LEXINGTON WOODS APARTMENTS

Located in Cedar Springs MI

Mailing Address: 8180 Cook St., Montague, MI 49437 Office: (231) 893-2739 * Fax: (231) 893-5501 *
TDD/TTY DIAL 711
Dear Applicant,
Thank you for your interest in our apartment community. We look forward to the opportunity to help
provide you and your family with your housing needs. Should you have any questions or need help with the
application please call the site office at the number listed above.

In order for your application to be processed in a timely manner it is important for you to be thorough in
completing it. There is a $25.00 Application Fee (non-refundable) per application.

In order for your application to be considered complete it must have the following:
ü Application Fee (money order – cash is not accepted).
ü All adult member(s) sign, print, and date the Authorization for release of Information (page 1).
ü All adult member(s) complete, sign and date a Verification Checklist (page 7 & 8).
(Should you need additional checklists, please contact the site office)
ü All adult member(s) sign and date page 6 of the application.
ü Social Security number and date of birth for all household members.
ü All adult members must also provide a copy of their social security card and current I.D. with the application.
ü Current address for all adult members.
ü Name, address, and phone number for all income, assets, and expenses listed on the application (i.e.,
employer, financial institute, childcare provider, medical provider, etc).
ü Name, address, and phone number for current and previous landlord/mortgage holder for all adult members.

Again, thank you for giving us the opportunity to help provide you and your family a new home.
Please do not hesitate to call us at the number above should you have any questions or need help in
completing the enclosed application.

Sincerely,

Jeanne Rebedew
Site Manager
Lexington Woods Apts

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades
 HOW DID YOU HEAR ABOUT US???

Please take a minute and check off how you heard about us. This helps us best determine ways of
getting information out to prospects.

Thank you

⃝ Newspaper classified advertisement

⃝ Published publication (free newspaper, Magazine, rental booklet)

⃝ Flyer or tear-sheet in public venue (store, post office, laundry mat etc)

⃝ A friend or family member

⃝ gardnergroupofmichigan.com

⃝ Property website

⃝ Online advertising (Rentlinx, Michigan housing locator, Zillow, etc.)

⃝ Service provider (FIA, MI Works etc.)

⃝ Current Resident

⃝ Direct Mailer

⃝ Chamber of commerce

⃝ Local Real Estate agent

⃝ Drive by

⃝ Other:___________________________________________________________________
RD Approved APPLICATION FOR OCCUPANCY

Lexington Woods Apartments

OF Cedar Springs, M ICHIGAN
Mailing Address: 8180 Cook Street, Montague MI 49437
(231)893-2739 Fax (231)893-5501 TDD/TTY DIAL 711
For Office Use Only
Date Rcvd:_______
Time:___________

AUTHORIZATION for Release of Information

CONSENT
I authorize and direct any Federal, State, or local agency, organization, business, or individual to release to and verify my application for participation, and/or maintain
my continued assistance under the Section 8, Rental Rehabilitation, Low-Income Public and Indian Housing, Section 515/8 and/or other housing assistance programs. I
understand and agree that this authorization or the information obtained with its use may be given to and used by the USDA RHS, Rural Development administering and
enforcing program rules and policies. I also consent for USDA RHS, Rural Development, or the manager to release information from my file about my rental history to USDA
RHS, Rural Development, credit bureaus, collection agencies, or future property owners. This includes records on my payment history, and any other violations of my lease or
occupancy policies.

INFORMATION COVERED
I understand that, depending on program policies and requirements, previous or current information regarding my household or me may be needed. Verifications and
inquiries that may be requested, include but are not limited to:
Identity and Marital Status Employment, Income, and assets
Medical or Child Care allowances Credit and Criminal Activity
Residences and Rental activity

GROUP OR INDIVIDUAL THAT MAY BE ASKED

The groups of individuals that may be asked to release the above information (depending on program requirements) include but not limited to:

Previous Landlords (including Public Housing Agencies) Employers Courts and Post Offices
Welfare Agencies Schools and Colleges State Unemployment Agencies
Law Enforcement Agencies Social Security Administration Medical & Childcare Providers
Support and Alimony Providers Retirement Systems Veterans Administration
Utility Companies Bank & Other Financial Institutions Credit Providers and Credit Bureaus

CONDITIONS
I agree that a photocopy of this authorization may be used for the purpose stated above. The original of this authorization is on file in the management office and will
stay in effect for a year and one month from the date signed. I understand I have the right to review my file and correct any information that I can prove is incorrect. I certify that
the unit applied for will be my household’s primary residence and my household and I will not maintain a separate subsidized rental unit in a different location.

SIGNATURES:
______________________________________ ______________________________________________ _______________
Head of Household (Print Name) Date

______________________________________ ______________________________________________ _______________

Spouse (Print Name) Date

______________________________________ _______________________________________________ _______________

Adult Member (Print Name) Date

______________________________________ _______________________________________________ _______________

Adult Member (Print Name) Date

NOTE: THIS GENERAL CONSENT MAY NOT BE USED TO REQUEST A COPY OF A TAX RETURN. IF A COPY OF A TAX RETURN IS NEEDED, INS
FORM 4506, “REQUEST FOR COPY OF TAX FORM” MUST BE PREPARED AND SIGNED SEPARATELY.

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades
1
 Preliminary Rental Application
Please note that this is a preliminary application and gives no lease or rent rights.

Community Lexington Woods Apts. Office Phone (231) 893-2739 Date _________________
Unit Size: 1 2 3 4 Unit Type: Apartment Studio Townhouse (circle one)
Would you or a member of your household benefit from the design features of a barrier free unit YES or NO?
Would you like to request a disability adjustment to income? YES or NO?
Applicant: _________________________Email__________________________Phone (__)_____________________
Co-Applicant: _____________________Email__________________________Phone (__)_____________________
Applicant History

Applicant Co-Applicant
Current Address: Current Address:

Date: From____________ Rent $: Date: From____________ Rent $:

To:__________________ To:__________________
Reason for Moving: Reason for Moving:
Current Landlord: Current Landlord:
Address: Address:
Phone: Phone:

Previous Address: Previous Address:

Date: From____________ Rent $: Date: From____________ Rent $:

To:__________________ To:__________________
Reason for Moving: Reason for Moving:
Current Landlord: Current Landlord:
Address: Address:
Phone: Phone:

Previous Address: Previous Address:

Date: From____________ Rent $: Date: From____________ Rent $:

To:__________________ To:__________________
Reason for Moving: Reason for Moving:
Current Landlord: Current Landlord:
Address: Address:
Phone: Phone:
If you have resided at additional addresses within the past five (5) years please attach the information on a separate sheet.

The information contained in this application is treated confidentially. No information will be revealed to anyone
without the express written consent of the applicant.

_____________________________________ ______________________________________
Head of Household Date Co-Applicant, Spouse/Co-Head Date

This institution is an equal opportunity provider

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."
 Please list all persons that will occupy the residence.
Name Maiden Name Relationship of Social Security
(First, Middle Initial, Last)
Date of Birth Head of Household
(If applicable) Number
1. Head of Household
2.
3.
4.
5.
6.
Employment
Applicant Co-Applicant
Employer: Employer:
Address: Address:

Phone: Phone:
Length of Employment: Length of Employment:
Position: Position:
Salary/wage: Per: Salary/wage: Per:
Supervisor: Supervisor:
Status: Full-time: Part time: Status: Full-time: Part time:
List average hours per week worked: List average hours per week worked:
Total household income from all other sources: (i.e. Social Security pension, Child Support, Section 8 Certificate, etc.
Source:______________________________________ Amount: ______________________________________
Source:______________________________________ Amount: ______________________________________
Source:______________________________________ Amount: ______________________________________

Do you or any member of your household engage in current illegal use or illegal distribution of a controlled
substance or have you previously been convicted of the same? YES or NO (Circle one)

If you answered “yes” to the above question, have you successfully completed a controlled substance abuse
program or are you presently enrolled in such a program? YES or NO (Circle one)

Provide asset information below:

Type of Assets Name of Bank Balance Rate
Stock or Bond
Account Number
Current Value Dividend Real Estate
of interest
1.
2.
3.
4.
5.
Have you disposed of any assets in the last two years? Yes or No?
If “yes” please list asset and value received: __________________________________________________

This institution is an equal opportunity provider

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."
NUMBER OF VEHICLES ____________

1. MAKE/MODEL__________________ YEAR______ COLOR_________________ TAG#_______________ STATE_________

2. MAKE/MODEL__________________ YEAR______ COLOR _________________ TAG#_______________ STATE_________

DRIVER’S LICENSE/ID#S
Applicant_________________________
Co-Applicant____________________________________
PERSON TO CONTACT IN CASE OF EMERGENCY

NAME__________________________________________________________ RELATIONSHIP____________________________

TELEPHONE_______________________ ADDRESS_________________________________________________________________

YOU’RE NEEDS: a. Do you request DISABILITY ADJUSTMENT to income? ___________

b. Do you request BARRIER FREE ACCESSIBLE UNIT? ____________
c. Do you request or think you may be eligible for ELDERLY STATUS adjustment to Income? ________
d. Indicate if you are 62 years of age or over and/or disabled of any age to qualify for an elderly project
___________________________________________

OTHER UNITS:Circle a. I certify that the unit applied for will be my household’s primary residence; and
BOTH or indicate why
b. I and my household do not and will not maintain a separate subsidized rental unit in a
Different location. If not true, describe: _____________________________________

2. NET INCOME FROM BUSINESS/PROFESSION OR REAL ESTATE OR PERSONAL PROPERTY

____________________________________________ $____________ per____________

____________________________________________ $____________ per____________

3. SOCIAL SECURITY / SSI PAYMENTS

HOUSEHOLD MEMBER

_______________________________________ Social Security ___________________ $____________ per month

_______________________________________ Social Security ___________________ $____________ per month

_______________________________________ SSI_____________________________ $____________ per month

_______________________________________ SSI_____________________________ $____________ per month

_______________________________________ STATE SSI______________________ $____________ per month

_______________________________________ STATE SSI______________________ $____________ per month

4. PENSIONS; ANNUITIES; RETIREMENT FUNDS; IRA ACCOUNTS

HOUSEHOLD MEMBER SOURCE, ADDRESS AND PHONE #

_____________________________________ _____________________________________ $__________ per hr.________

_____________________________________

_____________________________________ _____________________________________ $__________ per hr.________

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades

4
5. ALL OTHER INCOME –Include income from ALL OTHER SOURCES, such as: Unemployment; Disability Compensation;
allowances for Head of Household in Armed Forces; Public Assistance; AFDC; Welfare, Interest, dividends,
and other income of any kind from real or personal property.

HOUSEHOLD MEMBER SOURCE, ADDRESS, AND PHONE #

___________________________ ______________________________________ $__________per hr._________

___________________________ ______________________________________ $__________per hr._________

6. CHILD CARE EXPENSE –List amount paid by family for the care of minor children under 13 years of age when such care is necessary to enable a
member of the family to be employed or to further his or her education.

NAMES & ADDRESS OF CHILD CARE PROVIDER

_________________________________________________________________ $__________per hr, $ _________per week

_________________________________________________________________

7. ATTENDANT CARE & AUXILIARY APPARATUS EXPENSES: List amount paid by family for each member of the family who is a person
with disabilities, to the extent necessary to enable any member of the family to be employed.

NAME & ADDRESS OF ATTENDANT CARE OR AUXILIARY APPARATUS PROVIDER

________________________________________________________________ $____________per week / month

________________________________________________________________ $____________per week / month

8. MEDICAL EXPENSES (To be completed for Elderly Families)-Include total expenses including anticipated medical expenses to be incurred
over the next twelve months. Nursing home care paid from tenant family(s). List additional medical expenses (include name and address) on back of this
page.

NAME & ADDRESS OF MEDICAL PROVIDER(S)

________________________________________________________________ $____________per month

________________________________________________________________ $____________per month

________________________________________________________________ $____________per month

________________________________________________________________ $____________per month

9. MEDICARE HOUSEHOLD MEMBER

________________________________________________________ $____________per month

________________________________________________________ $____________per month

C. ASSET INFORMATION – List all information for Tenant, Spouse, and Co-Tenant

1. CASH ON HAND – List all amount on hand at present time: (Not in Bank) BALANCE $______________

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades

5
 “I/We certify that the rental which I/We occupy will be my/our primary residence and further certify that I/We do not and will
not maintain a separate subsidized rental unit in a different location.”

“I/we certify that I/we are not presently using or addicted to a controlled substance, nor have I/we ever been convicted of possession
or distribution of a controlled substance.”

“I/we hereby acknowledge that my application for occupancy may be denied for various reasons, including but not limited to: a
poor rental payment history, bad credit, failure to properly care for a past residence, a history of disturbing neighbors, a history of
violations of previous rental agreements or past evictions.”

“I/we hereby acknowledge that the landlord may refuse to add persons to my lease as lawful occupants of the premises, should the
landlord find that such persons do not meet the landlord’s lawful tenant selection criteria, regardless of any familial or martial
relationship between myself and the prospective tenant.”

“I/we certify that all of the information on this application is true and correct to the best of my/our knowledge and belief.
Inquiries may be made to verify this information.

_________________________________________________ _____________
Applicant’s Signature Date

_________________________________________________ _____________
Co-applicant’s Signature Date

The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure the Federal Government,
acting through Rural Development, that Federal Laws prohibiting discrimination against tenant applications on the basis of race, color, national
origin, religion, sex, familial status, age, 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. However, if you choose not to furnish
it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Applicant: I do not wish to furnish this information. ___________________

Co-Applicant: I do not wish to furnish this information. ___________________

PLEASE COMPETE ALL SECTIONS

ETHNICITY: Applicant: ( ) …Hispanic or Latino Co-Applicant: ( ) …Hispanic or Latino

( ) …Not Hispanic or Latino ( ) …Not Hispanic or Latino

RACE: (Select one or more) Applicant Co-Applicant

( ) . . . . . . . . . . .American Indian, Alaska Native. . . . . . . . . . . ( )

( ) . . . . . . . . . . . . . . . . . Asian . . . . . . . . . . . . . . . . . . . . . . . . . ( )

( ) . . . . .. . . . . . Black/African American . . . .. . . . . . . . . . . . . ( )

( ) . . . . .. . . . . . Native Hawaiian/Pacific Islander . . .. . . . . . . ( )

( ) . . . . . . . . . . . . . . . . . White . . . . . . . . . . . . . . . . . . . . . . . . ( )

GENDER: Applicant Co-Applicant

( ) Male ( ) Female ( ) Male ( ) Female

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades
6
 VERIFICATION CHECKLIST
FOR RURAL DEVELOPMENT APARTMENT COMMUNITIES

Apartment Community
Please complete a separate form for each household member (excluding members under 18)

Name __________________________________________________ Apt. #_______ New Move-in_______ Recertification _______

YES NO
____ ____ I receive income from full and/or part - time employment
____ ____ I am an independent contractor and/or self employed
____ ____ I regularly receive cash contributions or gifts from persons not living with me (include rent or utility)
____ ____ I receive periodic payments from Worker’s Compensation
____ ____ I receive Veteran’s Administration benefits
____ ____ I receive G. I Bill benefits
____ ____ I receive disability or death benefits other than Social Security
____ ____ I receive Social Security
____ ____ I receive Supplemental Security Income (S.S.I.)
____ ____ I receive Public Assistance (Excluding Food Stamps and Medicaid).
____ ____ I receive educational grants or scholarships
____ ____ I receive unemployment benefits
____ ____ I receive child support or alimony
____ ____ I receive periodic payments from trust, annuities or inheritance
____ ____ I receive periodic payments from insurance policies
____ ____ I receive periodic payments from retirement funds or pensions
____ ____ I receive periodic payments from lottery winnings
____ ____ I receive income from rental of real or personal property
____ ____ I have real estate, land contracts, or mobile homes
____ ____ I have income from Interest, dividends, and/or other net income from real or personal property not listed above.
____ ____ I have checking account(s). How many banks? ____
____ ____ I have saving account(s). How many banks? ____
____ ____ I have time certificates(s). How many banks? ____
____ ____ I have certificates of deposit. How many banks? ____
____ ____ I have IRA’s or Keogh accounts
____ ____ I have treasury bills
____ ____ I have stocks
____ ____ I have bonds
____ ____ I have personal property held for investments (gems, jewelry, coin collections, etc.)
____ ____ I have disposed of assets within the last two (2) years.
____ ____ I pay child care expenses (to be gainfully employed or to further education) for children under 13
____ ____ I am eligible for unreimbursed reasonable attendant care and auxiliary apparatus expenses for each person of the
family who is a person with disabilities, to the extent necessary to enable any member of the family to be employed.
____ ____ I pay Medicare premiums
____ ____ I pay medical insurance premiums others than Medicare
____ ____ I pay medical or prescription expenses which are not reimbursed by insurance
____ ____ I need two (2) bedrooms for Medical reasons
____ ____ I need a Barrier Free Unit
____ ____ I am eligible for “elderly status” income adjustment, that being, I am 62 years of age or disabled.
____ ____ I am a full time student.

I/WE ACKNOWLEDGE THAT IF THIS IS AN APPLICATION FOR A LOW INCOME HOUSING TAX CREDIT COMMUNITY THAT I/WE
MUST FIRST MEET IRS SECTION 42 REQUIREMENTS IN ORDER TO BE CONSIDERED FOR TENANT SELECTION.
I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, ALL STATEMENTS ARE TRUE AND THAT WHEN CIRCUMSTANCES CHANGE, I
WILL NOFIFY THE MANAGER FOR POSSIBLE RECERTIFICATION. I UNDERSTAND THAT FAILURE TO DISCLOSE ALL ASSETS AND INCOME
WILL RESULT IN EVICTION FROM THIS APARTMENT COMMUNITY AND RECAPTURE OF UNEARNED RENT SUBSIDES.

_________________________________________ __________________________________ ___________

Signature-Applicant or Resident Witness-Agent for Management Date

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades

7
 VERIFICATION CHECKLIST
FOR RURAL DEVELOPMENT APARTMENT COMMUNITIES
Apartment Community
Please complete a separate form for each household member (excluding members under 18)

Name __________________________________________________ Apt. #_______ New Move-in_______ Recertification _______

YES NO
____ ____ I receive income from full and/or part - time employment
____ ____ I am an independent contractor and/or self employed
____ ____ I regularly receive cash contributions or gifts from persons not living with me (include rent or utility)
____ ____ I receive periodic payments from Worker’s Compensation
____ ____ I receive Veteran’s Administration benefits
____ ____ I receive G. I Bill benefits
____ ____ I receive disability or death benefits other than Social Security
____ ____ I receive Social Security
____ ____ I receive Supplemental Security Income (S.S.I.)
____ ____ I receive Public Assistance (Excluding Food Stamps and Medicaid).
____ ____ I receive educational grants or scholarships
____ ____ I receive unemployment benefits
____ ____ I receive child support or alimony
____ ____ I receive periodic payments from trust, annuities or inheritance
____ ____ I receive periodic payments from insurance policies
____ ____ I receive periodic payments from retirement funds or pensions
____ ____ I receive periodic payments from lottery winnings
____ ____ I receive income from rental of real or personal property
____ ____ I have real estate, land contracts, or mobile homes
____ ____ I have income from Interest, dividends, and/or other net income from real or personal property not listed above.
____ ____ I have checking account(s). How many banks? ____
____ ____ I have saving account(s). How many banks? ____
____ ____ I have time certificates(s). How many banks? ____
____ ____ I have certificates of deposit. How many banks? ____
____ ____ I have IRA’s or Keogh accounts
____ ____ I have treasury bills
____ ____ I have stocks
____ ____ I have bonds
____ ____ I have personal property held for investments (gems, jewelry, coin collections, etc.)
____ ____ I have disposed of assets within the last two (2) years.
____ ____ I pay child care expenses (to be gainfully employed or to further education) for children under 13
____ ____ I am eligible for unreimbursed reasonable attendant care and auxiliary apparatus expenses for each person of the
family who is a person with disabilities, to the extent necessary to enable any member of the family to be employed.
____ ____ I pay Medicare premiums
____ ____ I pay medical insurance premiums others than Medicare
____ ____ I pay medical or prescription expenses which are not reimbursed by insurance
____ ____ I need two (2) bedrooms for Medical reasons
____ ____ I need a Barrier Free Unit
____ ____ I am eligible for “elderly status” income adjustment, that being, I am 62 years of age or disabled.
____ ____ I am a full time student.

I/WE ACKNOWLEDGE THAT IF THIS IS AN APPLICATION FOR A LOW INCOME HOUSING TAX CREDIT COMMUNITY THAT I/WE
MUST FIRST MEET IRS SECTION 42 REQUIREMENTS IN ORDER TO BE CONSIDERED FOR TENANT SELECTION.

I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, ALL STATEMENTS ARE TRUE AND THAT WHEN CIRCUMSTANCES CHANGE, I
WILL NOFIFY THE MANAGER FOR POSSIBLE RECERTIFICATION. I UNDERSTAND THAT FAILURE TO DISCLOSE ALL ASSETS AND INCOME
WILL RESULT IN EVICTION FROM THIS APARTMENT COMMUNITY AND RECAPTURE OF UNEARNED RENT SUBSIDES.

_________________________________________ __________________________________ ___________

Signature-Applicant or Resident Witness-Agent for Management Date

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades
8
 Lexington Woods APARTMENTS
OF Cedar Springs, M ICHIGAN
Mailing Address: 8180 Cook St., Montague, MI 49437 * (231) 899-2739 Fax (231) 893-5501
TDD/TTY DIAL 711

VERIFICATION OF RENTAL HISTORY

RE: ___________________________________________________________________________ (Tenant)

TO: ___________________________________________________________________________ (Current Landlord)

FROM: __________________________________________________________________ (Employee Name & Phone #)

The above identified person has applied for residency at ______________________________________ and has indicated to us that you now have (or
recently had) this family as a tenant in your property located at:
__________________________________________________________________________________________
As indicated by this person’s signature noted below, the tenant consents to the release of information pertaining to their rental history as
___________________________________________________. We would greatly appreciate your cooperation in completing the applicable areas below.

PLEASE ANSWER THE FOLLOWING QUESTIONS REGARDING THE TENANT’S RENTAL HISTORY:

1. How long has the above tenant resided at this address? _______________________________________________
2. How many bedrooms? _________________________________________________________________________
3. What is the monthly rental? _____________________________________________________________________
4. Has the tenant ever been behind in the payment of the monthly rent? _____________________________________
5. How often has the tenant been late in the payment of the monthly rent? ___________________________________
6. What type of damages, if any, has the tenant caused in the unit or on common property? _____________________
____________________________________________________________________________________________
7. Has the tenant been charged for any damages to the unit? ______________________________________________
If so, how much? ______________________________________________________________________________
8. Has any action ever been taken against the tenant for disturbing other tenants, or controlling the behavior of other household
members or guests? ________________ If so, what type of action? _______________________________________
____________________________________________________________________________________________
9. If this tenant moved and reapplied for housing in the future, would you rent to him/her again?__________ If not,
Why? _______________________________________________________________________________________
10. Additional Comments:_________________________________________________________________________
___________________________________________________________________________________________

DATE: _________________________ SIGNATURE____________________________________________________

TITLE: ______________________________________ PHONE NUMBER___________________________________

TENANT SIGNATURE ___________________________________________________________________________

“APPLICANT PLEASE SIGN BOTTOM OF PAGE WHERE HIGHLIGHTED ONLY – DO NOT FILL IN FORM”

This institution is an equal opportunity provider

Esta instituciòn es un proveedor de servicios con igualdad de oportunidades
9
 Resident Selection Criteria

We take pride in our management and in our Community. We actively seek good residents to make their homes with
us, and we strive to provide the best service we possibly can while they live in our Community. We screen all our
applicants very carefully and we verify all information provided to us on the rental application you complete and from
other sources available to us.

All adult applicants 18 or older must submit a fully completed, dated, and signed residency application. Applicant
must provide proof of identity in the following forms, drivers license or state issued picture ID and social security
card.

An applicant’s household income must be stable and adequate to afford the rent and still be able to cover the rest of
his/her household expenses. The Gardner Management standard for rent affordability is that no more than 50% of
household income should be used for rent. Exceptions can be made only if the applicant will be receiving subsidy.

The number of members in a household, relative to the size of the apartment must meet local and/or state housing
standards. To prevent overcrowding and undue stress on plumbing and other building systems, we restrict the number
of people who may reside in a rental unit. Occupancy policies set standards regarding the number of persons that can
be adequately housed in a unit of a particular size. In developing the occupancy policy for each unit, the owner will
take into account the following:
• State and local codes regarding the number of persons permitted to dwell in a unit of a particular size;
• The size of the rooms in the particular unit;
• Procedures for sizing households for different unit types (how to consider temporarily absent households
members); and
• The order in which the property will house eligible applicants and re-house existing tenants.
• A tenant who is disabled will not be considered over housed if the tenant requests an additional room for a
live-in aide or an apparatus related to the tenant’s disability.

In determining these restrictions, we adhere to all applicable Fair Housing Laws.

Credit Checks must not contain any of the following:

1. Unpaid landlord judgments or evictions,
2. Unpaid utility collections, or
3. Extensive history of bad checks.

Criminal History:

All applicants must consent to a criminal background investigation, which will be conducted in accordance with the
Fair Credit Reporting Act, as amended.

The results of this investigation, along with other qualifying factors, will determine whether the applicant is qualified
to lease the apartment.

This institution is an equal opportunity provider

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."
With respect to criminal history, an applicant shall not be approved based on any of the following information:

1. Any applicant or household member is currently engaging in or has engaged in during a reasonable time as
determined by the owner or Gardner Management before the submission of the application of any of the
following:
a. Drug-related criminal activity,
b. Violent criminal activity,
c. Other criminal activity that would threaten the health, safety, or peaceful enjoyment of the property
by other residents; or
d. Other criminal activity that would threaten the health or safety of the owner or any employee,
contractor, subcontractor or agent of the owner or Gardner Management who is involved in the
management and/or maintenance of property.

2. If the applicant or household member was evicted in the past three years from federally assisted housing for
drug related criminal activity (unless the evicted member has successfully completed an approved supervised
drug rehabilitation program or the family member who was responsible for the eviction is not part of the
application).

3. An applicant or household member who is currently engaged in the illegal use of drugs or whose illegal use
of drugs or pattern of illegal use of drugs would likely interfere with the health, safety or the peaceful
enjoyment of the property by other residents.

4. An applicant or household member is subject to a state sex offender lifetime registration requirement.

5. An applicant or household member for whom there is reasonable cause to believe that a household
member’s abuse or pattern of abuse of alcohol interferes with the health, safety, and the peaceful enjoyment of
the community by other residents (This provision will be enforced consistent with the Fair Housing Act; the
fact that the applicant has an alcohol problem is not grounds, by itself, to deny the application).

Reconsideration
If you receive a denial due to information obtained from your criminal history screening and feel that you have new
supporting information to add for reconsideration, please submit a request in writing with any supporting
documentation to the site manager.

Our Community is a No Pet Community

Previous rental history reports from landlords must reflect timely payment, sufficient notice of intent to vacate, no complaints
regarding noise, disturbances or illegal activities, no unpaid NSF checks and no damage to unit or failure to leave the property
clean and without damage at time of lease termination.

Applicants will be required to pay a security deposit at the time of lease execution. Applicants must be able to put utilities in
their name and be able to pay any utility deposits that may be required.

Our company policy is to report all non-compliance with terms of your rental agreement or failure to pay rent, or any amount
owed to the collection agency and to the credit bureau.

This institution is an equal opportunity provider

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."
The purpose of this policy outlined at 7 CRF 3560.155 (e) and HB-2-3560. Asset Management Handbook
Chapter 6, concerning Occupancy Policies in Rural Development Section 515

Assigning an Available Unit:

Once a unit becomes available, the borrower must decide who is entitled to that unit based on a variety of factors.
Eligible tenants residing in the property who are either under-or over-housed receive priority over new applicants
if relocating them into the newly vacant unit would bring the household into compliance with the occupancy
policy for the property. If there are no such over or under-housed existing tenants, the borrower must use the
Project’s occupancy policy to look at applicants on the waiting list who are eligible based on the unit size. From
the universe, the borrower must determine, based on income levels and proprieties, which applicant is entitled to
the unit. The order in which applicant households are entitled to housing depends on two factors:
• The income level of the household; and
• The priorities for which the household may qualify.
When an applicant first submitted an application, the borrower made an initial determination as to whether the
The household was very low-, low-, or moderate-income. Based on this assessment, the applicant was assigned to
the very low-, low-, or moderate-income waiting list. When looking for the next eligible tenant for the vacant unit,
the borrower must first go to the very-low income waiting list. If there are no applicants on the very-low income
waiting list who qualify for the vacant unit based on the property’s occupancy policy, then the borrower may go to
the low-income waiting list. Only if there are no eligible applicants for the unit on the low-income waiting list may
the borrower select an eligible applicant from the moderate-income waiting list.

We are an equal opportunity housing provider. We fully comply with all Federal Fair Housing Laws. We do not discriminate
against any person because of race, color, religion, sex, handicap, familial status, or national origin, sexual orientation and
reprisal. We also comply with all state and local Fair Housing Laws.

Please sign and date this letter and return with application(s).

_________________________________________________ _________________________
Signature Date

_________________________________________________ _________________________
Signature Date

This institution is an equal opportunity provider

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."
Full Nondiscrimination Statement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights
regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating
in or administering USDA programs are prohibited from discriminating based on race, color, national
origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age,
marital status, family/parental status, income derived from a public assistance program, political
beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or
funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary
by program or incident.

Persons with disabilities who require alternative means of communication for program information
(e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible
Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the
Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in
languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint
Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any
USDA office or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992.

Submit your completed form or letter to USDA by:

(1) Mail: U.S. Department of Agriculture

Office of the Assistant Secretary for Civil Rights

1400 Independence Avenue, SW

Washington, D.C. 20250-9410;

(2) Fax: (202) 690-7442; or

(3) Email: [email protected].

USDA is an equal opportunity provider, employer, and lender.

Full Nondiscrimination Statement (Spanish)

De acuerdo con la ley federal de derechos civiles y las reglamentaciones y politicas de

derechos civiles del Departamento de Agricultura de Estados Unidos (U.S. Department of
Agriculture, USDA), se prohibe al USDA, sus agencias, oficinas y empleados, e instituciones
que participan o administran los programas del USDA, discriminar por motivos de raza,
color, origen nacional, religion, genero, identidad de genero (incluidas las expresiones de
genero), orientaciòn sexual, discapacidad, edad, estado civil, estado familiar/parental,
ingresos derivados de un programa de asistencia publica, creencias politicas, o reprimendas o
represalias por actividades previas sobre derechos civiles, en cualquier programa o actividad
llevados a cabo o financiados por el USDA (no todas las bases se aplican a todos los programas).
Las fechas limite para la presentaciòn de remedios y denuncias varian segun el programa o el
incidente.

Las personas con discapacidades que requieran medios altemativos de comumicaciòn para
obtener informaciòn sobre el programa (por ej., Braille, letra grande, cinta de audio, lenguaje
americano de sefias, etc.) deberan comunicarse con la Agencia responsable o con el Centro
TARGET del USDA al (202) 720-2600 (voz y TTY) o comunicarse con el USDA a trnvcs del
Servicio Federal de Transmisiones al (800) 877-8339. Asimismo, se pucde disponer de
infotmaciòn del programa en otros idiomas aciemas de ingles.

Para presentar una denuncia por discriminaciòn en el programa, complete el Formulario de

denuncias por discriminaciòn en el programa del USDA, AD-3027, que se encuentra en linea
en http://www.ascr.usda.gov/complaint filing cust.html, o en cualquier oficina del USDA, o
escriba una carta dirigida al USDA e incluya en la carta toda la informaciòn solicitada en el
formulario. Para solicitar una copia del formulario de denuncias, Bame al (866) 632-
9992. Envie su formulario completado o su carta al USDA por las siguientes medias: correo:
U.S. Department of Agriculture,
Office of the Assistant Secretary for Civil Rights, 1400
Independence Avenue, SW
Washington, D.C. 20250-9410;

(1) fax: (202) 690-7442; or

(2) correo electrònico: [email protected].

"Esta instituciòn es un proveedor de servicios con igualdad de oportunidades."