1) To be eligible for this property, you must be at least ...stewartproperty.net/wp-content/uploads/applications/TC-Cony.pdf · 110 Cony Street Augusta, ME 04330 Rental Rates as of

APPLICATION INSTRUCTIONS

Thank you for your interest. The following instructions, if followed properly, will ensure timely processing of your application and will prevent delays.

1) To be eligible for this property, you must be at least 55 years of age toqualify. Income limits do apply.

2) Please print clearly, in black or blue ink.

3) All questions must be answered. Incomplete applications will be returned.

4) Be sure that all household members sign both the Certification and Release ofInformation Authorization, located on the last page of the application.

Please call our office at 1-207-622-1014 if you have any questions, or e-mail us at [email protected]

*** PLEASE MAIL YOUR COMPLETED APPLICATION TO: ****

110 Cony Street Augusta, ME 04330

Rental Rates as of January 2020* 1 BEDROOM 2 BEDROOM

$582 - $700 $685-$827

SMOKING POLICY: The property you are applying for is smoke-free. Smoking is prohibited in the apartments, common areas, and outside grounds by any person. Please contact us for specific information.

*Rents subject to change without notice prior to lease signing.

TAX CREDITAPPLICATION FOR HOUSINGStewart Property Management Use Only:Property Name: Barrier Free (H/C unit) Requested? YES NOBedroom Size:

AcceptedRejected

Comments:

Time/D

ate St

amp

Property Name you are applying for: Number of bedrooms requested:__________

A. GENERAL INFORMATION

Full Name: Phone Number:

E-Mail:

B:

Relationship to HEAD Date of Birth Full Time Student? Social Security # Sex

HEAD

YES NONA If yes, please explain giving name and relationship:

YES NO

YES NO

www.stewartproperty.net

Are there any absent household members that are not listed under the Household Composition above?

Address:

If no, please explain:

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.

HOUSEHOLD COMPOSITION

Do you have primary physical custody of all children listed under the Household Composition above?

List all persons, including yourself, who will be living in the apartment. List the head of household first. ONLY include children who will be living in the apartment at least 50% of the time.

Full Name and middle initial

If yes, please explain giving name and relationship:Do you expect any additions to the household within the next 12 months?

Does anyone listed above have a maiden name, or alias? YES NO If yes, please list them below:

1 (REV 5-18) Tax Credit

rstewartText BoxPO BOX 10540Bedford, NH 03110603-641-2163

C: INCOME Please fill in each section, checking NO next to the items that you do not receive.Family Member Source of Income Gross Monthly Amount

Employment Wages $

Employment Wages $

Employment Wages $

Family Member Source of Income Name of Public Assistance Office Gross Monthly Amount

Public Assistance $

Family Member Source of Income Gross Monthly Amount

Social Security/SSI $




Pension/Annuities $

Pension/Annuities $


Unemployment Benefits $Unemployment Benefits $


VA Benefits $VA Benefits $

Check if NO Family Member Source of Income Gross Monthly Amount

Alimony $Child Support $Self Employment $Other Income $

D: ASSETS Please fill in each section, checking NO next to the items that you do not have.

Family Member Bank Name/Type 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

BONDS

STOCKS

$

Check if NO

Check if NO

Amount

Check if NO Name of Income Source


Check if NO

Name and Address of Employer

Check if NO

Check if NO

$

Check if NO

Check if NO


Check if NOCHECKING/SAVINGS ACCOUNTS, OR CD

YES NOAre there any changes expected in income within the next 12 months?If yes, please list family member and explain:


ASSETS, continued

Family Member Bank Name Account # Balance Interest Rate

$


$

$


$

$

Family Member Insurance Name Account #

Family Member Market Value

$

$

1) Do you own any property? YES NO Family Member:REAL 2) If yes, what type of property is it?

ESTATE 3) Where is the location of the property?4) What is the appraised market value?

5) Amount of mortgage or outstanding loan?

6) Is the property owned jointly? YES NO7) Do you now rent, or intend to rent this property? YES NO

1) Has any member of your household disposed of any asset(s) in the last two years? YES NO

E: PROGRAM INFORMATIONYES NO Has everyone in your household (ALL adults and children) been a student for ar least 5 months in

the current calendar 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.

If yes, please explain:

Have you ever resided in a federally assisted housing complex?

Check if NO

If yes, when and where?YES NO

YES NO

YES NO

2) If yes, what type of asset (e.g. cash, property, bank accounts)?

Check if NO

Check if NOWHOLE LIFE POLICIES (NOT TERM LIFE)

DISPOSED OF ASSETS 3) Market value when disposed:

4) Amount disposed for?

Check if NO

TRUST ACCOUNTS

Is this an irrevocable trust? YES NO

Amount

IRAs

Penalty for early withdrawal? YES NO

ANNUITIES/MUTUAL FUNDS/401K/403b

5) Date of transaction?

$

ANY OTHER ASSETS

$

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:

$

Do you require an accessible unit?

Check if NO Asset Type


PROGRAM INFORMATION, continued

F: HOUSING REFERENCESPlease 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



Name and Address of Previous Landlord: Phone Number of previous landlord:Are you related to this person? YES NO



Name and Address of Previous Landlord: Phone Number of previous landlord:Are you related to this person? YES NO

Please complete all areas below.

Will you or anyone in your household require a live-in care attendant?

How did you hear about the apartment for which you are applying?

landlord? If yes, please explain:YES NO Have you or any member of your household ever received an Eviction Notice or Notice to Quit from any

Housing Authority: Contact Person:Do you or anyone in your household have a Section 8 voucher?

Name of Live-in Care Attendant:

Current Address:

YES NO

If no, please explain:

YES NO Have you or any member of your household ever been evicted?

YES NO

Relationship (if any)

1st Previous Address:


Are you legally capable of entering into a lease agreement?

Resided here since:

YES NO

For each adult household member, list every state that they have ever lived in:

Lived there from_______________to________________.

Additional Info:

Additional Info:

2nd Previous Address:Lived there from_______________to________________.

Additional Info:


G: 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

H: CERTIFICATIONI/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 asecurity 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 Section 42 of the Internal Revenue Code and applicable sections of the HUD 4350.3 Occupancy Handbook and StewartProperty Management's Resident Selection Criteria. I/we understand that this application in no way ensures occupancy and that my/our applicationcan be rejected based on, but not limited to, poor credit or landlord references, police records indicating unacceptable or criminal behavior, and/or poorpersonal 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 falseinformation is punishable by law, and could be grounds for cancellation of this application or termination of residency after occupancy.

Date:

Date:

Date:

Date:I: 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 throughRural Development and HUD that SPM complies with the Federal laws prohibiting discrimination against tenant applications on the basis of race, colornational 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. Race:

American Indian/Alaskan Native Asian Black or African AmericanNative Hawaiian or other Pacific Islander

Ethnicity: Hispanic or LatinoGender: Male Female

Head of Household:

Spouse/Co-Tenant:

YES NO


YES NO Are YOU or ANY MEMBER of your household listed on any state sex offender registration program?If yes, please explain:

YES NO

YES NO

YES NOmisdemeanor crime? If yes, check the applicable box(es) here >

If yes, please explain:involving drugs?

Do you have any pets?If yes, please describe:

and please explain:

Do YOU or ANY MEMBER of your household currently use illegal drugs or abuse alcohol?

Head of Household:

Spouse/Co-Tenant:

(Check one or more)

WhiteNon-Hispanic or Latino

© 2018 Stewart Property Management, Inc5 (REV 12-18) Tax Credit

MISDEMEANOR FELONY

Property Name you are applying for: Number of bedrooms requested: Full Name: Phone Number: Address: Address_2: EMail: Address_3: Full Name and middle initialRow1: Date of BirthHEAD: FTS1: [ ]Social Security HEAD: SEX1: [ ]Full Name and middle initialRow2: HEADRow1: Date of BirthRow2: FTS2: [ ]Social Security Row2: Full Name and middle initialRow3: HEADRow2: Date of BirthRow3: FTS3: [ ]Social Security Row3: SEX3: [ ]Full Name and middle initialRow4: HEADRow3: Date of BirthRow4: FTS4: [ ]Social Security Row4: SEX4: [ ]Full Name and middle initialRow5: HEADRow4: Date of BirthRow5: FTS5: [ ]Social Security Row5: SEX5: [ ]Full Name and middle initialRow6: HEADRow5: Date of BirthRow6: FTS6: [ ]Social Security Row6: SEX6: [ ]Full Name and middle initialRow7: HEADRow6: Date of BirthRow7: FTS7: [ ]Social Security Row7: SEX7: [ ]Full Name and middle initialRow8: HEADRow7: Date of BirthRow8: FTS8: [ ]Social Security Row8: SEX8: [ ]Group1: OffDoes anyone listed above have a maiden name or alias YES NO If yes please list them belowRow1: Does anyone listed above have a maiden name or alias YES NO If yes please list them belowRow1_2: Does anyone listed above have a maiden name or alias YES NO If yes please list them belowRow2: Group2: OffDoes anyone listed above have a maiden name or alias YES NO If yes please list them belowRow2_2: Group3: OffGroup4: OffDo you expect any additions to the household within the next 12 months: If yes please explain giving name and relationshipYES NO: If no please explainYES NO: Check Box30: OffIf yes please explain giving name and relationship: SEX2: [ ]Check Box1: OffFamily MemberCheck if NO: Name and Address of EmployerEmployment Wages: fill_79: Family MemberCheck if NO_2: Name and Address of EmployerEmployment Wages_2: fill_80: Family MemberCheck if NO_3: Name and Address of EmployerEmployment Wages_3: fill_81: Check Box2: OffFamily MemberCheck if NO_4: Name of Public Assistance OfficePublic Assistance: fill_82: Check Box3: OffSource of Income: Family MemberCheck if NO_5: Social SecuritySSI: fill_83: Check Box4: OffCheck Box6: OffCheck Box9: OffFamily MemberCheck if NO_6: Social SecuritySSI_2: fill_84: Family MemberCheck if NO_7: Social SecuritySSI_3: fill_85: Family MemberCheck if NO_8: Check Box11: OffCheck Box12: OffFamily MemberCheck if NO_9: Name of Income SourcePensionAnnuities: fill_86: Name of Income SourcePensionAnnuities_2: fill_87: Check Box4a: OffFamily MemberCheck if NO_10: Family MemberCheck if NO_11: Name of Income SourceUnemployment Benefits: fill_88: Name of Income SourceUnemployment Benefits_2: fill_89: Check Box5: OffFamily MemberCheck if NO_12: Family MemberCheck if NO_13: Name of Income SourceVA Benefits: fill_90: Name of Income SourceVA Benefits_2: fill_91: Family MemberRow1: Name of Income SourceAlimony: fill_92: Check Box7: OffFamily MemberRow2: Name of Income SourceChild Support: fill_93: Check Box8: OffFamily MemberRow3: Name of Income SourceSelf Employment: fill_94: Family MemberRow4: Name of Income SourceOther Income: fill_95: Are there any changes expected in income within the next 12 months: Group5: OffIf yes please list family member and explain: Family MemberCheck if NO_14: Bank NameTypeCheck if NO: Account Check if NO: Bal1: Interest Rate: Family MemberCheck if NO_15: Bank NameTypeCheck if NO_2: Bal2: Account Check if NO_2: Interest Rate_2: Check Box10: OffFamily MemberCheck if NO_16: Bank NameTypeCheck if NO_3: Bal3: Account Check if NO_3: Interest Rate_3: Family MemberCheck if NO_17: Bank NameTypeCheck if NO_4: Bal4: Account Check if NO_4: Interest Rate_4: Family MemberCheck if NO_18: Bank NameTypeCheck if NO_5: Bal5: Account Check if NO_5: Interest Rate_5: Family MemberCheck if NO_19: Bank NameTypeCheck if NO_6: Account Check if NO_6: Interest Rate_6: Family MemberCheck if NO_20: Stock NameCheck if NO: V1: of Shares OwnedCheck if NO: Dividend Rate: Family MemberCheck if NO_21: Stock NameCheck if NO_2: V2: of Shares OwnedCheck if NO_2: Dividend Rate_2: Family MemberCheck if NO_22: SeriesCheck if NO: Date of IssueCheck if NO: fill_102: Family MemberCheck if NO_23: SeriesCheck if NO_2: Date of IssueCheck if NO_2: fill_103: Check Box13: OffCheck Box16: OffFamily MemberCheck if NO_24: Check Box19: OffBank NameCheck if NO: Account Check if NO_7: Bal6: Interest Rate_7: Group29: OffCheck Box14: OffFamily MemberCheck if NO_25: Bank NameCheck if NO_2: Account Check if NO_8: Bal7: Interest Rate_8: Family MemberCheck if NO_26: Bank NameCheck if NO_3: Account Check if NO_9: Bal8: Interest Rate_9: Group29a: OffCheck Box15: OffFamily MemberCheck if NO_27: Bank NameCheck if NO_4: Account Check if NO_10: Bal9: Interest Rate_10: Family MemberCheck if NO_28: Bank NameCheck if NO_5: Account Check if NO_11: Bal10: Interest Rate_11: Family MemberCheck if NO_29: Insurance NameCheck if NO: Account Check if NO_12: fill_41: Check Box17: OffFamily MemberCheck if NO_30: Asset TypeCheck if NO: fill_43: Family MemberCheck if NO_31: Asset TypeCheck if NO_2: fill_44: 1 Do you own any property: Group6: OffYES NO Family Member2 If yes what type of property is it: YES NO Family Member3 Where is the location of the property: YES NO Family Member4 What is the appraised market value: YES NO Family Member5 Amount of mortgage or outstanding loan: Group7: OffGroup8: OffGroup32: Off2 If yes what type of asset eg cash property bank accounts: 3 Market value when disposed: fill_51: 4 Amount disposed for: 5 Date of transaction: Group9: OffCheck Box18: OffCheck Box20: OffCheck Box21: OffCheck Box21a: OffManagement If yes list property name and dates: Do you require an accessible unit: Group11: OffIf yes please explain: Have you ever resided in a federally assisted housing complex: If yes when and where: Group10: OffGroup12: OffHave you or any member of your household ever been evicted: Group13: OffIf yes please explain_2: Group14: Offlandlord If yes please explain: Group15: OffIf no please explain: How did you hear: Do you or anyone in your household have a Section 8 voucher: Group16: OffHousing Authority: Contact Person: Will you or anyone in your household require a livein care attendant: Group17: OffName of Livein Care Attendant: Relationship if any: For each adult household member list every state that they have ever lived inRow1: Current AddressRow1: Resided here since: Current AddressRow2: Rent Amount: fill_48: Current AddressRow3: Are utilities included: Group18: OffCurrent AddressRow4: fill_50: Phone Number of current landlord: Name and Address of Current LandlordRow1: Group19: OffName and Address of Current LandlordRow2: Name and Address of Current LandlordRow3: Name and Address of Current LandlordRow4: Additional Info: 1st Previous AddressRow1: Lived there from: to: 1st Previous AddressRow2: Rent Amount_2: fill_53: 1st Previous AddressRow3: Are utilities included_2: Group20: Off1st Previous AddressRow4: fill_55: Phone Number of previous landlord: Name and Address of Previous LandlordRow1: Group21: OffName and Address of Previous LandlordRow2: Name and Address of Previous LandlordRow3: Name and Address of Previous LandlordRow4: Additional Info_2: 2nd Previous AddressRow1: Lived there from_2: to_2: 2nd Previous AddressRow2: Rent Amount_3: fill_58: 2nd Previous AddressRow3: Are utilities included_3: Group22: Off2nd Previous AddressRow4: fill_60: Phone Number of previous landlord_2: Name and Address of Previous LandlordRow1_2: Group23: OffName and Address of Previous LandlordRow2_2: Name and Address of Previous LandlordRow3_2: Name and Address of Previous LandlordRow4_2: Additional Info_3: Group24: OffGroup25: OffGroup30: OffGroup26: OffGroup27: OffGroup28: OffDo you have any pets: If yes please describe: criminal explain: If yes please explainYES NO: If yes please explainYES NO_2: involving drugs: If yes please explainYES NO_3: If yes please explainYES NO_4: If yes please explainYES NO_5: If yes please explainYES NO_6: If yes please explainYES NO_7: If yes please explainYES NO_8: Date: Date_2: Date_3: Date_4: Date_5: Date_6: Date_7: Date_8: Check Box22: OffCheck Box23: OffCheck Box24: OffCheck Box25: OffCheck Box26: OffCheck Box31: OffCheck Box27: OffCheck Box29: OffCheck Box28: Off

Documents

1) To be eligible for this property, you must be at least ...stewartproperty.net/wp-content/uploads/applications/TC-Cony.pdf · 110 Cony Street Augusta, ME 04330 Rental Rates as of