Town of Arlington, MA - Application for Affordable Rental Housing

Application for Affordable Rental Housing

HOUSING CORPORATION OF ARLINGTON

20 Academy Street, suite 203

Arlington, MA 02476

781 316-3429

APPLICATION FOR

AFFORDABLE RENTAL HOUSING

1. Name of applicant___________________________________________________

Current Address ____________________________________________________

____________________________________________________________

Home phone: ____________________ Work phone: ______________________

2. Household size (the total number of people expected to live in unit) ___________

Total adults: ____ Total children: ____

Number of bedrooms required: ________________________________________

Please list all household members, their age, and relationship to head of household.

Name: Age: Relationship

____________________________________________________

3. Reason for needing housing: (include information on current housing) _____________________________________________________________

_____________________________________________________________

4. Do you currently live, work, or have children at school in Arlington? _________

If yes, where? _________________________________________________

5. Estimate the gross household income from all household members over 18 for the next 12 months. List all sources, including but not limited to: salaries, alimony or child support payments, interest income, and government assistance. Please attach proof of income (W-2’s, IRS form 1040, pay stubs, proof of public assistance)

Household Source of Income Gross Income

Member ( name and address) for 12 months

____________________________________________________________________

Do you have a section 8 housing voucher? Yes No

6. Landlord references: Please list the names, addresses and phone numbers for all landlords for the past 5 years. List most recent first.

Dates of Landlord

Residency Name Address Phone

____________________________________________________________________

7. Other references: Please list the names and phone numbers of 2 personal references. If possible, one reference should be an employer.

Reference Name Phone # _______________Relationship

____________________________________________________________________

8. Criminal Record: Have you or any member of your household who will live in the unit been convicted of a misdemeanor or felony in the last five years? Yes No

If there is a criminal record, please explain: ____________________________________

Attachments--Please attach the following:

· Proof of income, including previous year’s IRS Form 1040 and pay stubs for previous month.

APPLICANT’S CERTIFICATION:

I understand that this application is not an offer of housing. I authorize the Housing Corporation of Arlington or its agent to make inquiries to verify the information I have provided in this application. I do hereby certify that all information within this application is true and correct. I understand that any false statement or misrepresentation may result in cancellation of this application.

SIGNED UNDER THE PAINS AND PENALTIES OF PERJURY

Applicant’s Signature: _____________________________ Date: ______________

PERMISSION TO REQUEST CREDIT REPORT

Applicant Name: ________________________________________________

Date of Birth: ___________________________________________________

Social Security Number: __________________________________________

Applicant Address: _______________________________________________

Co-applicant Name: ________________________________________________

Date of Birth: ___________________________________________________

Social Security Number: __________________________________________

Co-applicant Address: _______________________________________________

I hereby authorize the Housing Corporation of Arlington to obtain personal credit information pertaining to me and my family from any Credit Bureau and other sources.

APPLICANT __________________________________ DATE _______________

(Signature)

CO-APPLICANT _______________________________ DATE _______________

(Signature)