Florida Justice Transitions, Inc

Florida Justice Transitions, Inc 2500- 54th Avenue No Ste 100-B St Petersburg, Florida 33714

Office: 727-289-7020

Instructions for filing application:

1) Please be sure to complete all fields. Applications with blank field will be returned. If you do not have an answer or it does not apply to you simply mark the field, N/A.

2) Print clearly with black or blue ink only. If we can’t read the information we will have to return for clarification and this will detain your process.

3) Be sure to have your contact person call us concerning your information and to help arrange payments prior to your release.

4) Once the form is completed please review for accuracy of information.

5) All applicants should make provisions to have ready their social security card and a birth certificate. A copy of these items may be gotten in advance by a family member, but is extremely needed for the applicants success once arrived.

6) Once the application is completed and signed accordingly it should be faxed or mailed to the attention of the above listed address. Once received and reviewed, a representative of our program will call the contact person to verify the process and let them know if and when you have been accepted. Turn around time is usually within 72 hours.

7) 3 months in advance for rent $ 1,050.00 @ $ 350.00 a month plus $ 200.00 application fee MUST accompany application

Any questions please feel free to contact our office during normal business hours.

Florida Justice Transitions, Inc 1221 ½ 10th Sreet North St Petersburg, Florida 33705 www.floridajusticetransitions.com Office: 727-346-3350 501 (c) (3) Exempt Status

James E. Broderick President/CEO Don Sweeney, L.M.H.C.

INTAKE INFORMATION WAIVER FORM

NAME:______DATE:______EOS:______Last First Middle Initial

Gender: (Circle One) Male Female Date of Birth:______Marital Status: M S D Other______

Are You a U.S. Citizen: NO / YES Social Security Number:______Veteran: NO YES

Florida ID Number:______Any Felonies or Misdemeanors: NO Yes (If Yes Please Explain)

Home Address:______Phone/Cell Number:______

Receiving any public assistance: NO / YES If Yes, What type of benefits (Circle appropriate response below):

TANF Food Stamps Medicaid CCC SSI WIC Wages

Are you taking any medication(s)? NO YES IF YES, list any medications in the space provided:

______

Any history of alcohol abuse, drug abuse, or anger management issues: NO / YES If YES, explain below:

______

Can the applicant live amicable with others: NO / YES Any disabilities or special needs: NO / YES

If YES, list any disabilities and/or special needs:______

Can applicant care for himself/herself: NO / YES

Name of emergency contact:______Phone Number:______

Address of emergency contact:______Relationship of emergency contact to the resident: ______

Highest education level completed: ______High School Diploma (circle one) GED

Past or Current Employer: ______

Do you have a checking or savings account? NO YES Bank Name:______

If incarcerated, your classification officers name: ______Phone Number:______

Probation/parole officer/caseworker name: ______Phone Number:______

Predator? (Circle One) NO / YES CRD? (Circle One) NO / YES DC Number: ______

DR’s (Past 2 Years):______Length of Probation: ______FCCC: (Circle One) No Yes

COSTS MAY VARY BASED ON UNIT

Application Fee…………………… (must be sent with application)….……$ 200.00 (non-refundable) Partial Month Fees (Starting Date: ______) ………………………..…$______Monthly Fee (In Advance)………………………………………………….…$______

TOTAL DUE TO SECURE RESIDENCY……………….……………………$______

CREDIT CARD: VISA __ MASTERCARD __ OTHER __ NUMBER ______

Contact Person For Fee Information:

Jim Broderick 1221 ½ 10th Street North St. Petersburg, FL 33705 727-346-3350

When sending money contact the above listed person with the senders name, address, phone number, amount sent, the company sent through, and the reference number of the transaction.

Rev: 01-18-15

APPLICANT ACKNOWLEDGEMENT AND WAIVER

Applicant will review the above information and the following statement before admission.

“I have been advised that Florida Justice Transitions, Inc. is voluntary, the F.J.T. Program offers low-cost housing tothose looking to reside in a safe drug and violent free community. I understand that my stay here depends upon my effort and desire to improve my life. I agree to comply with all of the rules and regulations set forth by FJT and all staff members. I understand that non-compliance with any rule and/or regulation may result in immediate expulsion from the premises without any prior notice. I DO HEREBY WAIVE ANY AND ALL TENANT RIGHTS.”

______Date:______Signature of Applicant

______Printed Name of Applicant

______Date:______Signature of Witness

______Printed Name of Witness

______Date:______Signature of FJT Director

______Printed Name of FJT Director

Rev: 01-18-15

FLORIDA JUSTICE TRANSITIONS 1221 ½ 10TH STREET NORTH ST. PETERSBURG, FL 33705 727-346-3350

RULES AND REGULATIONS

1. No pets allowed by tenants/residents. No one shall feed strays. All animals running loose are considered strays. We work with Animal Control who pick up strays, handle them humanely, and place the healthy animals for adoption.

2. Each unit shall be used as a single-family residence, unless other arrangements are made with the office. All sales and rentals of privately-owned units must first be approved by the office.

3. Electricity/Propane is the tenants’/resident’s responsibility, except for those tenants/residents who are leasing a unit with the cost of utilities being included in the rent. No unit may be occupied without electric power. No electric power may be “borrowed” from another unit, except under conditions deemed necessary and approved by the office.

4. Security and/or key deposits are required on all units owned and rented by Palace Mobile Home Park.

5. The speed limit within PMHP is 10 MPH and is strictly enforced. Speeders will be given a warning. Continued speeding by tenants/residents who have received warnings will be served with a seven-day notice, which may result in eviction. This rule also pertains to privately-owned units. Please advise your guests of the speed limit in the Park.

6. Parking is permitted in designated areas only. NO PARKING is permitted on the roadways or on the grass around units. Violators will be towed at owners’ expense. Please advise your guests of this rule.

7. Motor vehicles without current tags/registration shall not be allowed anywhere in the park. No inoperable vehicles shall be allowed to remain for more than one week. No major automobile repairs or oil changes shall be allowed in the Park. Unregistered or inoperable vehicles will be towed at owners’ expense. Motorcycles will not be operated within the grounds of the Palace Mobile Home Park. Each tenant/resident who owns/operates a motorcycle must shut off the engine before entering the PMHP and manually place the motorcycle within the assigned parking area (i.e., drive way). When leaving, the motorcycle operator must manually navigate the vehicle to the entrance/exit of the park before operating the motorcycle.

8. Management has the right to enter any unit if tenants’/resident’s health is a concern, or if there is a possibility of a fire or other hazard that may be damaging to the unit or a threat to the tenants’/resident’s health and wellbeing.

9. It is the responsibility of the tenants/residents to keep all lots, patios, carports, and inside of units clean and uncluttered. Effective January 1, 2007, tenants (those not in the FJT program) are responsible for spraying for roaches and bugs, and for ridding their units of any vermin that may infest the units.

10. No indoor furniture, auto parts, building materials, hazardous materials, or other unsightly items are to be stored in and around the units, on carports, or under the units. No structural changes or painting of units is allowed without prior written approval. Closed-in porches are not to be used as storage areas.

11. All trash must be placed in plastic trash bags and taken to the dumpster. No trash may be accumulated, or trash bags left standing outside the units. Trash cans with tightly-fitting lids are permitted, but must not be allowed to overflow. Management reserves the right to limit the trash cans located at a unit. Should management be required to remove any brush, trash, or unauthorized items, it will be done at tenants’/resident’s expense, at a minimum charge of $25.00. All trash cans are to be stored inconspicuously in the back of the units.

12 Any activities by the tenants/residents or tenants’/resident’s guest(s) that are in violation of municipal, state, or federal laws are absolutely prohibited and are cause for eviction.

13. Loud parties, profanity and drunkenness are prohibited. All sound equipment must be kept at a moderate level at all times, in consideration of ones’ neighbors. No loud voices, televisions, sound equipment, or other disturbances shall be tolerated after 10:00 p.m. 14. No open alcoholic beverages are allowed in the Park, including the laundry room or common areas, except in and around the tenants’/resident’s units. All empty beverage containers and evidence of outside barbeques must be properly cleaned up, put away, and disposed of as appropriate. Violations will be dealt with seriously.

15. No washers or dryers are allowed inside or outside of the units, clothes are not to be hung around the lot at anytime. A Laundromat and clotheslines are provided for your convenience.

16. Drain stoppages in the units due to misuse are the responsibility of the tenant/resident. Repeated episodes of clogging may result in labor for repair to be charged to the tenant at the rate of $50.00 per hour, with a one-hour minimum charge.

17. Water is a precious and diminishing ecological resource. Therefore, the water furnished to the units, including privately-owned units, is for general household needs only. No swimming or wading pools, washing of cars, or watering of grass, shrubs, trees, or other plants is allowed. Watering cans only may be used for watering plant life. Absolutely no water hoses may be displayed anywhere on the outside of the premises or used for the above-mentioned purposes.

18. Management will unlock the door to a tenant’s/resident’s unit one time, only, within a six-month period, as a result of a lost key. Any additional requests for admittance to a unit shall incur a $15.00 charge, paid in advance to the office manager or manager’s agent. If tenant/resident causes damage to the unit due to attempting entry without a key, the cost of repairs will be charged to the tenant.

19. Out-of-town guests are welcome at your mobile home. Any guests staying more than one day must register at the office. Maximum visitation of guest(s) is two weeks per year. If more than two weeks’ visitation is required due to extenuating circumstances, such guest(s) must be approved by the management, and there will be a charge of $50.00 per person per month after the first two weeks of visitation. Male tenants/residents may have no females spend the night in their unit, and female tenants/residents may have no males spend in the night in their unit. Any visitors, whether registered or not, who cause a disturbance, will be evicted from the Park and prohibited from returning.

20. Rents/program fees are due and payable on the first day of each month, and are considered late after the 5th day of the month. A $50.00 late fee will be charged for rents/program fees paid between the 5th and the 15th days of the month for which rent is due. A late fee of $50.00 shall be charged for rents/program fees not paid by the 15th of the month for which rent is due. Such late fees, if applicable, will be deducted from the amount of rent/program fees paid before any money is applied to rent/program fees. This action will result in your rent/program fees being in default and may result in eviction proceedings being instituted.

21. Rent/program fee payments may be made in cash, by money order, or personal check. Checks that are returned unpaid for any reason will incur a statutory returned-check fee to the landlord of $25.00, plus reimbursement of any fees that may be charged to landlord’s bank. Reimbursement of the returned check must be made in cash or by money order. The subject tenant’s/resident’s account will be flagged to accept no further personal checks.

22. Individual unit owners are responsible for keeping plants, shrubs and the rented lot in a neat and attractive condition, as well as keeping the unit clean and painted. If this is not done, then the unit owner will be served with a written warning to correct the problem. If not corrected within a reasonable length of time, management reserves the right to correct such violations at tenants’ expense, charged at the current hourly rate for park maintenance men’s time.

I/WE HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS OF THE WITHIN-CONTAINED RULES AND REGULATIONS OF PALACE MOBILE HOME PARK. SPECIFICALLY, I UNDERSTAND THAT BREAKING ANY OF THE RULES AND REGULATIONS WITHOUT CORRECTING THE SPECIFIC VIOLATION, OR CONTINUED BREAKING OF ANY OF THE RULES AND REGULATIONS MAY RESULT IN EVICTION PROCEEDINGS BEING INSTITUTED AGAINST THE TENANT(S)/RESIDENT(S).

______DATE:______TENANT/RESIDENT SIGNATURE

RULES AND REGULATIONS.REV.01/14/2015 F J T PERSONAL PROPERTY ADDENDUM

PLEASE BE NOTIFIED THAT EVERY RESIDENT OF THE Florida Justice Transitions, Inc.,(F.J.T.) program who shall leave personal property unattended in their assigned unit for any reason such as: Absconding, Violation of

Probation or Conditional Release, leaving the program owing fees, et cetera, that said personal property shall be removed from the assigned unit and stored. After a period of (30) days, said personal property shall become the sole property of F.J.T., and cannot be recovered by said resident. After said 30-day period, F.J.T. has sole discretion how to dispose of said property, such as donating to Goodwill or make use of said property in any manner it sees fit.

The owner of said personal property as described above, prior to the end of the 30-day period may designate an individual to take possession of said personal property, by making said designation in writing, notarized and signed supplying the designated person’s name, address, phone number, and an alternate phone number. It is the programs resident’s responsibility to contact their designated person to retrieve the personal property. Although F.J.T. may make an effort to contact this designated person, F.J.T. will not be responsible for ensuring that the designated person is contacted and actually takes possession of said personal property within the 30-day period.

No personal property belonging to a Program member, who has vacated a unit to which he has been assigned, will be released to any person whomsoever until all back resident fees and any other unpaid costs have been paid in full.

The undersigned F.J.T. program resident hereby acknowledges that he has read, understands and agrees to the foregoing addendum to personal property.

______Name (printed) Signature Date

______Witness name (printed) Signature Date

Rev: 01-18-2015