Fillable INSTRUCTIONS FOR COMPLETING RENTAL APPLICATION

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INSTRUCTIONS FOR COMPLETING RENTAL APPLICATION

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INSTRUCTIONS FOR COMPLETING RENTAL APPLICATION
Please read these instructions in full before completing your application.
1. You must fill out the application and required attachments completely. Please identify the Property
Name. If there is information that doesn’t apply, please write “N/A” in the blank.
2. Information provided on this Application will be treated as confidential.
3. You intend to reside in the development as your primary and sole residence.
4. You may apply for more than one unit type, however, your household size and composition must be
appropriate for the unit size.
5. Information for all adults 18 years of age and older planning to reside in the apartment must be provided.
6. All information provided will be verified. If you have intentionally falsified or omitted information, your
application will be rejected.
7. Your total household income and assets must be within the required limits:
Include as income: income of all household members 18 years of age and older, includes but is not
limited to gross income from employment, including overtime; bonuses and commissions; self-
employment; pensions; annuities; dividends; interest on assets; social security; social security
supplement; alimony and child support; veterans' benefits; unemployment and disability compensation;
welfare assistance; regular gifts; etc.
Include as assets: the current value of all savings, checking; express debit cards and investment accounts
(including retirement and educational accounts), real estate, investment property, etc. (Do not include
automobile(s) and other personal property.)
8. Divestment of assets within two years of application for greater than $1,000 for less than fair market value
will be counted for imputation of income at full and fair value.
9. You must have sufficient income to afford the rent. Generally, you should be paying no more than 40
percent of your gross income to rent or have assets equal to at least two years of rent or a 2-year history
of paying more than 40%.
10. Credit/Criminal background checks and rental references will be obtained for all adult household
members 18 years of age and older.
11. You have not committed any fraud in connection with any federal or state housing assistance program,
and you do not owe rent or other amounts in connection with housing assistance.
12. Applications will be reviewed as quickly as possible to determine preliminary eligibility.
13. Priority for the accessible units will be for families which require physical accommodations.
14. If you are disabled and require an accessible unit, an extra bedroom for equipment or for a Personal Care
Attendant, a reasonable modification of the housing, or a reasonable accommodation of rules, policies,
practices or services, please include a letter from your primary health care provider explaining such
special requirements.
15. Completed applications may be mailed or returned in person to the management office at the property.
16. For more information, please call the management office.
RIGHT TO REASONABLE ACCOMMODATION
Peabody Properties, Inc. will consider a reasonable
accommodation, upon request for qualified people with
disabilities when an accommodation is necessary, not
just desirable, to ensure equal access to the
development, its amenities, services and programs.
Reasonable accommodations may include changes to
the building, grounds, or an individual unit; changes to
policies, practices, and procedures; and mitigating
circumstances.
RIGHT TO ASL INTERPRETER
All tenants, applicants, and potential applicants who are
deaf or hard of hearing have a right to an appropriate,
certified interpreter paid for by Peabody Properties.
VAWA (2013) VIOLENCE AGAINST WOMENS
ACT REAUTHORIZATION
Peabody Properties and HUD provide protections for
victims of domestic violence, dating violence, stalking
and sexual assault. This is true for women and men and
is true for persons affiliated with the victims who
experience imminent threat.
This is an important document. If you require
interpretation, please call the telephone number below or
come to our offices and we will provide free interpretation
services.
Este es un documento importante. Si necesita
interpretación, por favor llame al número de teléfono a
continuación o venga a nuestras oficinas y le brindaremos
servicios de interpretación gratuitos.
這是重要的文件。如果您需要口譯服務，請撥打以下電話或
致電我們的辦公室，我們將提供免費的口譯服務。
Isso é um documento importante. Se necessitar de
interpretação, por favor ligue para o número de telefone
abaixo ou venha aos nossos escritórios e iremos fornecer
serviços de interpretação gratuitos.
Это важный документ. Если вам требуется устный перевод,
позвоните по указанному ниже номеру телефона или
приходите в наши офисы, и мы предоставим бесплатные
услуги устного перевода.
Đây là một tài liệu quan trọng. Nếu bạn yêu cầu phiên dịch,
vui lòng gọi số điện thoại bên dưới hoặc đến văn phòng
của chúng tôi, chúng tôi sẽ cung cấp dịch vụ phiên dịch
miễn phí.
 



Sa a se yon dokiman enpòtan. Si ou bezwen
entèpretasyon, tanpri rele nimewo telefòn ki anba a oswa
vini nan biwo nou yo epi n ap bay sèvis entèpretasyon
gratis.
Kani waa dukumenti muhiim ah. Haddii aad u baahan
tahay tarjumaad, fadlan wac lambarka taleefanka ee hoos
ku yaal ama kaalay xafiisyadayada waxaanan ku siin
doonnaa adeegyo tarjumaad lacag la’aan ah.
اذھ وھ ﺔﻘﯾﺛو ﺔﻣﺎھ. اذإ تﻧﻛ ﺔﺟﺎﺣﺑ ﻰﻟإ ﺔﻣﺟرﺗ ﺔﯾروﻓ ، ﻰﺟرﯾﻓ لﺎﺻﺗﻻا مﻗرﺑ فﺗﺎﮭﻟا
ﺎ
ً
ﻧﺎﺟﻣ ﺔﯾروﻔﻟا ﺔﻣﺟرﺗﻟا تﺎﻣدﺧ رﻓوﻧﺳو ﺎﻧﺑﺗﺎﻛﻣ ﻰﻟإ روﺿﺣﻟا وأ هﺎﻧدأ
Telephone:
MA
-
TTY 711 or 1.800.439.2370
781.794.1000
RI
-
TTY 711 or 1.800.745.5555
FL
-
TTY 711 or 1.800.955.8771
NJ
-
TTY 711 or 1.800.852.7899
©2021 Peabody Properties, Inc. All Rights Reserved. Page 1 of 4 02.22.21
You must fill out the application and required attachments
completely. If there is information that doesn’t apply,
please write “N/A” in the blank. Also, please make sure
you list a Property Name.
( Note if accessibility features are requested: Mobility Vision Hearing )
RENTAL APPLICATION
First Name
MI
Last Name
Male Female Non-Binary Choose not to share
Social Security Number
Phone (Home, Mobile, or Other)
Email
Resided Since
to Current
Address: Street and Apartment #
Town/City
State
Zip
Month/Year
Applicant #2:
What is your gender identity or expression?
First Name
MI
Last Name
Male Female Non-Binary Choose not to share
Social Security Number
Phone (Home, Mobile, or Other)
Email
Resided Since
to Current
Address: Street and Apartment #
Town/City
State
Zip
Month/Year
How did you hear about this development?
PRESENT LANDLORD
Landlord Name:
Tel.#:
Fax #:
Landlord Address:
Street
Apt. #
Town/City
State
Zip
Is apartment rented to you?
YES
NO
If NO, explain:
Are you presently under lease?
YES
NO
If YES, when does lease expire?
Reason for leaving:
Amount of rent per month
$
# of Bedrooms:
# of Occupants:
Do you own a home? YES
NO
Are you receiving rental assistance?
YES
NO
If Yes, what housing authority?
Did you receive any notice of termination of tenancy?
YES NO
If YES, explain:
Reason for applying at this development?
PREVIOUS LANDLORD
(Five (5) Year History Required)
Landlord Name:
Tel. #:
Fax #:
Landlord Address:
Street Apt. # Town/City State Zip
Applicant’s Address:
Street
Apt. #
Town/City
State
Zip
Was apartment rented to you?
YES
NO
If NO, explain:
# of people residing at premise:
Length of tenancy:
from
to
Amount of rent per month
$
Were you then under a lease? YES NO If YES, did you remain for its term? YES NO
Did you receive any notice of termination of tenancy?
YES NO
If YES, explain:
The reason for your leaving:
MANAGEMENT USE ONLY
Date/Time Application Received:
_______
_______________________
______________________________
Pr
operty Name:
Bedroom size(s) a
pplying for:
A
pplicant #1:
©2021 Peabody Properties, Inc. All Rights Reserved. Page 2 of 4 02.22.21
Please provide list of all states in which any household member has resided:
Please list all previous apartment address if above are less than five (5) years:
Landlord Name:
Landlord Address
:
Why did you leave this apartment?
Did you ever receive any notices of termination of tenancy while at this apartment? YES NO If yes, please explain:
Complete the following information for each member of your family, including yourself, who will be occupying the apartment:
NAME
RELATIONSHIP
DATE OF BIRTH
GENDER*
OCCUPATION
F.T. STUDENT
YES / NO
SOCIAL SECURITY or
TAX I.D. NUMBER
*The information provided for gender is for demographic purposes and is optional.
EMPLOYMENT (A minimum of 1 years’ worth of employment history, if applicable, for each household member 18 years of age and older):
Individual Employed:
Employer Name:
Address:
Dates of Employment:
from
to
Gross Wages / Salary
$
Yearly
Monthly
Weekly
Tel. #:
Contact Person / Supervisor:
Fax #:
Individual Employed:
Employer Name:
Address:
Dates of Employment:
from
to
Gross Wages / Salary
$
Yearly
Monthly
Weekly
Tel. #:
Contact Person / Supervisor:
Fax #:
OTHER SOURCES OF INCOME (for
all
Household Members):
AMOUNT RECEIVED PER MONTH
PERSON RECEIVING SUCH INCOME
Social Security
$
Supplemental Security Income (SSI)
$
Pension / Annuity / Trust
$
Public Assistance (TANF / AFDC / EAFDC / GR)
$
Unemployment Compensation
$
Worker’s Compensation
$
Child Support / Alimony
$
Student Financial Assistance
$
Gift Contributions
$
Other Income
(please specify)
$
©2021 Peabody Properties, Inc. All Rights Reserved. Page 3 of 4 02.22.21
PERSONS TO NOTIFY (Who is assisting you in completing this application and has permission to speak with us):
NAME
RELATIONSHIP
ADDRESS
TELEPHONE NUMBER
ASSETS Please list the assets
now owned or disposed of within the last two years
of anyone living in your household (
Include
Checking,
Savings, IRA, Money Market Account, Term Certificates, Real Estate, Stocks, Bonds, Certificates, Express Debit Card, and Cash on Hand
After Savings.):
ASSET DESCRIPTION
SOURCE / BANK NAME
AMOUNT OR VALUE
ACCOUNT NUMBER
$
$
$
$
$
$
$
ADDITIONAL INFORMATION:
Are you or any member of the household subject to lifetime sex offender registration requirement in any state? YES NO
Do you currently have a household pet?
YES
NO
; if YES, what type?
How many cars will be parked at the premises?
(copies of registration must be provided)
Year:
Registration #:
Make/Model:
Year:
Registration #:
Make/Model:
Have you or any household member ever committed any fraud in connection with any Federal Housing Assistance program?
YES NO ; if YES,
please explain
:
Have you or any household members on Federal Assistance ever been terminated for fraud?
YES
NO
; if YES,
please explain
:
©2021 Peabody Properties, Inc. All Rights Reserved. Page 4 of 4 02.22.21
EQUAL OPPORTUNITY / FAIR HOUSING INFORMATION
Peabody Properties, Inc. does not discriminate on the basis of race, color, religion, national origin, gender, disability, familial status, marital
status, sexual orientation, genetic information, veteran/military status, receipt of public assistance, ancestry, age, gender identity or other
basis prohibited by federal, state, or local law in the access or admission to its programs or employment or its programs, activities,
functions or services.
The following information will be required by the Federal Government to monitor this owner / management agent's compliance with Equal
Housing Opportunity and Fair Housing Laws. The law provides that an applicant may not be discriminated against on the basis of the
information supplied below whether or not the information is furnished.
Note: HUD Race and Ethnicity Data Form(s) must be attached for Subsidized Sites.
ETHNIC CATEGORIES
Hispanic or Latino
Not-Hispanic or Latino
RACE CATEGORIES
American Indian or Alaska Native Asian Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
I do not wish to furnish the above information
I hereby certify that the information provided in this application is true and complete to the best of my knowledge and hereby
acknowledge the understanding that this application constitutes my request for consideration as a tenant in the above development. It
does not constitute a lease or a promise by the owner or management agent that an apartment will be made available to me. I understand
that additional information may be requested to complete processing of my application.
I understand and grant permission for all of the above information to be verified by the owner/agent. I further understand and grant
permission to authorize a credit bureau service to make any consumer report and investigative consumer report, whereby information is
obtained through public records, personal or telephonic interviews with my neighbors, friends, or others with whom I am acquainted. This
inquiry may include information as to my character, credit worthiness, credit standing, and credit capacity. I understand that I have the right
to make a written request within a reasonable period of time to receive information about the nature and scope of any such report that is
made.
I understand that a false statement, misrepresentation or omission of any information on this application will affect approval for
residence; and, in the event that I take occupancy, it shall be considered material non-compliance with the lease and a basis for
termination of tenancy.
Finally, I understand and grant permission that information regarding my tenancy can and will be made available to a consumer credit
agency, criminal checks, and/or other inquiring about my tenancy with the apartment complex during and after my tenancy period.
RIGHT TO REASONABLE ACCOMMODATION
Peabody Properties, Inc. will consider a reasonable accommodation, upon request for qualified people with disabilities when an
accommodation is necessary, not just desirable, to ensure equal access to the development, its amenities, services and programs.
Reasonable accommodations may include changes to the building, grounds, or an individual unit; changes to policies, practices, and
procedures; and mitigating circumstances.
_______ Please check here if you would like to make a request for a reasonable accommodation. Management will then provide you
with a Request for a Reasonable Accommodation Form (RA-1) and complete a Referral Form (RA-2) to the property’s Resident Service
Coordinator to follow-up with you directly consistent with Management’s Reasonable Accommodation Policies and Procedures.
Date:
Signature:
Signature:
Signatures and proof of identification will be required of all those who sign lease.
Print application and mail to the community address.
RENTAL APPLICATION ATTACHMENT
(for all affordable housing programs)
This community may have certain preference criteria in place or a housing programs whereby certain deductions
or considerations may apply. Upon request to management, you may receive a copy of the Tenant Selection
Plan which describes the occupancy requirements, the application process and resident selection criteria
including eligibility and screening requirements for residency at the property.
I
f you would like to be considered for a preference, deduction or special consideration should they apply to the
property for which you are submitting this application, please respond to the following questions.
Documentation will be required to verify eligibility for a preference, deduction, or other special consideration.
1.
Are you homeless due to displacement by natural forces such as fire, earthquake, flood, natural cause or
declared disaster?
YES NO
If yes, please describe:
2.
Are you or are you about to be homeless due to displacement by Urban Renewal?
YES NO
If yes, please describe:
3. Are you or are you about to be homeless due to overcrowding in housing that is too small for your
family?
YES NO
4.
Have you or any member of your household suffered actual or threats of physical violence by a spouse
or another member of the household? If yes, household member will be requested to complete form
HUD-5382
YES NO
5.
Are you displaced as a result of government action or a presidentially declared disaster?
YES NO
If yes, please describe:
6.
.
Are you or any member of your household a veteran?
YES NO
7.
Are you currently seeking housing through CBH or DMH?
YES NO
8.
Are you or any member of your household a person with a disability?
YES NO
If yes, please provide name(s) of the household members:
9.
Does any member of your household require an apartment with accessible features?
YES NO
If yes, please indicate type: Wheelchair Adapted
Hearing/Visually Adapted
OMB 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.
Instructions: 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.
Si
gnature of Applicant: _____________________________________________ Date: _______________________________
T
he 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.
Privacy 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)
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INSTRUCTIONS FOR COMPLETING RENTAL APPLICATION

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Completed 29 May 2021

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