease signing. In-place tenants must complete the format as part of
their next interim or annual re-certification. This process will allow the owner/agent to collect the needed information on all members of the
household. Completed documents should be stapled together for each household and placed in the household’s file. Parents or guardians are to
complete the self-certification for children under the age of 18. Once system development funds are provide and the appropriate system upgrades
have been implemented, owners/agents will be required to report the race and ethnicity data electronically to the TRACS (Tenant Rental
Assistance Certification System). This information is considered non-sensitive and does no require any special protection.
There is no penalty for persons who do not complete the form.
_____
________________________________ ____________________________
form HUD-27061-H (9/2003)
2
Instructions for the Race and Ethnic Data Reporting (Form HUD-27061-H)
A. General Instructions:
This form is to be completed by individuals wishing to be served (applicants) and those that
are currently served (tenants) in housing assisted by the Department of Housing and Urban
Development.
Owner and agents are required to offer the applicant/tenant the option to complete the form.
The form is to be completed at initial application or at lease signing. In-place tenants must
also be offered the opportunity to complete the form as part of the next interim or annual
recertification. Once the form is completed it need not be completed again unless the head of
household or household composition changes. There is no penalty for persons who do not
complete the form. However, the owner or agent may place a note in the tenant file stating
the applicant/tenant refused to complete the form. Parents or guardians are to complete
the form for children under the age of 18.
The Office of Housing has been given permission to use this form for gathering race and
ethnic data in assisted housing programs. Completed documents for the entire household
should be stapled together and placed in the household’s file.
1. The two ethnic categories you should choose from are defined below. You should check one
of the two categories.
1. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin, regardless of race. The term “Spanish
origin” can be used in addition to “Hispanic” or “Latino.”
2. Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or origin, regardless of race.
2. The five racial categories to choose from are defined below: You should check as many as
apply to you.
1. American Indian or Alaska Native. A person having origins in any of the original
peoples of North and South America (including Central America), and who maintains
tribal affiliation or community attachment.
2. Asian. A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China,
India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
3. Black or African American. A person having origins in any of the black racial
groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to
“Black” or “African American.”
4. Native Hawaiian or Other Pacific Islander. A person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
5. White. A person having origins in any of the original peoples of Europe, the Middle
East or North Africa.
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
Blue Ledge Co-op
A.K.A. Roslindale Senior Non-Profit Housing, Incorporated
House Rules
These house rules have been approved by the residents of the co-op and
are enforceable by a court of law as they are an attachment to your lease
agreement. The house rules were designed with your safety and comfort in
mind. It is your legal responsibility to become familiar with these rules, and to
ensure that you and your guests comply with them.
Your support and cooperation as a resident member is of utmost
importance in order to promote harmonious and pleasant living conditions
within the co-op. The observance of the requirements and guidelines set forth
herein will help you, your neighbors and management staff to maintain this
cooperative as an outstanding place to live.
If you have trouble understanding this document in any way, please notify
management immediately.
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Blue Ledge Co-op is part of the CSI Support & Development family of cooperatives
CSI Disclosure Notifications
Questions Concerning this Notice
CSI Support & Development is dedicated to providing decent, and affordable housing to our residents. If you have
any questions about this notice, please contact the management office.
If you are disabled and wish to request a reasonable accommodation or if you have difficulty understanding English,
please request our assistance and we will ensure that you are provided with meaningful access based on your
individual needs.
This is an important notice. Please have it translated. (English)
Esto es un aviso importante. Por favor téngalo traducido. (Spanish)
Ceci est un avis important. Le faire traduire, s'il vous plait. (French)
这是一个重要的通知。请翻譯這分文件。(Chinese)
이것은 매우 중요한 통지 입니다. 꼭 번역하시기 바랍니다. (Korean)
Это очень важное сообщение . Переведите пожалуйста. (Russian)
Acesta este un mesaj important. Vâ rugâm sâ apelaţi la cineva sâ vi-l traducâ. (Romanian)
Jest to ważna informacja. Proszę mieć to przetłumaczone. (Polish)
هﺎﺑﺗﻧا! هذھ ﺔﻘﯾﺛوﻟا ﺔﻣﮭﻣ. ءﺎﺟرﻟا ﺎﮭﺗﻣﺟرﺗ (Arabic)
Ky është një njoftim i rëndësishëm. Ju lutemi ta përktheni këtë (Albanian)
Your response to this letter does not preclude you from exercising other avenues available if you believe that you
are being discriminated against on the basis of race, color, religion, sex, national origin, familial status, handicap, or
any other state or locally protected classes.
Consideration of the Need for Reasonable Accommodation
You have the right to request a reasonable accommodation to assist in facilitating a meeting with CSI Support &
Development. CSI Support & Development will consider extenuating circumstances where this would be required
as a matter of reasonable accommodation.
Protections Provided Through the Violence Against Women Act Reauthorization of 2013 (VAWA 2013)
HUD provides protections for victims of acts of domestic violence, dating violence, stalking and sexual assault.
This is true for women and men. While victims are still required to meet criminal and screening requirements, you
will not be subject to denial solely because you are a victim of an act covered under VAWA 2013. Where someone is
abusive to other members of the household, only the abuser may be evicted. Residents in assisted housing facing
threat of domestic violence, sexual assault or stalking or threat of such violence can be allowed early lease
termination for a matter of safety. If you would like to exercise your VAWA protections, please contact CSI Support
& Development immediately.
Notification of Non-Discrimination Based on Disability
CSI Support & Development does not discriminate on the basis of disability status in the admission or access to, or
treatment or employment in, its federally assisted programs and activities. We have a 504 coordinator designated to
coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and
Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988): CSI Support &
Development, Attn: 504 Coordinator, 8425 E. 12 Mile Road, Warren, MI 48093, 586-753-9002, TDD 800-348-7011
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
Table of contents
1. Apartment Inspections: Page 4
A. Bed Bug Inspections
B. Bi-annual apartment Unit
Inspections
2. Apartment Maintenance: Page 4
A. Alterations
B. Work Orders
3. Behavior: Pages 5-6
A. Bullying
B. Guns
C. Noise
D. Offensive Behavior
E. Illegal drug activity
F. Smoking
4. Common Areas: Pages 6
A. Community spaces
B. Dress code
C. Grounds
5. Guests/Visitors: Page 6
A. General information
6. Safety and Security: Page 7-8
A. Fire safety
B. Door Entry Security
A (CSI) indicates the rule is a CSI policy and cannot be changed without board approval
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
1. Apartment Inspections:
A. Bed bug inspections
a. If residents/members suspect any bed bug activity in their apartments, they are
required to report the issue to the co-op officers or the co-op liaison,
immediately.
b. Residents/ Members must comply with and prepare their apartments for
inspections and exterminations, per instructions.
c. Residents/ Members must not bring in objects that have been previously
thrown into the garbage or found along the side of the road. If residents exhibit
habits that are deemed to promote the infestation of their apartments, they w
ill
b
e required to pay for treatments and/or face possible eviction proceedings.
d. Do not try to exterminate bed bugs yourself. Do not spray any insecticides,
alcohols, or chemicals in your apartment, as these products neither prevent nor
eliminate bed bugs.
e. Residents/ Members must comply with the prevention, inspections, apartment
preparations, treatments and ongoing measures to safeguard the co-op from
bed bug infestations.
B. Annual apartment Unit Inspections:
a. Members are expected to pass apartment inspections, which will be at
least once a year.
2. Apartment Maintenance:
A. Alterations:
a. Per the lease agreement, no alterations of any kind can be made to your
apartment without previous written approval.
B. Work orders:
a. Members are required to report all damages and repairs needed in a
timely matter, per work order procedures.
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
3. Behavior:
A. Bullying: (CSI)
a. CSI Support & Development respects the rights, privacy and privileges of
all individuals that are engaged in CSI managed cooperative housing. All
co-op members are recognized as a team that share common goals for
the improvement in his/her home for each and every member. Diversity
is valued in race, color, sex, age and ability. Volunteers and paid staff are
similarly recognized and should be treated equally. Behavior that appears
to be disrespectful towards others and/or poor conduct at co-op
meetings or CSI Support & Development sponsored events is
unacceptable.
b. Bullying includes comments or conduct intended to intimidate, humiliate
or isolate people in a way that causes physical or emotional distress. This
behavior is demoralizing and counter-productive to our cooperative
management system and will not be tolerated in any CSI Support &
Development Services’ co-op. Therefore, the following shall apply:
i. Verbal aggression, including, but not limited to, threatening,
taunting, harassment, stalking, starting rumors, and hate speech
may result in disciplinary action up to and including eviction.
ii.
Physical aggression, including, but not limited to, hitting, kicking,
pushing, choking, and punching shall result in eviction.
B. Guns:
a. Lethal weapons shall include all deadly weapons, which, from the manner used,
are calculated or likely to produce death or serious bodily injury. This includes,
but is not limited to all firearms, hunting knives, switchblades, bows and arrows,
machetes, billy clubs, tasers, stun guns, BB guns, pellet guns and paint guns.
Residents shall not carry or possess lethal weapons anywhere within the
building or on the co-op property other than to transport such items between
residents’ apartments and their vehicle, in which case such lethal weapons must
be concealed or transported in an appropriate carrying case. All such lethal
weapons must remain in the immediate control of the resident and must be
stored in resident’s apartment in such a manner so as to prevent any other
resident, guest, authorized or unauthorized person from gaining access to such
weapon.
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
b. Implying possession of, threatening to use, displaying to any other person
(including to any other resident), brandishing, using, or discharging a weapon
either in the building or on the co-op property is strictly prohibited except in the
act of self-defense as may be permitted by law. Residents shall timely report to
management the presence of any person within the building or on the property,
who is possessing a lethal weapon in violation of these provisions.
c. The discharge of any fireworks or firecrackers is prohibited in the building and
property.
d. The possession of lethal weapons by any guests of residents, excluding police
officers, is strictly prohibited.
C. Noise:
a. Quiet hours are between 11:00pm and 7:00am but please be mindful
that at all other times of the day, that the noise you make in your
apartment and common areas can disturb others. Please maintain a
respectful noise level at all times.
D. Offensive Behavior
a. Abusive, offensive, or foul language or behavior will not be tolerated
E. Illegal drug activity:
a. The Controlled Substances Act categorizes marijuana as a Schedule 1
substance and therefore the manufacture, distribution, possession or use
of marijuana is a federal criminal offense and not allowed on any CSI
property because of federal funds received. Because the Controlled
Substances Act prohibits all forms of marijuana use, the use of “medical
marijuana” is illegal under federal law even if it is permitted under state
law and is considered a lease violation. (CSI)
F. Smoking:
a. Blue Ledge Co-op is gradually transforming into a 100% smoke free Co-
op; smoking is not allowed in any common area or within 25 feet of the
building. There are a few members who are still permitted to smoke in
their own apartments, because they signed a waiver prior to the full
implementation of the new smoking rules. All new members as of July 1
st
2013 are not allowed to smoke inside their own apartment.
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Blue Ledge Co-op is part of the CSI Support & Development family of cooperatives
4. Common Areas
A. Community spaces:
a. Eating and drinking outside your apartment is only allowed in designated
areas: floor lounges and community room.
b. No sleeping in lounges, in common areas or on outside benches.
b. Absolutely no soliciting in the building. To protect resident’s/ Members
rights to quiet enjoyment in their apartments, residents and their guests
are prohibited from soliciting door to door.
B. Dress code:
a. Members should be appropriately dressed in common areas
C. Grounds
c. No feeding of any wildlife on the building premises.
5. Guests/Visitors:
A. General information
a. Members are responsible for their guests. The member will be held
responsible for all acts of negligence on the part of their guests.
b. Only those that are on the lease agreement, are permitted to reside in the
apartment. Guests are permitted to stay a maximum of 30 days in each
calendar year. Members may request extensions for extenuating
circumstances either in writing or in person to the office.
c. Visiting pets are not allowed in the building.
6. Safety and Security:
A. Fire Safety
a. Apartment doors into halls must be kept closed at all times (this is a city fire
ordinance).
b. Follow the fire emergency procedures that are located on the back of your
apartment door.
c. All apartment entrance doors are fire rated and must not be punctured,
pierced, or altered in all way.
B. Door Entry Security
a. Under no circumstances should any member admit visitor’s other than their own
into the building, this is for the safety and protection for all residents.
b. All outside ground-level doors must not be propped or jammed open under any
circumstances.
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lue Ledge Co-op is part of the CSI Support & Development family of cooperatives
c. Outer door key or fob must not, under any circumstances, be given to anyone
besides the residents. In case of emergency a specially marked key may be
requested from the president, for a limited time.
d. Charge for lost security key/fob will be the current cost to replace it.
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Blue Ledge Co-op
Rules for Animal Ownership
In accordance with 24 CFR Part 5(C)
Pet Ownership for the Elderly or Persons with Disabilities
Revised: December 20,2017
Residents/Members are permitted to own and keep common household animals in their
dwelling units. These animal rules have been established to ensure the co-op is decent,
safe and sanitary and that all residents/members can live in peace and quiet comfort.
The animal rules are an attachment to the lease agreement.
Your support and cooperation of these rules is of utmost importance in order to promote
harmonious and pleasant living conditions within the co-op.
Summary of Rules for Animal Ownership:
CSI Disclosure Notifications………………………………………………..……..Page 2
Definitions of Assistance Animals, Disability and Pets……………………..….Page 3
Animals and Reasonable Accommodations………………………………….....Page 3
Requirements for All Residents (Including Non-Animal Owners)....................Page 4
Registration of All Animals……………………………………………………..….Page 4
Care of Animals and Property………………………………………..…………...Page 5
Disruptive Animal Behavior………………………………………………..………Page 5
Inspections for Residents/Members with Animals……………………..…….....Page 6
Damages from Animals……………………………………………………..……..Page 6
Care for Animals in the Event of Death, Incapacity or Refusal of/by Owner...Page 6
Pet Rules…………………………………………………………………………....Page 7
Co-op Procedures for Animal Rule Violations…………………………..………Page 7
Co-op Procedures for Animal Rule Amendments……………………..………..Page 8
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CSI Disclosure Notifications
Questions Concerning this Notice
CSI Support & Development is dedicated to providing decent, and affordable housing to our residents. If you have
any questions about this notice, please contact the management office.
If you are disabled and wish to request a reasonable accommodation or if you have difficulty understanding English,
please request our assistance and we will ensure that you are provided with meaningful access based on your
individual needs.
This is an important notice. Please have it translated. (English)
Esto es un aviso importante. Por favor téngalo traducido. (Spanish)
Ceci est un avis important. Le faire traduire, s'il vous plait. (French)
这是一个重要的通知。请翻譯這分文件。(Chinese)
이것은 매우 중요한 통지 입니다. 꼭 번역하시기 바랍니다. (Korean)
Это очень важное сообщение . Переведите пожалуйста. (Russian)
Acesta este un mesaj important. Vâ rugâm sâ apelaţi la cineva sâ vi-l traducâ. (Romanian)
Jest to ważna informacja. Proszę mieć to przetłumaczone. (Polish)
.ءﺎﺟرﻟا ﺎﮭﺗﻣﺣرﺗ .ﺔﻣﮭﻣ ﺔﻘﯾﺛو هذھ (Arabic)
Ky është një njoftim i rëndësishëm. Ju lutemi ta përktheni këtë (Albanian)
Your response to this letter does not preclude you from exercising other avenues available if you believe that you
are being discriminated against on the basis of race, color, religion, sex, national origin, familial status, handicap, or
any other state or locally protected classes.
Consideration of the Need for Reasonable Accommodation
You have the right to request a reasonable accommodation to assist in facilitating a meeting with CSI Support &
Development. CSI Support & Development will consider extenuating circumstances where this would be required as
a matter of reasonable accommodation.
Protections Provided Through the Violence Against Women Act Reauthorization of 2013 (VAWA 2013)
HUD provides protections for victims of acts of domestic violence, dating violence, sexual assault, or stalking. These
protections are not only available to women, but are available equally to all individuals regardless of sex, gender
identity, or sexual orientation, and for persons affiliated with victims who experience imminent threat. While
victims are still required to meet criminal and screening requirements, and lease requirements, you will not be
subject to denial solely because you are a victim of an act covered under VAWA 2013. Where someone is abusive to
other members of the household, only the abuser may be evicted. Residents in assisted housing facing threat of
domestic violence, sexual assault or stalking or threat of such violence can be allowed early lease termination or a
unit transfer for a matter of safety. If you would like to exercise your VAWA protections, please contact CSI Support
& Development immediately.
Notification of Non-Discrimination Based on Disability
CSI Support & Development does not discriminate on the basis of disability status in the admission or access to, or
treatment or employment in, its federally assisted programs and activities. We have a 504 coordinator designated to
coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and
Urban Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988): CSI Support &
Development, Attn: 504 Coordinator, 8425 E. 12 Mile Road, Warren, MI 48093, 586-753-9002, TDD 800-348-7011
3
Definitions:
Assistance Animal: In accordance with the Fair Housing Amendment Act of 1988, Section 504
of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, the co-op seeks
to accommodate persons with disabilities who require the assistance of a qualified
service/therapy/companion/emotional support animal. These are referred to as “assistance
animals.” Assistance animals are not considered pets.
Disability: “Disability” is defined as a physical or mental condition or impairment that is medically
cognizable, diagnosable, and substantially limits one or more of a person’s major life activities.
Pet: A “pet” is a domesticated animal kept for ordinary enjoyment and companionship. A pet is
not considered an assistance animal.
Animals and Reasonable Accommodations
Under the Fair Housing Amendment Act and comparable state laws, assistance animals may be
allowed to accompany individuals in housing as a reasonable accommodation if, and only if, the
person requesting the accommodation has a disability or someone is making the request for a
person with a disability.
CSI Support & Development is committed to reasonably accommodate persons with disabilities
who require the assistance or presence of an animal. However, CSI is also mindful of the health
and safety concerns of all the residents/members. Therefore, CSI balances the needs of the
individual with the disability with the potential impact of animals on other residents.
Processing a request for an assistance animal is done in accordance with CSI’s Reasonable
Accommodation and Modification Policy and with the requirements set forth by HUD and the
Department of Justice.
A resident/member or applicant requesting an assistance animal must provide the CSI liaison
(management agent) assigned to the co-op with a request for reasonable accommodation if
he/she would like CSI to waive any pet rules (additional pet rules are listed on page 7). This
request can be made in writing or verbally to the liaison. The liaison must verify the disability
and/or need in compliance with the guidance provided by HUD and the Department of Justice. If
the disability is not obvious or previously known, the CSI liaison will verify, with a licensed
medical professional, that there is the presence of a disability and the need for an assistance
animal. There must be an identifiable relationship, or connection, between the requested
accommodation/modification and the individual’s disability. Refer to the Reasonable
Accommodation and Modification Policy and the co-op liaison for more information on the
process.
A reasonable accommodation will not be unreasonably withheld if the resident/member makes
the specific request and CSI receives written verification of the disability status if the said
disability and/or need are not obvious. All reasonable accommodation requests are considered.
click to sign
signature
click to edit
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Requirements for All Residents (Including non-animal owners): Residents/members of the
community and their guests are required to abide by the following practices:
1. Do not touch or pet any animal unless invited to do so.
2. Do not feed animals unless invited to do so.
3. Do not deliberately startle animals that live on the property.
4. Do not separate or attempt to separate an owner from his/her assistance animal.
5. Do not inquire for details about a person’s disabilities. The nature of a person’s disability
is a private matter.
6. Residents/members with medical conditions that are affected by animals (respiratory
diseases, asthma, severe allergies) should contact the co-op liaison if they have a health
or safety-related concern about exposure to an animal. The individual will be asked to
provide medical verification. The liaison will make reasonable attempts to resolve any
conflict in a timely manner, considering the conflicting needs and/or accommodations of
all persons involved.
Registration for All Animals:
1. All applicants and resident/members must register their assistance animals and pets with
the co-op leasing committee before allowing the animal to live in the unit. The applicant
or resident/member must register the animal before it is brought onto the property, and
must update the registration at least annually. The registration will include:
a. A certificate signed by a licensed veterinarian or a statue or local authority
empowered to inoculate dogs and cats stating that the animal has received all
inoculations required by applicable state and local law;
b. A certificate of spaying or neutering signed by a licensed veterinarian (Dogs and
cats must be spayed or neutered prior to occupancy. An exception may be made
to this rule if spaying/neutering poses a health threat to the animal. A licensed
veterinarian must verify this.);
c. If applicable, a license certificate from the appropriate agency;
d. Information sufficient to identify the animal;
e. The name, address, and phone number of one or more responsible parties who
will care for the animal if the resident/member is hospitalized, dies, is
incapacitated, is incarcerated or is otherwise unable to care for the animal;
f. A signed certification from the animal owner stating that he/she has read the rules
for animal ownership and agrees to comply with them.
2. Registration of an animal may be refused if:
a. The animal owner fails to provide complete animal registration information or fails
to update the animal registration annually;
b. A determination is made, based on the animal owner’s habits and practices, that
the animal owner will be unable to keep the animal in compliance with the animal
rules and/or other lease obligations; or
c. The animal poses a threat to the health of safety of other residents/members,
guests, vendors or service providers or staff;
5
d. The animal would interfere with other resident/members’ peaceful enjoyment of
the property; The presence of the animal would change the nature of the program
or cause undue financial and administrative burden;
e. The resident/member has a history of animal neglect or abuse.
If registration of an animal is denied, such notice of refusal will be given to the animal
owner. The notice will state the basis for the refusal and will be served in accordance
with the procedures under Animal Rules Amendments and Animal Rules Violations.
Care of Animals and Property:
1. Required animal licenses must be worn at all times, in accordance with state/local laws.
2. Care should be taken so that the animal’s food and water dishes do not attract pests.
3. Animals left unattended for an unreasonable amount of time and animals that are
improperly cared for will be reported to the co-op and/or authorities.
4. Sanitary Standards:
a. Dogs must be housebroken and cats must be trained to use a litter box.
b. Dogs must be removed from the building for exercise and to deposit waste.
Designated areas on the grounds may be used for animal exercise.
c. Animal owners must pick up and properly dispose of all waste by bagging, tying
tightly, and taking to the dumpster or dropped down the trash chute (if this does
not violate any house rules prohibiting trash chute for animal waste and if the co-
op has an operable trash chute). Toilets may not be used.
d. Waste must be cleaned from litter boxes daily and litter must be changed at least
weekly. Soiled litter must be disposed of by bagging, tying tightly, and taking to the
dumpster or dropped down the trash chute (if the co-op has an operable trash
chute and it is not prohibited by the co-op’s trash room rules). Do not dispose of
cat litter, cage waste or shaving in the toilet.
e. A separate waste removal charge of $5 per occurrence will be imposed on animal
owners who fail to remove waste in accordance with the prescribed animal rules.
f. Failure to properly remove and dispose of animal waste is considered a minor
lease violation. Three or more instances of minor lease violations may result in
additional penalties up to and including termination of tenancy of the
resident/member.
Disruptive Animal Behavior:
1. Dogs and cats will remain inside the animal owner’s apartment unless they are being
carried or on a leash that is no longer than six (6) feet long or on a retractable leash that
is extended no longer than six (6) feet and directly controlled by a responsible person.
Animal owners must have control over the animal on any part of the property at all times.
(Please note that the use of an electronic leash is not sufficient for the purposes of
compliance with this rule. The animal must be on a physical leash, harness, or other
effective restraint while in common areas in and outside the building.) The animal owner
acknowledges that other resident/members may have allergies related to animals or are
easily frightened by animals. The animal owner, therefore, agrees to exercise common
sense and courtesy with respect to other residents/members’ right to the peaceful and
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quiet enjoyment of the premises. Animals must be carried or walked on a leash on the
grounds of the building, and walked in designated areas only.
2. Animals must not be allowed to jump on, impede or otherwise limit any resident/member,
staff, vendor or guest’s use of the property, including public and common areas.
3. Animal owners must control the noise and odor caused by their animals so that other
residents/members are not disturbed.
4. No animal that bites, attacks, or demonstrates other aggressive behavior towards humans
or other animals may be kept on the property.
5. Animal owners shall assume liability for any injury sustained by residents/members,
guests or staff members that is caused by the owner’s animal.
Inspections for Residents/Members with Animals:
1. Inspections of the animal owner’s apartment, after reasonable notice to the animal owner
and during reasonable hours, are allowed. Such inspection will only be permitted if a
signed written complaint is received, or if reasonable grounds are present to believe that
the conduct or condition of an animal in the apartment constitutes, under applicable state
or local law, a nuisance or threat to the health or safety of the other resident/members or
other persons in the community.
2. Animal owners must cooperate with inspectors, maintenance staff, vendors, service
people, volunteers and staff for routine unit inspections and/and or services as required
by the lease and in compliance with notification requirements. The animal owner must
restrain or remove the animal if necessary to allow services/inspections or have prior
accommodation approval regarding any extenuating circumstances.
Damages from Animals:
1. Animal owners are solely financially responsible for any damage to persons or property
caused by their animals. Costs to repair damages may be assessed at any time and are
due within thirty (30) days of invoice/charge.
2. Apartments occupied by cats, dogs or other four-legged, warm-blooded animals may be
fumigated at the animal owner’s expense upon vacating, or upon any evidence of fleas or
other pests attracted to animals.
Care for Animals in the Event of Death, Incapacity or Refusal of/by the Animal Owner:
1. If the health or safety of an animal is threatened by the death or incapacity of the animal
owner, or by other factors that render the animal owner unable to care for the animal, the
co-op may contact the responsible party or parties listed in the animal registration required
under the animal registration rules (above). If the responsible party is unwilling or unable
to care for the animal, or despite reasonable efforts no contact with the responsible party
has been made, the appropriate state or local authority may be requested to remove the
animal, where this liability otherwise is not imposed by state and local laws or regulations.
2. If the animal becomes vicious, displays symptoms of severe illness, or demonstrates other
behavior that constitutes an immediate threat to the health or safety of other
residents/members, and the animal owner refuses to remove the animal or the co-op is
unable to contact the animal owner, the co-op may request the state or local authority to
remove the animal.
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3. If no state or local authority is authorized to remove the animal, the lesser may enter the
animal owner’s apartment to remove the animal and to place the animal in a facility that
will provide care and shelter until the animal owner or a representative of the animal owner
is able to assume responsibility for the animal, but no longer than 30 days. The cost of the
animal care facility provided shall be the financial responsibility of the animal owner. The
co-op is not responsible for the care or the return of the animal.
Pet Rules: These additional rules DO NOT apply to assistance animals, but DO apply to pets:
1. Pets are restricted to small domesticated animals, such as a dog, cat, bird, fish, rodent
(including a rabbit) or turtle that are traditionally kept in the home for pleasure rather than
for commercial purposes.
2. Only one four-legged, warm-blooded animal is allowed per apartment as a pet.
3. The weight of the pet must not exceed 20 pounds at maturity. Owners must provide proof
of such weight.
4. Fish tanks are limited to 20-gallon tanks. Water damage is the financial responsibility of
the resident/member.
5. Pets are not permitted in public areas of the building except while directly entering or
exiting the building.
Co-op Procedures for Animal Rules Violations:
The following procedures will be taken if these animal rules are found to have been violated:
1. A written notice of the animal rule violation must be served on the animal owner by:
a. Sending a letter by first class mail properly stamped and addressed to the
resident/member at his/her apartment with a proper return address; or
b. Serving a copy of the notice on any adult answering the door at the
resident’s/member’s apartment, or if no adult responds, by placing the notice under
the door, if possible, or else by attaching the notice to the door.
2. The notice of the animal rule violation must:
a. Contain a brief statement of the factual basis for the determination and the animal
rule or rules alleged to be violated;
b. State that the animal owner has 10 days from the effective date of serve of the
notice to correct the violation (including, in appropriate circumstances, removal of
the animal) or to make a written request for a meeting with the management agent
to discuss the violation;
c. State that the animal owner is entitled to be accompanied by another of his/her
choice at the meeting; and
d. State that the animal owner’s failure to correct the violation, to request a meeting,
or to appear at a requested meeting, may result in initiation of procedures to
terminate the animal owner’s tenancy.
3. If the animal owner makes a timely request for a meeting to discuss an alleged rule
violation, a mutually agreeable time and place for the meeting shall be established, but no
later than 15 days from the effective date of the service of the notice of the animal rule
violation, unless all parties agree to a later date. At the animal rule violation meeting, the
8
animal owner and the co-op management agent (a co-op representative may also be
present at this meeting) shall discuss any alleged animal rule violation and attempt to
correct it. As a result of the meeting, the animal owner may be given additional time to
correct the violation.
4. If the animal owner and the co-op are unable to resolve the animal rule violation at this
meeting, or if the co-op determines that the animal owner has failed to correct the animal
rule violation within any additional time provided for this purpose, written notice may be
served on the animal owner in accordance with the notice requirements in the Procedures
for Animal Rule Violations (1a,b), or at the meeting, if appropriate, requiring the animal
owner to remove the animal.
5. The notice for animal removal must:
a. Contain a brief statement of the factual basis for the determination and the animal
rule or rules that have been violated;
b. State that the animal owner must remove the animal within 10 days of the effective
date of the notice of the animal removal, or of the meeting if notice is served at that
meeting; and
c. State that failure to remove the animal may result in initiation of procedures to
terminate the animal owner’s tenancy.
6. Steps may not be initiated to terminate an animal owner’s tenancy based on an animal
rule violation, unless:
a. The animal owner has failed to remove the animal or correct an animal rule
violation within the acceptable time periods specified in these animal rules,
including any additional time permitted to the animal owner; and
b. The animal rule violation is sufficient to begin procedures to terminate the animal
owner’s tenancy under the terms of the lease and applicable regulations.
7. Procedures to remove an animal in accordance with the provisions of applicable state or
local law may be initiated at any time if the animal’s conduct or condition is duly determined
to constitute a nuisance or a threat to the health or safety of other occupants of the project
or of other persons of the community where the project is located.
Co-op Procedures for Animal Rules Amendments:
Amendment of these animal rules may be made at any time by following these procedures:
1. Notice of the proposed changes in the animal rules shall be served on each
resident/member provided in these amendment procedures (#3 below). The notice shall
include the text of the proposed changes in the rules, state that the residents/members or
their representatives may submit written comments on the rules, and state that all
comments must be submitted no later than 30 days from the effective date of the notice
of the proposed changes in the rules. The notice may also announce the date, time, and
place of a meeting to discuss the proposed changes in the rules.
2. Residents/members or their representatives may submit written comments on the
proposed changes in the animal rules by the date specified in the notice. One or more
meetings with the residents/members during the comment period may be convened to
discuss the proposed changes in the rules, and oral comments on the proposed changes
may be made at this meeting. Comments made at meetings shall be summarized, reduced
to writing, and submitted before the end of the comment period. The final changes in the
9
pet rules will be developed after reviewing the written comments from residents/members
and their representatives and summarized comments from the meetings. Attempts will be
made to resolve the issues raised by the comments. The content of the final changes in
the animal rules is within the sole discretion of CSI Support & Development, subject to the
above provisions.
3. Notice as required under these animal rules must be made by:
a. Sending a letter by first class mail properly stamped and addressed to the
resident/member at his/her apartment with a proper return address; or
b. Serving a copy of the notice on any adult answering the door at the
resident’s/member’s apartment, or if no adult responds, by placing the notice under
the door, if possible, or else by attaching the notice to the door; or
c. For service of notice to residents/members of a high-rise building (any building
equipped with an elevator and a community room), posting this notice in at least
three conspicuous places within the building and maintaining the posted notices
intact and in legible form for 30 days.
4. For purposes of computing time periods following service of the notice, service is effective
on the day that all notices are delivered or mailed, or in the case of service by posting, on
the day that all notices are initially posted.
5. The revised animal rules take effect:
a. Upon renewal of the lease and in accordance with any applicable regulation; and,
b. When a resident/member registers an animal.
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Completed 19 April 2021

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