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Thank you for your interest in obtaining housing

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INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR ASSISTED HOUSING:
Thank you for your interest in obtaining housing at one of our properties. The following
instructions, if followed properly, will ensure timely processing of your application and will
prevent delays.
1) Please indicate which property you are applying for. Please do not request “ANY” You
must print out different applications for each property that you are applying for.
2) Please print clearly, in black or blue ink.
3) All questions must be answered. Incomplete applications will be returned if not filled out
completely.
4) All household members that are 18 years of age or older are required to be screened for a
criminal record check. Enclosed is the form for New Hampshire. Please complete one
criminal record form for each household member age 18 or over. (Print additional copies
as necessary) If you have never resided in New Hampshire then you are not required to
submit the form.
5) Be sure that all household members 18 years of age or older sign both the Certification
and Release of Information Authorization, located on the last page of the application.
6) All household members must complete and sign the citizenship declaration form. Please
follow the instructions on the form. (Minors require guardian’s signature)
7) Per Government Regulations, a copy of your social security card for each household
member is required prior to admission. If not available, only one of the following is
acceptable as an alternative: 1) Driver’s license with SSN 2) Identification card issued by
a federal, State, or local agency 3) a medical insurance provider, or an employer or
trade union. 4) Earnings statements on payroll stubs 5) Bank statement 6) Form 1099 7)
Benefit award letter 8) Retirement benefit letter 9) Life insurance policy 10) Court
records
Please call our office at 603-524-6673 if you have any questions, or e-mail us at
jmoore@stewartproperty.net
*** PLEASE MAIL YOUR COMPLETED APPLICATION TO: ****
STEWART PROPERTY MANAGEMENT
151 Elm Street
Laconia, NH 03246
SMOKING POLICY: The property you are applying for is presently smoke-free. Smoking is
prohibited in the apartments, common areas, and outside grounds. Please contact us for specific
information.
LEAD PAINT: Some properties we manage were built prior to 1978 and may contain Lead Based Paint, which is a concern
particularly for children under 7 and pregnant women. Please call us to ask us for specifics on the property that you are applying for.
APPLICATION FOR HOUSING
Stewart Property Management Use Only:
Property Name: Barrier Free (H/C unit) Requested?
YES NO
Bedroom Size:
Accepted
Rejected
Property Name you are applying for:
Number of bedrooms requested:__________
_
Elderly Housing Only: If you are not yet 62 years old, are you eligible for occupancy based on your status as an individual
with disabilities? _______Yes ________No
Full Name:
B:
Relationship to HEAD Date of Birth Full Time Student? Social Security Number Gender
HEAD
C: INCOME
Please fill in each section, checking NO next to the items that you do not
receive. Please use additional sheets of paper if necessary.
Family Member Source of Income Gross Monthly Amount
Social Security
$
Social Security $
Social Security $
Family Member Source of Income Gross Monthly Amount
SSI Benefits
$
SSI Benefits $
Family Member Source of Income Gross Monthly Amount
Pension/Annuities
$
Pension/Annuities $
Comments:
Phone Number:
Check if NO
Name of Income Source
E-Mail:
Name of Income Source
Name of Income Source
Check if NO
Check if NO
Please complete the following application and return it to Stewart Property Management, Inc. (SPM). All items must be complete in order to determine your
eligibility. If an item does not apply to you, please check NO next to the question. SPM does not discriminate on the basis of race, color, sex, age, religion,
national origin, family or marital status, disability, sexual orientation, perceived sexual orientation, gender, or gender identification. Please note a copy of all
household members social security cards will be required prior to admission . * If you do not have a social secur
ity card, please obtain an alternative form of
identification that would verify your number. Please call us fo
r a list of acceptable
substitu
tions
.
FAMILY SUMMARY
Tim
e
/Dat
e
Sta
m
p
List all persons, including yourself, who will be living in the apartment. List the head of household first.
City/St/Zip:
Full Name and middle initial
1 (REV 4-21) S8/RD
B:
FAMILY SUMMARY
B:
FAMILY SUMMARY
A:
GENERAL INFORMATION
Address:
Does anyone listed above have a maiden name, or alias? YES NO If yes, please list them below:
If anyone that does not have a Social Security Number, were they age 62 or older as of January 31, 2010, AND were they
receiving HUD rental assistance at another location on January 31, 2010? YES
NO
If yes, please list them below:
www.stewartproperty.net
NOTE: FOR THE PURPOSES OF CALCULATING RENT, AN ELDERLY OR DISABLED HOUSEHOLD QUALIFIES FOR A
$400 DEDUCTION FROM ANNUAL INCOME AND MAY QUALIFY FOR A DEDUCTION FOR MEDICAL EXPENSES. ANY
HOUSEHOLD MAY QUALIFY FOR A $480 DEDUCTION PER CHILD OR DISABLED ADULT DEPENDENT AND CHILDCARE
AN/OR DISABILITY ASSISTANCE EXPENSE
INCOME, continued
Family Member Source of Income Gross Monthly Amount
VA Benefits
$
Family Member Source of Income Gross Monthly Amount
Employment Wages
$
Employment Wages $
Family Member Source of Income Gross Monthly Amount
Unemployment Benefits
$
Unemployment Benefits $
Check if NO
Family Member Source of Income Gross Monthly Amount
Alimony
$
Child Support $
Self Employment $
TANF/PATH/APTD $
Other Income $
D: ASSETS
Please fill in each section, checking NO next to the items that you do not have.
Please use additional sheets of paper if necessary.
Family Member Bank Name Account # Balance Interest Rate
$
$
$
SAVINGS ACCOUNTS/EBT/PRE-PAID DEBIT CARDS
Family Member Bank Name Account # Balance Interest Rate
$
$
$
Family Member Bank Name Account # Balance Interest Rate
$
$
$
Family Member Stock Name # of Shares Owned Value Per Share Dividend Rate
$
$
$
Family Member Series Date of Issue
Name of Income Source
Name of Income Source
$
CERTIFICATES OF DEPOSIT (CD)
Check if NO
Check if NO
Amount
Check if NO
$
$
Check if NO
Check if NO
Name of Income Source
Name of Income Source
Penalty for early withdrawal? YES NO
Check if NO
CHECKING ACCOUNTS
YES NO
Are there any changes in income expected within the next 12 months?
If yes, please list family member and explain:
STOCKS
BONDS
Check if NO
Check if NO
2 (REV 5-18) S8/RD
ASSETS, continued
Family Member Bank Name Account # Balance Interest Rate
$
$
$
Family Member B
ank Name Account # Balance Interest Rate
$
$
$
Family Member B
ank Name Account # Balance Interest Rate
$
$
$
Family Member I
nsurance Name Account #
YES NO
Family Member:
6) Is the property owned jointly?
7)
D
o you now rent, or intend to rent this property?
1)
Has any member of your household disposed of any asset(s) in the last two years?
YES NO
E: EXPENSES
Medical Expenses
Complete this section if head or spouse is 62 or older or disabled. Only list out
of pocket expenses that are not reimbursed by any other source. Please use
additional sheets of paper if necessary.
Check if NO
Family Member Medical Expense Monthly Expense
Medicare
$
Medicare $
Health Insurance $
Health Insurance $
Pharmacy $
Pharmacy $
Pharmacy $
5) Amount of mortgage or outstanding loan?
YES NO
REAL
ESTATE
1) Do you own any property?
2) If y
es, what type of property is it?
3) Market value when disposed:
Penalty for early withdrawal? YES NO
TRUST ACCOUNTS
Is this an irrevocable trust? YES NO
IRAs
4)
Amount disposed for?
5)
D
ate of transaction?
ANNUITIES/MUTUAL FUNDS/401K/403b
YES NO
2) If yes, what type of asset (e.g. cash, property, bank accounts)?
$
$
Name & Address of Pharmacy
$
Check if NO
Check if NO
Check if NO
Amount
$
Check if NO
WHOLE LIFE POLICIES (NOT TERM LIFE)
DISPOSED
OF ASSETS
3)
Where is the location of the property?
4)
What is the appraised market value?
3 (REV 5-18) S8/RD
EXPENSES, Continued
Physician $
Physician $
Physician $
Other $
Child Care
Complete for children 12 and younger. Only list amounts that are paid out of
pocket and are not reimbursed by any other agency.
Check if NO
Family Member being
cared for:
Weekly Expense
$
$
Handicap Assistance
Expense
Check if NO
Family Member Type of Expense Weekly Expense
$
$
F:
PROGRAM INFORMATION
YES NO
Is any member of the household a full or part time student?
Full Time Part Time
YES NO
Has everyone in your household (adults and children) been a student for ar least 5 months in the current
c
alendar year or; is everyone
in your household (adults and children) currently a student, or planning to
become one within the next 12 months.
If yes
, please check the applicable status from the list below:
Married and filing a joint tax return
Receiving Social Security Title IV payments (NHEP, RUFA)
Participating in a job training program with assistance
The full-time student is a single parent with minor children who are claimed as
dependents on their tax return.
None of the above.
Name & Address of Child Care Provider
Do you or anyone in your household have a Section 8 voucher? YES NO
landlord? If yes, please explain:
Name & Address of Provider
If yes, when and where?
If no, please explain:
Have you or any member of your household ever been evicted?
How did you hear about the apartment for which you are applying?
YES NO
Are you legally capable of entering into a lease agreement?
Do you require an accessible unit?
YES NO
Have you or any member of your household ever received an Eviction Notice or Notice to Quit from any
YES NO
Will you or anyone in your household require a live-in care attendant?
Name of Live-in Care Attendant:
Relationship (if any)
For each adult household member, list every state that they have ever lived in:
Housing Authority: Contact Person:
YES NO
YES NO
If yes, please explain:
If yes, please explain:
YES NO
YES NO
Have you ever resided in a federally assisted housing complex?
Name & Address of Provider
YES NO
Have you or any member of your household ever lived at any property managed by Stewart Property
Management? If yes, list property name and dates:
4 (REV 5-18) S8/RD
Check if NO
G: HOUSING REFERENCES
Please list your current address and landlord first, then your 2 other most recent addresses and landlords.
Rent Amount: $
Are utilities included?
YES NO
If, No, how much are utilities per month?
$
Name and Address of Current Landlord: Phone Number of current landlord:
Are you related to this person?
YES NO
Additional Info:
Rent Amount: $
Are utilities included?
YES NO
If, No, how much are utilities per month?
$
Name and Address of Previous Landlord: Phone Number of previous landlord:
Are you related to this person?
YES NO
Additional Info:
Rent Amount: $
Are utilities included?
YES NO
If, No, how much are utilities per month?
$
Name and Address of Previous Landlord: Phone Number of previous landlord:
Are you related to this person?
YES NO
Additional Info:
H: OTHER INFORMATION
Have YOU or ANY MEMBER of your household ever been arrested or convicted of any felony or any
Have YOU or ANY MEMBER of your household ever been arrested or convicted in any incident
Current Address:
Resided here since:
Please complete all areas below.
YES NO
YES NO
Do YOU or ANY MEMBER of your household currently use illegal drugs or abuse alcohol?
If yes, please explain:
involving drugs?
Do you have any pets?
YES NO
1st Previous Address:
YES NO
If yes, please explain:
misdemeanor crime? If yes, check the applicable box(es) here >
Lived there from_______________to________________.
If yes, please describe:
2nd Previous Address:
and please explain:
Lived there from_______________to________________.
5 (REV 5-18) S8/RD
MISDEMEANOR
FELONY
OTHER INFORMATION, CONTINUED
I: CERTIFICATION
I/We hereby certify that I/we do not and will not maintain a separate, subsidized rental unit in another location. I/we
understand that I/we must pay a security deposit prior to occupancy.
I/we certify that the housing I/we will occupy will be my/our only residence.
I/We understand that eligibility for housing will be based on either the USDA Rural Development or the Department of
Housing and Urban Development's eligibility criteria and Stewart Property Management's Resident Selection Criteria.
I/we understand that this application in no way ensures occupancy and that my/our application can be rejected based
on, but not limited to, poor credit or landlord references, police records indicating unacceptable or criminal behavior,
and/or poor personal interview.
I/We certify that the information given in this application is true to the best of my/our knowledge. I/We understand
that any false information is punishable by law, and could be grounds for cancellation of this application or termination
of residency after occupancy.
Date:
Date:
Date:
Date:
J: RELEASE OF INFORMATION AUTHORIZATION
I/We do hereby authorize Stewart Property Management, Inc., and its staff to obtain information or materials deemed
necessary to determine my/our eligibility for housing, including, but not limited to contacting Local, State and Federal
agencies, organizations, credit bureaus and landlords that may provide information that could substantiate or verify
information given in this application. I/We authorize Stewart Property Management, Inc, to obtain a copy of my credit report.
Date:
Date:
Date:
Date:
The information regarding race, ethnicity, and gender solicited on this application is requested in order to assure the
Federal Government, acting through Rural Development and HUD that SPM complies with the Federal laws prohibiting
discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age,
sexual orientation, marital status and disability are complied with. You are not required to furnish this information,
but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against
you in any way.

A
merican Indian/Alaskan Native 
A
sian Black or African American
Native Hawaiian or other Pacific Islander
Ethnicity:
Hispanic or Latino
Gender:
Male
© 2018 Stewart Property Management, Inc
YES NO
YES NO
If yes, please explain giving name and relationship:
YES NO
Are YOU or ANY MEMBER of your household listed on any state sex offender registration program?
If yes, please explain:
YES NO
Do you have primary physical custody of all children listed under the Household Composition on page 1?
If no, please explain:
Are there any absent household members that are not listed under the Household Composition on page 1?
Female
Race:
(Check
one or more)
White
Non-Hispanic or Latino
Spouse/Co-Tenant:
If yes, please explain giving name and relationship:
Head of Household:
Head of Household:
Spouse/Co-Tenant:
Do you expect any additions to the household within the next 12 months?
6 (REV 12-18) S8/RD
PART 1
DECLARATION OF CITIZENSHIP STEWART PROPERTY MANAGEMENT, INC.
P.O. BOX 10540
BEDFORD, NH 03110
DATE:______________________
PLEASE PROVIDE ALL INFORMATION REQUESTED
PART 1: APPLIES TO ALL FAMILY MEMBERS
Each person who will benefit under the Section 8 Rental Assistance Program must either be a citizen or national of the United
States, or be
a non-citizen who has eligible immigration status that qualifies them for rental assistance as determined by the U.S.
Department of Housing and Urban Development and the U.S. immigration and Naturalization Service.
One box on this form must be checked for each fam
ily member indicating status as a citizen or a national of the United States or
a non-citizen with eligible immigration status. Family members residing in the unit to be assisted that do not claim to be a citizen
or national of the United States, or do not claim to be a non-citizen with eligible immigration status should not check any box.
All adults must sign where indicated. For each child who is not 18 y
ears of age, the form must be signed by any adult member
of the family residing in the dwelling unit who is responsible for the child. Use blank lines to add family members who are not
listed.
I am a I am a
Citizen or non-citizen
Date National with eligible
of of the immigration Signature of Adult Listed to the left,
First Name Last Name Birth U.S.
status or Signature of Guardian for Minors.
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
____________ _________________ _________
or X______________________________
_________________________________________________________________________________________________________________
Warning-Title 18 US Code Section 1001 states that a person is guilty of a felony for knowingly and willingly making a false or fraudulent
statement to any department or agency of the United States. If this form contains false or incomplete information, you may be required to
repay all overpaid rental assistance you received, fined up to $10,000, imprisoned for up to 5 years; and/or prohibited from receiving future
assistance.
HEAD OF HOUSHOLD CERTIFICATION
As head of household, I certify, under penalt
y of perjury, that all members of my household are listed on Part 1 of this form and that members
of my household that have not checked either box on Part 1 of this form do not claim to be citizens or nationals of the United States, or non-
citizens with eligible immigration status.
Signature__________________________________ Date_________________________
NOTE: Family members who have checked a box indicating that they are a
non-citizen with eligible immigration status must
complete part 2 of this form.
PART 2: APPLIES TO NON-CITIZENS FAMILY MEMBERS ONLY
All family members who have claimed eligible immigration status on Part 1 of this form must provide this office with an original of
one of the following documents.
1. Form I-551, Alien Registration Receipt Card
2. Form I-94, Arrival-Departure Record with appropriate annotations or documents
3. Form I-699, Temporary Resident Card
4. Form I-688B, Employment Authorization Card
5. A receipt issued by the INS indicating that an application for issuance of a replacement document in one of the above-
listed categories has been made and the applicant’s entitlement to the document has been verified.
Please call________________________at______________________to arrange for delivery and copying of original documents.
Do not mail original documents to this office.
If documents are not presented and verified, your family’s rental assistance may be reduced, denied, or terminated as provided
in regulations promulgated by the U.S. Department of Housing and Urban Development, pending available appeals processes.
CONSENT TO VERIFY ELIGIBLE IMMIGRATION STATUS
Each family member required to complete Part 2 of this form must sign below granting consent to verify eligible immigration
status. For each child who is not 18 years of age, the form must be signed by any adult member of the family residing in the
dwelling unit who is responsible for the child.
Date
of Signature of Adult Listed to the left,
First Name Last Name Birth or Signature of Guardian for Minors.
Office Use Only
INS VERIF. #
___________________
___________________
___________________
___________________
___________________
___________________
___________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
____________ _________________ _________ X______________________________
Evidence supplied with this form may be released by the Housing Agency, without responsibility for its further use or
transmission, to the Immigration and Naturalization service for purposes of verification of the immigration status of the
individual or to the U.S. Department of Housing and Urban Development, as required. The U.S. Department of Housing and
Urban Development is not responsible for the further use or transmission of the evidence or other information.
PART 2
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.
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.
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)
To be completed by the Owner/Agent
OWNERS SUMMARY OF FAMILY
Mbr.
No.
Last Name of Family Member
First Name
Relationship to
Head of Household
Sex
Date of Birth
1
2
3
Declaration
Date Verified
Head
2
3
4
5
6
7
8
Declaration Legend: 1. -- Citizen/National 2. --Noncitizen with eligible immigration status 3. --Not contending eligibility
DO NOT COMPLETE THIS
SUMMARY, THIS IS FOR
STEWART PROPERTY
MANAGEMENT USE
ONLY. PLEASE RETURN
THIS PAGE WITH YOUR
APPLICATION
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Completed 7 December 2021

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