Leasing Application

COMPLEX: CANDY MOUNTAIN LEASING APPLICATION RECEIVED COMPLETE: ______(DATE & TIME) – office use only

APPLICANT INFORMATION

Name: ______Birthdate: ______Social Security #: ______

Current Address: ______City: ______State: ______Zipcode: ______How Long: ______

Home Phone #: ______Alternate Number: ______Current Landlord: ______

Landlord City/State Address: ______Zip: ______Phone #: ______City/State/ Employer1 ______Address: ______Zip: ______Employer Length of Phone: ______Occupation: ______Employment: ______Supervisor: ______City/State Employer2 ______Address: ______Zip: ______Employer Length of Phone: ______Occupation: ______Employment: ______Supervisor: ______

Have you ever been convicted of a felony? ______If yes, when and why? ______

Have you or any member of your household been convicted of a drug misdemeanor within the past 3 years? ____ If yes, when & why? ______

______

Are you or anyone in your household subject to the lifetime sex offender registry? _____ If yes, who? ______

Reason for Drivers State How many Moving ______License # ______Issued ______vehicles ______

Previous residences – include landlord name, address including city & state, phone number and dates of residence:

CO-APPLICANT / CO-SIGNER INFORMATION

Name: ______Birthdate: ______Social Security #: ______

Current Address: ______City: ______State: ______Zipcode: ______How Long: ______

Home Phone #: ______Alternate Number: ______Current Landlord: ______

Landlord City/State Address: ______Zip: ______Phone #: ______City/State/ Employer1 ______Address: ______Zip: ______Employer Length of Phone: ______Occupation: ______Employment: ______Supervisor: ______City/State/ Employer2 ______Address: ______Zip: ______Employer Length of Phone: ______Occupation: ______Employment: ______Supervisor: ______

Have you ever been convicted of a felony? ______If yes, when and why? ______

Have you or any member of your household been convicted of a drug misdemeanor within the past 3 years? ____ If yes, when & why? ______

______

APPLICATION.COM Are you or anyone in your household subject to the lifetime sex offender registry? _____ If yes, who? ______

LEASING APPLICATION PAGE 2

Reason for Drivers State How many Moving ______License # ______Issued ______vehicles ______

Previous residences – include landlord name, address including city & state, phone number and dates of residence:

INTENDED OCCUPANTS OF APARTMENT – list all individuals except applicant/co applicants that will reside in the household

NAME RELATIONSHIP BIRTHDATE SOCIAL SECURITY NUMBER

AUTOMOBILE INFORMATION

MODEL MAKE TAG NUMBER COLOR

IN CASE OF EMERGENCY, ILLNESS, OR ACCIDENT, PLEASE NOTIFY:

Name: ______Relationship: ______Phone #: ______

Address: ______City/State/Zip: ______

Doctor: ______Phone #: ______Hospital: ______

DISABLED (Applies to both the applicant and co-applicant)

Persons which meet the definition of disabled qualify for a $ 400.00 deduction to their annual income when determining rent contribution and certain other deductions. See the attached pages for information which defines disabled. If you feel that you qualify and would like to request this adjustment to your income, please indicate in the space provided below:

( ) YES ( ) NO

If you have indicated your desire to request this adjustment, then we will need only sufficient information (documentation) to confirm your qualification for the disabled status. Failure to provide this information may result in denial of these deductions.

Would you like to request a disabled designed unit? ( ) YES ( ) NO

Would you like to request reasonable accommodations/modifications to the unit? ( ) YES ( ) NO

If yes, what type of accommodations/modifications would you like to request? ______

APPLICATION.COM I (we) understand that this application must be filled out completely and accurately. I (we) certify the information is accurate and I (we) understand that any misrepresentations will disqualify me (us). I (we) further certify that the housing occupied on these premises will be my (our) permanent residence and I (we) do not/will not maintain a separate subsidized rental unit at any other location.

APPLICATION.COM LEASING APPLICATION PAGE 3

By signing this application, I (we) hereby authorize the management (or it’s agent) of this complex, for purposes of this application. To contact and obtain any information required from any of the individuals or entities listed on this application, or from any other individuals or entities as may be required. Management further reserves the right to release this information for purposes of collection of outstanding debts. “This form may be reproduced or photocopied and constitutes continuing permission or assent to update said information or documentation as required by management during this tenancy or any extension or renewal thereof”.

I (we) understand that the managing agent will verify, in writing through a third party, the information provided on this application.

I (we) also understand that my household wages are subject to being verified through a third party source by the Farmers Home Administration, RDA or HUD.

WARNING Section 1001 of the Title 18, United States Code provides, “Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or entry, shall be fined not more than $ 10,000.00 or imprisoned not more than five years, or both.

If the application is accepted, one month’s prorated rent and security deposit must be paid and lease and tenant certification must be executed in advance before occupancy of the apartment. NO REFUND WILL BE MADE except to comply with state and federal guidelines. All rent is due and payable in advance on the FIRST DAY OF THE MONTH.

Date possession of apartment desired: ______

BY SIGNING BELOW, I CERTIFY I HAVE READ AND UNDERSTAND ALL THE ABOVE.

Applicant: ______Date: ______

Co-Applicant: ______Date: ______

How did you hear about our apartment community? _____ Newspaper _____ Phonebook _____ Resident _____ Drive-by

_____ Flyer/Brochure _____ Other Explain: ______

Comments:

FmHA regulations require that all applicants/tenants reveal all sources of income and assets. This application is not considered complete and therefore can not be processed until the attached certification of income and assets have been completed by both the applicant and co- applicant. In cases of elderly, handicapped or disabled applicants, a medical expense questionnaire must be also be filled out as part of the application process.

The information regarding race, national origin, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Farmers Home Administration that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age, and handicap 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/national origin and sex of individual applicants on the basis of visual observation or surname.

Sex of Applicant: ______Race: ______Sex of Co-Applicant: ______Race: ______

Marital Status: Marital Status: Single: _____ Married: _____ Separated: _____ Single: _____ Married: _____ Separated: _____

Equal Housing Opportunity TDD 1-800-548-2546

APPLICATION.COM APPLICATION.COM Race and Ethnic Data U.S. Department of Housing OMB Approval No. 2502-0204 Reporting Form and Urban Development (Exp. 12/31/2007) Office of Housing

Candy Mountain Apartments 105 Candy Mountain Road Birmingham, AL 35217

Name of Property Project No. Address of Property

Charles Martin & Burton Olshan RD 515 Name of Owner/Managing Agent Type of Assistance or Program Title:

Name of Head of Household Name of Household Member

Date (mm/dd/yyyy):

Select Ethnic Categories* One

Hispanic or Latino

Not-Hispanic or Latino Select Racial Categories* All that Apply American Indian or Alaska Native

Black or African American

Native Hawaiian or Other Pacific Islander

*Definitions of these categories may be found on the reverse side.

There is no penalty for persons who do not complete the form.

______

Signature Date

Public reporting burden for this collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This information is required to obtain benefits and voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. This information is authorized by the U.S. Housing Act of 1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing and Community Development Technical Amendments of 1984. This information is needed to be incompliance with OMB-mandated changes to Ethnicity and Race categories for recording the 50059 Data Requirements to HUD. Owners/agents must offer the opportunity to the head and co-head of each household to “self certify’ during the application interview or lease signing. In-place tenants must complete the format as part of their next interim or annual re-certification. This process will allow the owner/agent to collect the needed information on all members of the household. Completed documents should be stapled together for each household and placed in the household’s file. Parents or guardians are to complete the self- certification for children under the age of 18. Once system development funds are provide and the appropriate system upgrades have been implemented, owners/agents will be

APPLICATION.COM required to report the race and ethnicity data electronically to the TRACS (Tenant Rental Assistance Certification System). This information is considered non-sensitive and does no require any special protection.

Instructions for the Race and Ethnic Data Reporting (Form HUD-27061-H)

A. General Instructions: This form is to be completed by individuals wishing to be served (applicants) and those that are currently served (tenants) in housing assisted by the Department of Housing and Urban Development. Owner and agents are required to offer the applicant/tenant the option to complete the form. The form is

to be completed at initial application or at lease signing. In-place tenants must also be offered the

opportunity to complete the form as part of the next interim or annual recertification. Once the form is

completed it need not be completed again unless the head of household or household composition changes.

There is no penalty for persons who do not complete the form. However, the owner or agent may place a

note in the tenant file stating the applicant/tenant refused to complete the form. Parents or guardians are to

complete the form for children under the age of 18.

The Office of Housing has been given permission to use this form for gathering race and ethnic data in

assisted housing programs. Completed documents for the entire household should be stapled together and

placed in the household’s file.1. The two ethnic categories you should choose from are defined below. You

should check one of the two categories. Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican,

South or Central American, or other Spanish culture or origin, regardless of race. The term “Spanish

origin” can be used in addition to “Hispanic” or “Latino.”

1. Not Hispanic or Latino. A person not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

2. The five racial categories to choose from are defined below: You should check as many as apply to you. 1. American Indian or Alaska Native. A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. 2. Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam 3. Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black” or “African American.” 4. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 5. White. A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

APPLICATION.COM INCOME AND ASSETS QUESTIONAIRE

Complex: Candy Mountain Apartments _____ Application _____ Recertification

Applicant/Resident: ______Co-Applicant/Co-Resident: ______

ASSETS SECTION:

1. Do you have any of the following: Est. Amt./Value Interest Rate a. Checking Accounts ( ) Yes ( ) No ______b. Savings Accounts ( ) Yes ( ) No ______c. Certificate of Deposits ( ) Yes ( ) No ______d. Money Market Funds ( ) Yes ( ) No ______e. Stocks/Bonds ( ) Yes ( ) No ______f. Treasury Bills ( ) Yes ( ) No ______g. IRA/Keough Accounts ( ) Yes ( ) No ______h. Company Retirement Accounts ( ) Yes ( ) No ______i. Pension Funds ( ) Yes ( ) No ______j. Trust Accounts ( ) Yes ( ) No ______if yes, is it irrevocable? ( ) Yes ( ) No k. Cash held in safety deposit box ( ) Yes ( ) No ______l. House ( ) Yes ( ) No ______m. Rental Property ( ) Yes ( ) No ______n. Other investments ( ) Yes ( ) No ______

2. Have you received any lump sum payments such as: a. Inheritances ( ) Yes ( ) No ______b. Lottery Winnings ( ) Yes ( ) No ______c. Insurance Settlements ( ) Yes ( ) No ______d. Workman’s Compensation ( ) Yes ( ) No ______e. Social Security Disability Settlement ( ) Yes ( ) No ______f. Unemployment Compensation Settlement ( ) Yes ( ) No ______g. VA Disability Settlement ( ) Yes ( ) No ______h. Severance Pay ( ) Yes ( ) No ______i. Capital Gains ( ) Yes ( ) No ______j. Educational Grants or Scholarships ( ) Yes ( ) No ______k. Other ( ) Yes ( ) No ______

3. Have you disposed of any assets for less than fair market Value in the past two (2) years ( ) Yes ( ) No ______

TOTAL ESTIMATED AMOUNT / VALUE OF ASSETS $ ______

INCOME SECTION

1. Do you receive any of the following: a. Wages, Salary, etc. thru employment ( ) Yes ( ) No ______b. Income from a business or profession ( ) Yes ( ) No ______c. Income from military ( ) Yes ( ) No ______d. Social Security ( ) Yes ( ) No ______e. SSI ( ) Yes ( ) No ______f. AFDC or other Public Assistance ( ) Yes ( ) No ______g. Alimony ( ) Yes ( ) No ______h. Child Support Payments ( ) Yes ( ) No ______i. Unemployment Compensation ( ) Yes ( ) No ______

CONTINUE ON BACK APPLICATION.COM j. Workman’s Compensation ( ) Yes ( ) No ______k. Severance Pay ( ) Yes ( ) No ______l. Retirement Income ( ) Yes ( ) No ______m. Annuities Income ( ) Yes ( ) No ______n. Insurance Policies Income ( ) Yes ( ) No ______o. Disability or Death Benefits ( ) Yes ( ) No ______(Other than Social Security or SSI) p. Income from Rental Property ( ) Yes ( ) No ______q. Other ( ) Yes ( ) No ______

2. Do you regularly receive monetary gifts or non cash contributions from persons outside the household for: a. Rent (do not include section 8) ( ) Yes ( ) No ______b. Utilities ( ) Yes ( ) No ______c. Groceries ( ) Yes ( ) No ______d. Clothing ( ) Yes ( ) No ______e. Miscellaneous Household Supplies ( ) Yes ( ) No ______f. Other ( ) Yes ( ) No ______

TOTAL ESTIMATED AMOUNT OF INCOME $ ______

MISCELLANEOUS INFORMATION

1. Do you pay child care expenses for children age 12 or younger that enables a family member to go to work or to school? (Note: This amount should not exceed the amount earned at work or should not exceed a sum reasonably expected to cover class time and travel time to and from classes. Also, for this expense to be allowed as a deduction from income, the amount is not to be paid to a family member living in the household, is not to be reimbursed by an agency or individual and is allowed only if there is no adult member of the household capable of providing the care.)

( ) Yes ( ) No Estimated Amount $ ______

2. Do you have any disabled assistance expenses that enable a family member (including the disabled members) to work. (Note: This expense may be given for amounts which exceed 3% of annual income provided they are not paid to a member of the household or reimbursed by an agency or individual.)

( ) Yes ( ) No Estimated Amount $ ______

I/We certify that the above statements are true and complete to the best of my/our knowledge. I/We understand that is my/our responsibility to report to management, such changes in income, assets and expenses whenever they occur. SUBMITTAL OF FALSE STATEMENTS OF INFORMATION IS PUNISHABLE UNDER FEDERAL LAW.

Applicant/Resident Date

Co-Applicant/Co-Resident Date

APPLICATION.COM Management Agent Date

APPLICATION.COM APPLICANT / TENANT CERTIFICATION ASSETS: CURRENT & DISPOSED

FmHA 515 regulations require that all applicants/tenants reveal all sources of income and assets. Applicants/tenants for housing in this FmHA 515 property must fill out this asset certification by filling in the requested information and certifying this form.

CURRENT ASSETS (List all assets currently held and the cash value. Cash value is the market value les any reasonable cost that would be incurred in converting the asset to cash, i.e. broker and legal fees.)

ASSET CASH VALUE ASSET CASH VALUE

Applicants/tenants must also disclose any assets disposed of for less than fair market value in the two years preceding the effective date of the recertification or recertification.

Did you have any assets in the last two years not listed above? ______If yes, did you dispose of any assets of less than market value? ___ (This means that the assets were either given away or sold at less than the allotted market value.)

If yes, what were the assets, market value, amount received and date you disposed of the assets?

Any assets listed as disposed of for less than fair market value in the two years preceding the effective date of the certification or recertification will be counted as assets if the difference between the value and the amount received exceeds $1000.

I do hereby certify that the information listed on this form and the questions answered are true and complete the best of my knowledge. I further certify that I have revealed all assets currently held or previously disposed of and that I have no other assets than those listed on this form (other than personal property). I realize that false statements are fraudulent and are a criminal offense, which is punishable by fine or imprisonment or both.

______Date Applicant / Tenant

______Date Co - Applicant / Co-Tenant

______Date Co-Signer

APPLICATION.COM BANK VERIFICATION (TENANT COMPLETE TOP PORTION ONLY)

THIS WILL AUTHORIZE ______TO RELEASE (Name of Bank or Financial Institution) THE INFORMATION REQUESTED BELOW REGARDING FAMILY CHECKING, SAVINGS, CD’S, IRA/KEOUGH ACCOUNTS, AS WELL AS ANY OTHER INFORMATION APPLICABLE TO MY INCOME OR FINANCIAL WORTH.

FULL NAME SOCIAL SECURITY NUMBER

SIGNATURE OF AUTHORIZATION STREET ADDRESS

DATE CITY/STATE/ZIP

TO WHOM IT MAY CONCERN:

THE FAMILY/INDIVIDUAL NAMED ABOVE IS A RESIDENT/APPLICANT FOR HOUSING WHICH HAS RENTS THAT ARE SUBSIDIZED THROUGH THE FARMERS HOME ADMINISTRATION OR THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT. FEDERAL REGULATIONS REQUIRE THAT IN ORDER FOR A FAMILY TO BE ELIGIBLE FOR THIS FORM OF ASSISTANCE, THE INCOME OF THE FAMILY, AS WELL AS ITS ASSETS MUST NOT EXCEED CERTAIN ESTABLISHED LIMITS. THE INFORMATION REQUESTED BELOW WILL BE HELD IN STRICT CONFIDENCE AND WILL BE USED ONLY TO DETERMINE THE ELIGIBILITY OF THE FAMILY FOR THE HOUSING SUBSIDY.

SINCE WE CANNOT APPROVE THIS FAMILY/INDIVIDUAL FOR THE PROGRAM UNTIL THIS INFORMATION IS RECEIVED, WE WOULD APPRECIATE YOUR COOPERATION AND PROMPT ATTENTION IN COMPLETING THOSE APPLICABLE PORTIONS OF THIS INQUIRY. THANK YOU!

BANK OFFICIALS COMPLETE THE FOLLOWING: MANAGEMENT OF CANDY MOUNTAIN

NAME SIGNATURE

SIGNATURE

DATE TITLE CANDY MOUNTAIN APARTMENTS 105 CANDY MOUNTAIN ROAD DATE BIRMINGHAM, AL 35217 PHONE: (205) 854-6000 FAX: (205) 854-6898 TELEPHONE NUMBER

(OVER)

APPLICATION.COM Checking Acct # (s) Current Balance (s) Average Balance (s) Annual Interest Rate

Savings Acct # (s) Current Balance (s) Average Balance (s) Annual Interest Rate

Certificate of Deposit (s) Current Balance (s) Average Balance (s) Annual Interest Rate

IRA/Keogh Acct (s) Current Balance (s) Average Balance (s) Annual Interest Rate

APPLICATION.COM LANDLORD REFERENCE VERIFICATION

I/We authorize you to provide Candy Mountain Apartments any and all information requested regarding my rental history. A copy of this authorization may be accepted as an original.

______Applicant Date

______Co-Applicant Date

Realtor: ______

Realtor Address: ______

Phone: ______

Applicant Address: ______

Dates Resided: ______

1. Was the applicant or co-applicant a resident at your complex? Yes ___ No ___

2. How long did the applicant reside at your complex? ______

3. Did the applicant pay rent on time? Yes ___ No ___ If no, please explain: ______

4. Did the applicant or the applicant’s household cause any problems while residing at your complex? Yes ___ No ___ If yes, please explain: ______

5. Did the applicant ever have eviction proceedings initiated against them? Yes ___ No ___ If yes, please explain: ______

6. Would your recommend the applicant for housing? Yes ___ No ___ If no, please explain: ______

7. Additional Comments: ______

______

______Manager, Asst. Manager, Leasing Agent Date

For Candy Mountain Office Use Only

Verified by: _____ Mail _____ Fax _____ Verbal

______Office Staff Signature Date

APPLICATION.COM Candy Mountain Apartments 105 Candy Mountain Road Birmingham, AL 35217 (205) 854-6000 Fax: (205) 854-6898 TDD: 1-800-548-2546 Visit Our Web Site www.candymountainapartments.citymax.com RENTAL RATES

Rental rates are based on your Net Annual Income Effective 01-01-2011

Candy Mountain Apartments require a net household income of at least $ 1,500.00 gross per month unless rental assistance is available or you have a section 8 voucher.

1 BEDROOM UNIT……………………………………………………..444.00 TO 530.00 PER MONTH 2 BEDROOM UNIT……………………………………………………..484.00 TO 585.00 PER MONTH 3 BEDROOM UNIT……………………………………………………..504.00 TO 664.00 PER MONTH APPLICATION FEE INDIVIDUAL……………………………………………………………………………………… $20.00 MARRIED COUPLES……………………………………………………………………………...$20.00 ROOMMATES……………………………………………………………………………………...$23.00 INDIVIDUALS WITH CO-SIGNERS…………………………………………………………….. $23.00

PLEASE BRING PICTURE IDENTIFICATION WITH SOCIAL SECURITY NUMBER VERIFICATION UPON RETURN OF APPLICATION

This is a non-refundable fee and is used to check credit and references. Each applicant is run through Trans Union Credit Association. Please make your Cashier’s Check or Money Orders payable to Guardian Companies and allow 48 hours for your application to be processed. We will advise you in writing if your application is accepted or rejected.

All lines must be completed on the application and the ‘INCOME/ASSET QUESTIONAIRE’ before it is returned to the office. If an item on the application does not apply to you or your household, please put N/A in the line. On the ‘INCOME/ASSET’ form, please be sure to include an amount on all lines that apply either to you or anyone in your household. The day you turn in your application we will be required to make a copy of your driver’s license. All assets must be verified by third party either a recent bank statement or a letter from the institute where your assets are being held.

Since we do require that all employment and/or income be verified in writing by the employer, be sure and put the complete mailing address on your application including zip codes. Do not take this form to the employer.

Once you application is approved you will be required to pay a security deposit in the amount of $250.00. Please make your Cashier’s Check or Money Order payable to Candy Mountain Apartments.

We allow pets (under 30 pounds) with a fee of $250.00, per pet. Please note that the pet fee is non-refundable and must be paid before bringing the pet onto the property.

If all information requested is provided to us accurately we will be able to process your application in a timely manner. Should you have any questions concerning the application, please call the office Monday and Tuesday, 8 a.m. to 4:30 p.m., Wednesday through Friday, 8 a.m. to 6 p.m., (closed Noon to 1 p.m. weekdays) Closed Saturday & Sunday.

Thank you, Candy Mountain Management

Equal Housing Opportunity TDD 1-800-548-2546

APPLICATION.COM