KESTREL PARK TOWNHOMES

APPLICATION FOR KESTREL PARK TOWNHOMES

2401 14TH ST E, GLENCOE, MN 55336
PLEASE CALL THE PROPERTY YOU'RE APPLYING FOR TO CHECK AVAILABILITY BEFORE COMPLETING AN APPLICATION.
- A $30 application fee will be due at the end of this application.
- A holding fee will also be required to HOLD your unit. This fee will go towards your deposit and will be collected by the Property Manager. (Please consult with the property manager). Until this fee is paid a unit will not be held for you.
- Please use "CAPS LOCK" for all answers.
- ALL household members over the age of 18 and who are not legally married MUST complete a sepearate application.

Resident Selection Criteria

Please read the below resident selection criteria before continuing.
Applicant(s) hereby acknowledge that they have read and received a copy of the Resident Selection Criteria at the time of this application.
Acknowledged and Agreed: *

Clear
Date *

Month Day Year
Date
Acknowledged and Agreed:

Clear

Part V - Special Needs

To be completed by applicant.
Does anyone in your household have special needs? *

Yes No
Special living accommodations required? *

Yes No
If yes, please explain. *
Does your household have any needs that might be better served by a unit which is accessible to persons with mobility, hearing or visual impairments? *

Yes No

Part VI - In Case of Emergency, Notify.

To be completed by applicant.
Emergency Contact #1
Name *

First Name Last Name
Relationship *
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contact #2
Name *

First Name Last Name
Relationship *
Phone Number *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Documents Upload
Please upload the following documents:
- Copies of Identification Cards (Drivers License or ID)
- Copies of Social Security Cards
File Upload

Cancel of

Part X - Resident's Statement

To be completed by applicant.
I/we understand that the above information is being collected to determine my/our eligibility for residency. I/
we authorize the owner/manager to verify all information provided on this Application/Certification and my/our
signature is our consent to obtain such verification. I/we certify that I/we have revealed all assets currently held
or previously disposed of and that I/we have no other assets than those listed on this form (other than personal
property). I/we further certify that the statements made in this Application/Certification are true and complete to
the best of my/our knowledge and belief and are aware that false statements are punishable under Federal law.

Any applicant, who purposefully falsifies, misrepresents or withholds any information related to program eligibility or
submits inaccurate and/or incomplete information on this application will not be considered for housing.
SIGNATURE OF ALL PARTIES TO THIS APPLICATION, 18 YEARS OR OLDER:
Applicant Signature (Head of Household) *

Clear
Date *

Month Day Year
Date
Applicant Signature (Co-Head of Household)

Clear
Date

Month Day Year
Date
Other Applicant Signature

Clear
Date

Month Day Year
Date
Did this application require special assistance in completing? *

Yes No
This application required assistance in completing due to: *
Assistance was provided by: *

First Name Last Name
Date assistance was provided. *

Month Day Year
Date

Authorization to Release Confidential Information

Housing Tax Credit Program

As a condition of participating in an affordable housing program, I understand the property owner is required to initially
and annually certify each resident’s eligibility for such program. Consequently, I understand it is necessary for me to
give authorization for specific income, asset, medical, and childcare expense information to be provided on one or more
of the following forms:

Employment
Unemployment
Self-Employment
Social Security/SSI
Public Assistance
Regular Contributions
Alimony/Child Support
Student Status & Financial Aid
Landlord Verification
Life Insurance

Military Pay
Veteran's Benefit
Worker's Compensation
Bank
Pension/Annuity
Stocks/Bonds
Real Estate
Disability Status
Medical Providers
Trust Accounts

This authorization is limited to the forms listed above and expires 365 days after the date of my signature below unless revoked in writing by me earlier. By my signature below, I authorize the representative individuals to disclose my specific income, asset, and medical information as requested on the forms above. No other information may be released without my express written authorization.

Signature *

Clear
Printed Name *

First Name Last Name
Date *

Month Day Year
Date
By the signature of its authorized management agent, and in consideration for execution of this Authorization by
the applicant/resident, property representative warrants the following:
1. Information requested on the above form is required and necessary to complete certification of the
  applicant/resident’s eligibility to reside in the above housing property;
2. The information requested above will be used for no purpose other than determining such
  applicant/resident’s eligibility; will be maintained as confidential personal information subject to disclosure
  only as required by property administrative or judicial process, and will not be otherwise disclosed by the
  property owner or management; and
3. The property owner and management have instituted procedures that insure all personally identifiable
  information provided pursuant to this authorization will be maintained in electronic or magnetic form,
  sufficient to protect such information form any unauthorized use, access, or disclosure.

General Consent Release
Maiden/Former Name (if applicable)

First Name Last Name
Drivers License/ID Number *
State *
Employment
Current Job (# of Years)
Current Job Income (Monthly)
I authorize RENTBUREAU and MetroPlains to investigate my criminal history, residential, employment and income history, and bank and credit history for the purpose of housing and/or employment. The source of the information may come from, but is not limited to: Credit Bureaus; banks and other depository institutions; current and former employers; federal or state records including State Employment Security Agency records, county or state criminal records as follows, or other sources s required. It is understood that a photocopy or facsimile copy of this form will serve as authorization.

This authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.
Applicant's Signature *

Clear
Date *

Month Day Year
Date
Have you lived in any other state? *

Yes No
If yes, please list city, county, state. *
If additional state, please list city, county, state.
Is there a spouse also applying to live at the property included on this application? (If yes, you'll be asked to include the general release of information for that individual as well.) *

Yes No
Date *

Month Day Year
Date
Hour Minutes AM/PM Option
(Spouse) Authorization to Release Confidential Information

Housing Tax Credit Program

Signature *

Clear
Printed Name *

First Name Last Name
Date *

Month Day Year
Date
By the signature of its authorized management agent, and in consideration for execution of this Authorization by
the applicant/resident, property representative warrants the following:
1. Information requested on the above form is required and necessary to complete certification of the
  applicant/resident’s eligibility to reside in the above housing property;
2. The information requested above will be used for no purpose other than determining such
  applicant/resident’s eligibility; will be maintained as confidential personal information subject to disclosure
  only as required by property administrative or judicial process, and will not be otherwise disclosed by the
  property owner or management; and
3. The property owner and management have instituted procedures that insure all personally identifiable
  information provided pursuant to this authorization will be maintained in electronic or magnetic form,
  sufficient to protect such information form any unauthorized use, access, or disclosure.
(Spouse) General Consent Release
Spouse Full Name *

First Name Middle Name Last Name
Maiden/Former Name (if applicable)

First Name Last Name
Date of Birth *

Month Day Year
Date
Drivers License/ID Number *
State *
Social Security # *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Employment
Current Job (# of Years)
Current Job Income (Monthly)
I authorize RENTBUREAU and MetroPlains to investigate my criminal history, residential, employment and income history, and bank and credit history for the purpose of housing and/or employment. The source of the information may come from, but is not limited to: Credit Bureaus; banks and other depository institutions; current and former employers; federal or state records including State Employment Security Agency records, county or state criminal records as follows, or other sources s required. It is understood that a photocopy or facsimile copy of this form will serve as authorization.

This authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.
Applicant's Signature *

Clear
Date *

Month Day Year
Date
Have you lived in any other state? *

Yes No
If yes, please list city, county, state. *
If additional state, please list city, county, state.
Date *

Month Day Year
Date
Hour Minutes AM/PM Option

Application Fee Payment *

Kestrel Park Townhomes - Application Fee

$ 31.20

Total

$ 0.00

Credit Card

Should be Empty:

	Yes	No	Household Member #(s) (# Listed Above)	Gross Monthly Amount	Source of Income
Wages or Salaries (gross income)
Child Support (court ordered amount)
Alimony
Social Security and/or Railroad Pension
Supplemental Security Income (SSI)
Public Assistance (TANF, General Assistance)
Veterans Administration Benefits
Pensions, IRA, and/or 401(k) (Keogh Accounts) (Regular Periodic Payments)
Annuities (Regular Periodic Payments) (RMD's)
Unemployment Compensation
Disability, Death Benefits, Adoption Assistance and/or Life Insurance Dividends
Worker's Compensation
Severance Pay
Net Income from a Business (Self-Employment, Including Rental Property/Land)
Long-Term Medical Care Insurance Payments in Excess of $180/Day
Regular Cash & Non-Cash Contributions (Assistance with paying bills (including utilities), or gifts from companies, agencies, or individuals not living in the unit (not including groceries).
Lottery Winnings or Inheritances
All Regular Pay Paid to Members of the Armed Forces
Education, Grants, Scholarships or other Student Benefits
Other Income (Cash Payments)

	Yes	No	Household Member #(s)	Cash Value	Name of Bank or Institution
Savings Account
Checking Account (Demand Deposit Account) (6-Month Average Balance)
Certificate of Deposit
Prepaid Debit Card (Direct Express, NetSpend, Citibank, Reloadable Wal-Mart Cards, Red or Green Dot Cards, Etc.)
Trust Account
Real Estate or Contract for Deed
Retirement Fund / Annuities (Include 401k, IRA's or Keogh Accounts) (ONLY INCLUDE IF YOU HAVE ACCESS TO)
Mutual Funds
Saving Bonds
Money Market Account
Personal Property Held as an Investment (Collector or show car, stamp or coin collection, antiques, etc.)
Whole or Universal Life Insurance
Lump Sum Payments (Lottery winnings, inheritances, etc.)
Online Donation Accounts (GoFundMe, Kickstarter, Fundly, Local Bank)
Other

APPLICATION FOR KESTREL PARK TOWNHOMES

Resident Selection Criteria

Part III - Other

Part IV - Rental History

Part V - Special Needs

Part VI - In Case of Emergency, Notify.

Part VII - Household Income

Part VIII - Assets

Documents Upload

Part IX - Demographic Information

Part X - Resident's Statement

Authorization to Release Confidential Information

General Consent Release

(Spouse) Authorization to Release Confidential Information

(Spouse) General Consent Release

Credit Card