Fillable Dear Online Applicant, Thank you for your interest (CSI Support & Development)

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Dear Online Applicant,

Thank you for your interest in Franklin Park Villa

. 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. Application*

2. “Document Package for Applicant’s/Tenants Consent to Rele

ase 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

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 these cooperative apartments will require you to meet the inco

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 Franklin Park Villa Co-op, please call

the Leasing office at 617-983-5554

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.

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

FPV Page 1 of 6

APPLICATION

FRANKLIN PARK VILLA 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:

_______________________________________

How did you hear about this co-op apartment?

(example: newspaper or community center?)

Income limits may apply: 1 Person 2 Person Please note: Income limits subject to change by HUD.

$47,000 p/yr. $53,700 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

Relationship to head of household

Co-head/Spouse Child Other adult

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: y:

FPV Page 2 of 6

HOUSING INFORMATION

2. Will this unit be your only place of residency?

Yes No

This building may have a limited number of units with features 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. Franklin Park Villa 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, or

within 25 feet of the building there are approximately 5 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

10, 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 living. 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

FPV 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

FPV 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?)

FPV 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

FPV 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 Franklin Park Villa 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- FPV-PRAC

Rev 4/7/21

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

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.

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

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.

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.

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.

Form HUD-9887: Allow

s the release of information betwe

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.

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.

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

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

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

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.

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

Street, SW

Washington, DC 20410

December 2005

form

(12/2005)

HUD-1141

CSI Support & Development

Section 202/PRAC

Income Eligibility Fact Sheet

Franklin Park Villa

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 CSI Support & Development of

$100.

Eligibility:

Qualified applicants are eligible to live in this housing program subject to the following income limits:

Eligibility income limits as of 4/1/2021 (Date)

Boston (Area)

1 person 47,000 Annually

2 persons 53,700 Annually

Market rent for Franklin Park Villa Co-op Apartments is $973.00 (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. 4/7/2021

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)

Race 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

Date (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

Public 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)

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.

Franklin Park Villa Co-op is part of the CSI Support & Development family of cooperatives

Franklin Park Villa Co-op

A.K.A. Jamaica Plain Non-Profit Housing Corporation

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.

Franklin Park Villa 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

Franklin Park Villa 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. Lethal Weapons

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

Franklin Park Villa 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 will

be 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.

Franklin Park Villa 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. Lethal Weapons:

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.

Franklin Park Villa 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. Franklin Park Villa 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

2013 are not allowed to smoke inside their own apartment.

Franklin Park Villa Co-op is part of the CSI Support & Development family of cooperatives

4. Common Areas

A. Community spaces:

a. 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

a. 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.

Franklin Park Villa 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.

Approved: 2/14/2018

Franklin Park Villa 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

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

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

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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;

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

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.

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

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

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 29 May 2021

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