Parkview Apartments

Parkview Apartments ~ Winger, MN
Applicants Phone Number*
Applicant's Email*
example@example.com
All applicants, age 18 or older, other than co-head or spouse, are required to complete a separate application. Any applicant who purposefully falsifies, misrepresents or withholds any information related to program eligibility or submits inaccurate and/or incomplete information on this application or during the interview may be rejected for housing. All questions must be answered;

List the Head of Household and all other persons who will be living in the unit. Give the relationship of each family member to the head. Each household member age 18 years or older must sign this application.
Applicants Name*

First NameMiddle NameLast Name
Applicants Date of Birth*

MonthDayYear
Date
Applicants Social Security Number*
Student during this or upcoming calendar year?*
Is there any additional applicants?*

YesNo
Additional Applicants Full Name*
Relationship to Head*
2nd Applicants Date of Birth*

MonthDayYear
Date
2nd Applicants Social Security Number*
Student during this or upcoming calendar year?*
Race of Head of Household*

WhiteBlackAsian/Pacific IslanderAmerican Indian/Native American
Ethnicity of Head of Household*

HispanicNon Hispanic
Are you a Non-Citizen Student?*

YesNo
Are you a United States Citizen?*

YesNo
Current Housing Status Address*

Address

Street Address Line 2

CityState

Zip
Name of Landlord
Phone #
Landlord's Address
How long have you resided at your current address? From?*
To*
Previous Housing Address

Address

Street Address Line 2

CityState

Zip
Name of Landlord
Phone #
Landlord's Address
How long did you reside at this address? From?
To?
Household Member's Employer*
Employers Phone Number
Employers Address
Employers City
Employers State
Employers Zip Code
Start Date

MonthDayYear
Date
Position
Supervisor
Salary Frequency

HourlyWeeklyBi-WeeklyMonthlyAnnually
Salary $
Is there any additional Employers for Applicant's?
Additional Household Member's Employer
Employers Phone Number
Employers Address
Employers City
Employers State
Employers Zip Code
Start Date

MonthDayYear
Date
Position
Supervisor
Salary Frequency

HourlyWeeklyBi-WeeklyMonthlyAnnually
Salary $
Household Income Information

Do you receive or expect to receive...
Wages, salaries (includes overtime, tips, bonuses, commissions, self-employment?

YesNo
What is the Monthly Amount?
Does any member work for someone who pays them in cash?

YesNo
What is the Monthly Amount?
Regular pay for a member of the armed forces?

YesNo
What is the Monthly Amount?
Welfare or disability benefits (Examples: MFIP, SSI, etc)?

YesNo
What is the Monthly Amount?
Worker's compensation?

YesNo
What is the Monthly Amount?
Unemployment benefits or severance pay?

YesNo
What is the Monthly Amount?
Child support? (if court ordered, include even if it is not being received)

YesNo
What is the Monthly Amount?
Alimony?

YesNo
What is the Monthly Amount?
Social Security Payments (include unearned income of minor children)?

YesNo
What is the Monthly Amount?
Pensions (PERA, railroad, etc)?

YesNo
What is the Monthly Amount?
Retirement benefits?

YesNo
What is the Monthly Amount?
Death benefits?

YesNo
What is the Monthly Amount?
Annuities or life insurance dividends?

YesNo
What is the Monthly Amount?
Lump sum payment(s) (i.e., inheritance, insurance settlements, lottery winnings, capital gains)?

YesNo
What is the Monthly Amount?
Net income from rental property?

YesNo
What is the Monthly Amount?
Regular cash contributions or gifts from individuals not living in the unit?

YesNo
What is the Monthly Amount?
Household Assets

Do you have money held in.....
Checking Accounts?*

YesNo
Name of company/financial institution and location
Savings Accounts?*

YesNo
Name of company/financial institution and location
Stocks?*

YesNo
Name of company/financial institution and location
Capital Investments?*

YesNo
Name of company/financial institution and location
Bonds?*

YesNo
Name of company/financial institution and location
Trusts?*

YesNo
Name of company/financial institution and location
Securities?*

YesNo
Name of company/financial institution and location
Insurance Settlements?*

YesNo
Name of company/financial institution and location
401K?*

YesNo
Name of company/financial institution and location
IRA/KEOGH Accounts?*

YesNo
Name of company/financial institution and location
Certification of deposits?*

YesNo
Name of company/financial institution and location
Pension/retirement funds?*

YesNo
Name of company/financial institution and location
Money Market Funds?*

YesNo
Name of company/financial institution and location
Treasury Bills?*

YesNo
Name of company/financial institution and location
Safety Deposit Box?*

YesNo
Name of company/financial institution and location
Cash card to receive gov benefits?*

YesNo
Name of company/financial institution and location
Do you now own real estate?*

YesNo
Value $
Do you hold a contract for deed?*

YesNo
Value $
Do you have any coin collections, antique cars, gems/jewelry, stamps or any other items held as an investment (wedding rings and personal jewelry do not count)?*

YesNo
Value $
I/We hereby certify that I/We have or have not sold or disposed of any assets for less than Fair Market Value during the two year (24 month) period preceding the date of this application?*

I/We Have NotI/We have
HOUSEHOLD ALLOWANCE INFORMATION

Do you expect to incur any of the following expenses:
Child care which enables you or another household member to work, go to school or to seek employment?*

YesNo
Amount $
Attendant care for a handicapped or disabled household member so that an adult household member can work, seek employment or go to school?*

YesNo
Amount $
Medicare premiums?*

YesNo
Amount $
Other medical insurance premiums?*

YesNo
Amount $
Outstanding medical bills on which you are currently paying?*

YesNo
Amount $
Cost of assistive devices for a handicapped or disabled household member?*

YesNo
Amount $
Do you receive medical assistance through a public assistance agency/program?*

YesNo
Amount $
Do you expect to have any additional medical expenses during the next twelve (12) months?*

YesNo
Amount $
Miscellaneous

The following questions pertain to yourself and every member of your household who will occupy the unit.
Does your household have any needs that might be better served by an apartment which is accessible to persons with mobility, hearing or visual impairments?*
Do you or anyone else in your household qualify for housing because of a handicap or disability?*
Will anyone else live in the unit on either a full-time or part-time basis?*
Do you have sole legal and physical custody of your children?*
Are you now living or have you lived in a government-subsidized development?*
When? blanksName of development blank
Has your housing assistance ever been terminated for fraud, non-payment of rent or utilities, failure to cooperate with recertification procedures, for drug-related criminal activity or for any other reason?*
Have you/any member of your household ever been arrested/convicted of a felony or a misdemeanor other than a traffic violation?*
Are you or any member of your household subject to a lifetime registration under the State Sex Offender registration program?*
Do you/any member of your household have a pattern of alcohol abuse that would interfere with the health, safety or right to peaceful enjoyment of the premises by other tenants?*
Do you/any member of your household use an illegal drug or other illegal controlled substance?*
Have you/any member of your household ever been arrested/convicted of the illegal distribution/manufacture of an illegal drug/other controlled substance?*
Have you or any member of your household ever used different names from the names given in this application?*
Have you or any member of your household ever used social security numbers different from those listed in this application?*
Have you or any member of your household lived in any other state?*
blanks* How did you hear of this housing development?
Signatures
I/We understand the information in this application will be used to determine eligibility for Section 8 housing assistance and that

this information will be verified. I/We understand that any false information may make me/us ineligible for a unit.

I/We certify that all information given in this application is true, complete and accurate. I/We understand that if any of this information is false, misleading or incomplete, management may decline our application or, if move-in has occurred, terminate my/our lease agreement.

I/We understand that any action(s) by myself/ourselves or my/our household members, whether verbal or non-verbal, that harass, intimidate, threaten or are perceived by management to harass, intimidate or threaten the health or safety of the management stall or interfere with the management of the property is grounds for management to decline my/our application for housing.

I/We understand that if I/we or any member of my/our household suggest or offer bribes of money, material goods, etc., to the management staff responsible for determining either my/our placement on the waiting list of processing of my/our housing application is grounds for management to decline my/our application for housing.

I/We authorize management to make any and all inquiries to verify this information, directly or through information exchanged now or later with rental and credit screening services, and to contact previous and current landlords or other sources for credit and verification information which may be released to appropriate Federal, state or local agencies.

If my/our application is approved, and move-in occurs, I/we certify that only those persons listed in this application will occupy the unit, that it will be my/our only residence, and that there are no other persons for whom I/we have, or expect to have, responsibility to provide housing.

I/We agree to notify management in writing regarding any changes in household address, telephone numbers, income and household composition.

My/Our signature(s), as indicated below, acknowledge that I/we have read and completed each section of this rental application, as applicable.

All household members age 18 or older sign below:
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Additional Applicant's Signature

Clear
Date

MonthDayYear
Date
HUD Form 92006
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, City, State & Zip Code*
Phone Number*
Cell Phone No
Check YES if you choose NOT to provide the emergency contact information*

YesNo
Name of Additional Contact Person or Organization
Relationship to Applicant
Additional Contact's Address, City, State & Zip Code
Contacts Phone Number
Reasons to contact additional contact person: (Check all that apply)

EmergencyUnable to contact youTermination of rental assistanceEviction from unitLate payment of rentAssist with recertification processChange in lease termsChange in house rules
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
RHR RENTAL HISTORY REPORTS

General Consent Form - Each applicant 18 + over MUST complete a consent form
Last Name*
First*
Middle*
Maiden
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
Sex*
Social Security Number*
Driver's License #
Driver's License State
Home Phone Number*
I/We authorize Rental History Reports (RHR) and/or the above named company to do a complete investigation of all information provided within my application for residency. I/We have personally filled in and/or reviewed all information contained within the application. I/We understand failure to complete these documents completely and truthfully may result in denial and/or forfeit of deposit. A complete investigation may include any or all of the following: Credit Report, Verification of Employment and Income, Criminal Record Search, Rental History References (including MPHA), Unlawful Detainer/Eviction Investigation, Identity Trace, Sex Offender Search, Terrorism Search, Check Writing History, and Personal Interviews with all provided references. 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, count agencies as it relates to the applicant's eligibility, non-eligibility and/or benefit amounts received by the tenant, or other sourcesas required. It is understood that a photocopy or facsimile copy of this form will serve as authorization. I/We understand that I/We have a right tomake a written request within 30 days to receive information pertaining to this report if I/We are not accepted based upon information containedinthe report. I/We authorize RHR to produce to the credit granter Federal and State records of employment and income history, including State Employment Security Agency records. This authorization 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.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Is there additional applicants over 18 years of age? If so they must also complete a background check RHR General Consent Form

YesNo
RHR Rental History Reports

General Consent Form - Each applicant 18+ over must complete a consent form
Last Name*
First Name*
Middle Name*
Maiden
Current Address*
City*
State*
Zip Code*
Previous Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
Sex*
Social Security Number*
Driver's License Number
Driver's License State
Applicant's Phone Number*
I/We authorize Rental History Reports (RHR) and/or the above named company to do a complete investigation of all information application for residency. I/We have personally filled in and/or reviewed all information contained within the application. I/We understandfailureto complete these documents completely and truthfully may result in denial and/or forfeit of deposit. A complete investigation mayincludeorallof any the following: Credit Report, Verification of Employment and Income, Criminal Record Search, Rental History References (including MPHA), Unlawful Detainer/Eviction Investigation, Identity Trace, Sex Offender Search, Terrorism Search, Check Writing History, and PersonalInterviews with all provided references. 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, count agencies as it relates to the applicant's eligibility, non-eligibility and/or benefit amounts received by the tenant, or other sources as required. It is understood that a photocopy or facsimile copy of this form will serve as authorization. I/We understand that I/We have a right to make a written request within 30 days to receive information pertaining to this report if I/We are not accepted based upon information contained in the report. I/We authorize RHR to produce to the credit granter Federal and State records of employment and income history, including State Employment Security Agency records. This authorization continues in effect for one (1) year unless limited by state law, in whichthe case, authorization continues in effect for the maximum period, not to exceed one (1) year.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Parkview Apartments ~ Winger, MN

Household Income Information

Household Assets

HOUSEHOLD ALLOWANCE INFORMATION

Miscellaneous

Signatures

HUD Form 92006

RHR RENTAL HISTORY REPORTS

RHR Rental History Reports