Whitefish Housing Authority

WHITEFISH HOUSING AUTHORITY 100 4th Street East Whitefish, MT 59937 406-862-4143 406-862-4107 (fax) ======

Application for Whitefish Crossing

1) To be qualified for admission an applicant must: (a) Be a household as defined in WHA's Admission and Continued Occupancy Policy;

(b) Meet the HUD requirements on citizenship or immigration status;

(c) Have an annual income at the time of admission and subsequent annual reexams that meets the minimum income requirements and that does not exceed the income limits established by the Montana Board of Housing Tax Credit and MF Income Limits that are posted in WHA offices.

(d) Provide documentation of Social Security numbers;

(e) Meet or exceed the Applicant Selection Criteria, including attending and successfully completing a WHA-approved pre-occupancy orientation session, if requested to do so;

(f) Not have had a lease terminated in the past 3 years;

(g) Be able and willing to comply with the Whitefish Crossing lease; and

(i) Not have any household members engaged in any criminal activity that threatens the life, health, safety, or right to peaceful enjoyment of the premises by other tenants, and not have any household members engaged in any drug-related criminal activity.

2) Complete applications will be entered on the waiting list. The waiting list will then be processed according to unit type, size, and admission preferences.

3) Each applicant who meets the above qualifications may receive one unit of the size and type needed. If the applicant accepts the offer, the applicant will be offered a lease. If the applicant refuses the offer without good cause, WHA will remove the applicant's name from the waiting list and send a notice to the household of such removal. The applicant may reapply if the waiting list is open.

4) Applicants with disabilities may seek assistance with the completion of the application at WHA's office.

5) WHA will conduct a criminal record check on all applicants. A $10 Fee will be charged per adult in the household.

WHITEFISH CROSSING APPLICATION 1 Date of Application:

A. APPLICANT / HOUSEHOLD INFORMATION

FULL NAME BIRTH M/F SOC. SEC. # PHONE / EMAIL DATE

Do you or any members of your household that will live in the apartment need reasonable accommodation? Yes / No Wheelchair Accessibility? Yes / No

Have you or any member of your household been convicted of a felony? Yes /No Explanation: ______

B. HOUSING REFERENCES (List ALL landlords during the past three years)

1. Current address, city, state, zip:______

Current Home #:______, Cell #: _____

Name of present landlord: ______

Address of landlord: ______

Landlord Telephone: ______; Length of Time at address: ______

Present monthly rent: ______; Average monthly utility bills: ______

Reason for moving: ______

WHITEFISH CROSSING APPLICATION 2 If at present address less than three years, complete the following:

2. Previous address, city, state, zip:_

Name of previous landlord: ______

Address of landlord: ______

Landlord Telephone: ______; Length of Time at address: ______

Present monthly rent: ______; Average monthly utility bills: ______

Reason for moving: ______

C. EMPLOYMENT OR OTHER INCOME SOURCES

1. Applicant’s present employer(s): ______

Employer’s address: ______; Employer’s telephone: ______

Position: ______; How long employed: ______

2. Applicant’s previous employer: ______

3. Co-Head present employer(s): ______

4. Co-Head previous employer: ______

WHITEFISH CROSSING APPLICATION 3 5. Other adult’s present employer(s):______

6. Other adult’s previous employer:______

D. ANNUAL INCOME

Household Income Information: Please list the source and amount of all income expected for the coming 12 months for all household members, including yourself. Include all earnings and benefits received from Wages, AFDC/TANF, VA, Social Security, SSI, SSID, Unemployment, Worker's Compensation, Child Support, etc. Example: Wages, $150/week, SSI, $421/month

Household Income Source Amount $ Frequency Per Member Name Week/Month/Year

WHITEFISH CROSSING APPLICATION 4 E. ASSETS

1) Do you have a checking or savings account or own any certificates of deposit (CD), money market funds, trusts, IRA’s, stocks, bonds, etc.? Yes / No If yes, describe the type of asset please: ______

What is the market value of all assets?

2) Do you own any real estate? Yes / No If yes, what is the address?

3) Have you sold any real estate in the past two years? Yes / No If yes, what was the address / sale price?

F. PERSONAL REFERENCES (excluding family members)

1) Name: ______; Telephone: ______

2) Name: ______; Telephone: ______

WHA will be contacting all references and former landlords for the period three years from the date of application.

I/We certify that the statements on the application are true to the best of my/our knowledge and believe and understand that they will be verified. I/we authorize the release of information to the Whitefish Housing Authority by my/our employer(s), the Department of Public assistance, the Social Security Administration, and/or other business or government agencies. I/we understand that any false statement made on this application will cause me/us to be disqualified for admission.

Applicant Signature Date

Co-Applicant Signature Date WHITEFISH CROSSING APPLICATION 5 WHITEFISH HOUSING AUTHORITY 100 4th Street East Whitefish, MT 59937 406-862-4143 406-862-4107 (fax)

United States Department of Housing And Urban Development

CONSENT AND AUTHORIZATION FOR RELEASE OF CRIMINAL HISTORY RECORD INFORMATION

Pursuant to Sections 214 and 302 of the Montana Criminal Justice Information Act of 1979 (Chapter 5, Title 44), the undersigned hereby appoints the Whitefish Housing Authority, Inc. (“Authority”) as his/her agent for the purpose of inspecting any criminal history record information maintained on him/her by any criminal justice agency and authorizes said agency to release to the Authority any and all information, whether oral or recorded, factual or opinion, in any form or medium, relating to his/her criminal history. This consent is effective to three (3) months from the date signed below.

DATED this ______day of ______, ______

______Printed Name Date of Birth

______Signature Social Security Number

STATE OF MONTANA ) : ss. County of Flathead )

On______, before me, ______, Notary Public for the State of Montana, personally appeared, known to me to be the person whose name is ______subscribed to the within instrument, and acknowledged to me that (s)he executed the same.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and year herein above first written.

______Notary Public for the State of Montana

Residing at ______, Montana

WHITEFISH CROSSING APPLICATION 6 My commission expires: ______(NOTORIAL SEAL)

WHITEFISH CROSSING APPLICATION 7