APPLICATION PACKET · Letters of Recommendation, meeting all requirements (see Artist Eligibility...

Good Shepherd Center Artist Live-Work Studio Loft

APPLICATION PACKET

UNIT 506 Size: Approx. 585 sq.ft. Rent: $791 per month Deposit: $500 Availability: Immediately Address: 4649 Sunnyside Ave N, Seattle, WA 98103

Good Shepherd Center Artist Live/Work Rental Process Overview

The following is a brief overview of the application process and should serve as a checklist to help you submit a complete application. If you have any questions, please contact the Good Shepherd Center at 206-547-0204 or [email protected].

This application packet contains the following forms: General Rental Criteria Artist Eligibility Criteria Caretaker Criteria Application for Tenancy Resident Eligibility Application (REA) and instructions for its completion

Please read over all materials carefully. Incomplete applications will not be counted as “received”. Your application submittal must contain all of the following or it will not be considered:

Application for Tenancy form, completed and signed Artist résumé, meeting all requirements (see Artist Eligibility Criteria) Letters of Recommendation, meeting all requirements (see Artist Eligibility Criteria) Caretaker Criteria form, signed Proof of Income (copies of 2 most recent paystubs, if applicable; copies of tax returns for last 2 years) Resident Eligibility Application (REA) form, completed and signed Check for $35.00, made out to Historic Seattle PDA, for application fee. Fee is nonrefundable for

screened applicants (see #2, below). If not screened, your check will be returned or destroyed.

APPLICATION PROCESS

Applicants who are on our wait list will receive first priority, in chronological order. Our marketing efforts include a wide variety of local arts organizations and agencies as well as resources devoted to connecting people with affordable housing opportunities. The application process is as follows:

1. Submit Application MaterialsApplications must be submitted to the Good Shepherd Center management office, located at 4649 SunnysideAve N, Suite 226, Seattle, WA 98103 (on the main floor, to the right of the entrance lobby, next to theelevator), between the hours of 8am and 12pm (Noon) Monday through Friday. If the office is closed, anenvelope containing the application materials may be slid under the door.

2. Initial ScreeningApplications will be considered on a first-in-time basis, and will be screened in chronological order from theday and time of receipt. The first applicant to qualify by meeting all criteria necessary for approval will beselected to move forward in the rental process; if later deemed ineligible, or if applicant fails to completesubsequent steps or accept tenancy, the screening process will repeat with those next in line. Applicants whoare not selected for screening will be added to our wait list for future opportunities.

3. Verification of Affordable Housing EligibilityThe applicant who passes initial screening must complete and sign, within 48 hours, applicable forms fromthe Washington State Housing and Finance Commission (WSHFC), which are used to support and verifyapplicant’s eligibility, and to fulfill reporting requirements. Required forms include Household Demographicsand Authorization to Release Confidential Information, as well as others. Verification of eligibility may takeseveral days.

4. Approval and Offer of TenancyOnce steps 1 through 3 have been completed, the approved applicant will be offered a lease, which must beexecuted within 48 hours. If the first approved applicant does not accept the offer of tenancy within 48 hoursof when the offer is made, the next completed application will be screened and reviewed, and so on, inchronological order, until the offer of tenancy is accepted and a lease executed.

Good Shepherd Center General Rental Criteria

Application Fee: $35.00 per person. All occupants 18 years of age or older must submit a separate application. Applications will not be considered complete and will not be processed until fees are paid.

Occupancy Limit: The maximum number of allowed occupants per unit is 2 adults and 1 minor child.

Applicants must provide a valid government-issued photo ID and meet the following qualifying criteria:

CREDIT A consumer credit report showing at least three (3) accounts in good standing for three years or longer, and no delinquent or derogatory record. Unpaid collections, liens or judgments, or bankruptcies that have not been discharged, are grounds for denial. Comprehensive reusable tenant screening reports are not accepted.

INCOME Compliance with HUD limits for affordable housing:

Maximum annual income for a 1-person household: $31,650* Maximum annual income for a 2-person household: $36,150*

* Rent credit for caretaking duties ($4,746 annualized) shall be included in calculation of applicant’s income.

In addition, applicants must submit a completed Resident Eligibility Application as required by the Washington State Housing Finance Commission, including any forms and/or other supporting documentation needed for verification of income and assets, and any other submittals required by WSHFC or other governmental entity at present or in the future.

CRIMINAL RECORD No criminal convictions for crimes against persons or property. Offenses which will result in denial include, but are not limited to: crimes involving actual or potential physical harm to other individuals; crimes involving property damage; and crimes involving possession, manufacture, sale or delivery of any controlled substance, drug paraphernalia, or weapons. An outstanding warrant or an arrest record for a crime that is awaiting trial are also grounds for denial.

RENTAL HISTORY At least twelve months of verifiable, positive rental history or home ownership. A prior record of eviction, unlawful detainer action, property damage, or outstanding charges owed to a landlord or property management company will result in denial.

Failure to meet any of the above criteria may result in denial.

Conditional Approval: Applicants who do not qualify based on credit or rental history criteria may, at landlord’s discretion, be approved on condition of an increased deposit or qualified co-signer.

NOTICE: Our office screens applicants in part by obtaining a consumer report from:

CoreLogic SafeRent, LLC 7300 Westmore Road, Suite 3 Rockville, Maryland 20850-5223 888-333-2413

The report may contain information about credit history, prior rental history (including eviction proceedings and collections), and criminal records. If your application is denied or if other adverse action is taken as a result of information in your consumer report, you have the right to obtain a free copy of the report from the company named above and to dispute the accuracy of the information contained in such report.

Good Shepherd Center Artist Eligibility Criteria

The residences in the 5-South wing are designated as live/work lofts for professional artists. A professional artist, for our purposes, is a person who is regularly engaged in the fine arts as a career, not simply as a hobby, with a history of exhibiting their work to the public. The fine arts shall here be defined as: painting and drawing; sculpture; photography, including filmmaking and video production; performance art, including theatre, dance and choreography; literary arts, including creative writing and poetry; and musical composition. Applicants must demonstrate their artistic professionalism and commitment to their work by meeting the following qualifying criteria:

1. COMPENSATION FOR ARTWORKApplicant must receive or have received verifiable compensation for his/her artwork, in the form of sales,fees, commissions, royalties, residuals, and/or grants and financial awards; and such income derivedfrom compensation for artwork must constitute at least 10% of applicant’s total annual income for theprevious two years, cumulatively. Applicant is required to submit proof of eligibility in the form of taxreturns with appropriate schedules showing professional or business income derived from artworks, orother equivalent documentation as appropriate.

2. RÉSUMÉApplicant must provide a résumé of professional activity in the fine arts, containing at minimum thefollowing:

a. A brief summary of applicant’s career as a professional artist, describing relevant experience,body of work, and accomplishments;

b. A description of professional training received, either in an educational institution or from apractitioner or teacher recognized within his/her artistic profession;

c. A record of presentation of applicant’s artwork to the public by means of exhibitions, publications,performances, readings, screenings, or by any other means appropriate to the nature of his/herwork, arranged chronologically with dates and venues listed.

3. LETTERS OF RECOMMENDATIONApplicant must submit three (3) letters of recommendation from professionals engaged in the same (orclosely related) field of art. Each letter must be signed and include the author’s current address andphone number for verification.

Individuals qualifying as “professionals” may include: peers who have presented their artwork to thepublic within the last 12 months in the same manner as described in 2.a., above, or who have beenpublicly recognized for their work; members of professional associations or trade unions (or theirequivalent) appropriate to applicant’s artistic activity; professional art critics or appraisers; art teachersand instructors; individuals involved in the exhibition or promotion of artworks similar to applicant’s, suchas gallery or theatre owners/managers; and dealers, publishers, agents, or similar representativesappropriate to the nature of applicant’s work.

NOTICE: Applications will be deemed incomplete and will not be considered until such time as all documents, materials, and information required herein are received.

Good Shepherd Center Caretaker Criteria

We are looking for residents who have the ability to live and work cooperatively, and to be responsible custodians of the building. To qualify, applicants must be willing and able to contribute from 1 to 3 shifts per week (subject to change) in performance of caretaker responsibilities, as needed (see below for shift hours). Tenancy is conditioned upon employment as a caretaker on the property, for which Tenant will receive a full or partial rent credit in exchange for their services.

JOB DESCRIPTION: Caretakers reside on site and provide staffing and security services to the building on weekday evenings, and all day Saturday and Sunday. Responsibilities include:

Open the building to the public at 8:00 am, Monday through Saturday. Provide assistance to visitors, tenants, meeting room renters and others as needed. Monitor use of the chapel, provide and retrieve keys for renters, and make sure everyone is out by 11 pm. Perform hourly security rounds throughout the entire building. Perform a security round of the exterior of the building every other hour. Monitor public restrooms, assist with basic janitorial tasks and restock paper products as needed. Conduct an extensive and thorough closing round, which includes:

o Making sure all tenants and building visitors are out of the building;o Checking and making sure all windows are closed and locked;o Physically checking and making sure all exterior doors are closed and locked;o Making sure all doors to tenants’ spaces are closed and locked; ando Tuning off all lights where appropriate.

Provide a constant overnight “on-call” presence on site and be prepared to respond to any emergency.o If the building fire alarm is triggered, respond and work with fire alarm monitoring service and

follow building protocol for such an event.o If building security system is triggered, respond and work with monitoring service and be

prepared to engage with the police if necessary. Other duties as assigned by building manager.

General Information: Caretakers report to the Good Shepherd Center Building Manager. Weekday shifts are from 5:00 pm to approximately 11:30 pm, followed by an overnight on-call period; and 7:30 am to 8:00 am the next morning, during which the caretaker opens the building and performs one security round. Saturday and Sunday each have two shifts: the first from 8:00 am to 5:00 pm; the second from 5:00 pm to 11:30 pm, plus the overnight on-call duty.

Required Shifts: This position will initially be responsible for covering shifts on Thursday and/or Sunday evenings. This schedule is subject to change or extension in the future. Some shifts may be rotating, with multiple caretakers each taking sequential turns covering certain days. If any questions, contact Matt Murray at 206-547-0204 or [email protected].

ACKNOWLEDGEMENT: By signing below I hereby declare and agree that:

(1) I have read and do understand the caretaker job description and all other information hereinabove; (2) I understand that tenancy is conditioned upon continuous employment as a caretaker; and (3) I (check one) am / am not willing and able to fulfill the duties and responsibilities in the job

description and to cover the required shifts listed above.

Signature Printed Name Date

APPLICATION FOR TENANCY

(THIS SECTION FOR MANAGEMENT USE ONLY) Date Received: Application Fee: Photo ID Verified: Yes No

Property: Unit Number:

Rent: Expected Move-In Date: Lease Term:

All persons occupying the property over the age of 18 must complete a separate application.

Applicant Roommate w/ Cosigner Section 8

APPLICANT INFORMATION Name (full legal name) Date of Birth

Social Security Number Driver’s License Number

Phone Number Mobile Phone Email Address

RESIDENCE HISTORY Current Address Check one:

Own Rent Monthly Payment

If Rental, Current Landlord or Community Manager Name Current Landlord/Manager Daytime Phone

Previous Address (if less than 3 years at current, provide previous address) Check one: Own Rent

Monthly Payment

If Rental, Previous Landlord or Community Manager Name Previous Landlord/Manager Daytime Phone

EMPLOYMENT HISTORY Current Employer Monthly Income (Gross) Occupation or Position/Department

How Long? Current Supervisor’s Name Phone

Previous Employer (if less than 3 years at current, provide previous) Monthly Income (Gross) Occupation or Position/Department

How Long? Previous Supervisor’s Name Phone

Additional/Other Income (list amount, frequency, and source – child support, alimony and other maintenance need not be disclosed unless included for qualification)

VEHICLE INFORMATION Make Model Year License Plate State

Make Model Year License Plate State

PET INFORMATION (pets allowed by written agreement only and subject to certain limitations and conditions – service animals excepted) Type Weight Breed Age Color

EMERGENCY CONTACT Name Relationship Address Phone

Have you or any other person who would be occupying the property ever been convicted of, or pled guilty to, a criminal offense? If yes, please provide information for each offense (attach additional pages if necessary)

Yes No

Date: City, State: Type of Offense:

Are you or any other person who would be occupying the property required to register as a sex offender? Yes No

Have you ever been evicted, been named in an eviction, or been asked to vacate by a current or past landlord? Yes No

In compliance with state and federal consumer reporting law, you are hereby advised that a screening investigation will be conducted regarding the information contained in this application. The investigation may reveal information regarding your credit worthiness, character, employment, rental history, criminal history and similar information. By signing this application, you authorize Historic Seattle PDA and its agents to conduct said investigation by communicating with the persons/institutions named herein, consulting public records, and by inquiring of a consumer reporting agency in order to verify or supply such information.

DECLARATION OF APPLICANT: I hereby certify that all statements herein are true, complete and correct, and I understand that all questions requiring a yes/no answer which are left blank shall be deemed to be unanswered. I am aware that an incomplete application may cause a delay in processing and/or lead to denial of tenancy; and that false, fraudulent, or misleading information may be grounds for denial of tenancy or subsequent eviction. I hereby also acknowledge my receipt of a copy of the property’s rental criteria and eligibility requirements.

Signed: Date:

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RESIDENT ELIGIBILITY APPLICATION (REA)

Property Name: Unit #:

Household Name: Certification Type:

Current HH Size: Effective Date of Certification: Initial Certification

Number of Bedrooms: Original Certification Date: Re-Certification

THE FOLLOWING SECTION IS TO BE COMPLETED ENTIRELY BY THE APPLICANT/RESIDENT

HOUSEHOLD COMPOSITION:

Hshld Mbr First Name Last Name MI

Date of Birth mm-dd-yyyy

SSN *See page 4Last 4 digits

Fulltime Student Status **

Head Yes No

2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No

** Have you in this calendar year or will you in the next calendar year, be a fulltime student for five months or more?

Household Member’s Name:

Contact Phone: Contact E-mail:

Income Source or Employer: Phone:

Address:

Position: Hire Date:

Supervisor: Income/Salary: $

Household Member’s Name:

Contact Phone: Contact E-mail:

Income Source or Employer: Phone:

Address:

Position: Hire Date:

Supervisor: Income/Salary: $


RESIDENT ELIGIBILITY APPLICATION (REA) An Adult household members (see Instructions page for definition of Adult) must complete an REA. Adults should list all their income/assets

for the next 12 month period beginning on the anticipated date of move-in or recertification.


Household Member Name:

HOUSEHOLD MEMBER: (please check one) 1 (Head) 2 3 4 5 6 7

INCOME INFORMATION:

Yes No Annual Gross Income 1. I have a job or a verifiable start date within the next 12 months and

receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation:

Annual Gross Wages/Salary $

Annual Overtime $ Annual Bonus/Commission/Tips $

2. I am presently employed at an additional job. (NOT self-employed) $

3. I am self employed. (Attach signed tax return and appropriate schedules) Name of Business:

$ (use net income from business)

4. I am receiving or I have applied or will apply in the next 12 months: (check all that apply) Social Security (SSA);

Supplemental Social Security (SSI); or WA State (SSI). $

5. The household receives unearned income from family members age 17 or under (example: Social Security, trust fund disbursements, bank accounts, etc.).

Name of Member(s):

$

6. Do you receive child support? If no and there are children in the household, are you eligible for child support or is there a court order for child support? Yes No $

Number of court-ordered child support cases:

7. I receive alimony/spousal payments. $

8. I receive Public Assistance Income (TANF, GAU, FIP, ADATSA). $

9. I receive unemployment, Labor & Industries or disability benefits (not SSI). $

10. I am a member of the Armed Forces (Active, National Guard or Reserves). $

11. I am receiving income from a pension, annuity, retirement fund, insurance policy payments, death benefits or Veteran’s Benefits (not GI Bill benefits).

Source of Benefits:

a.) $

b.) $

12. I am receiving money regularly from family, church, friends, or any other form or regular/periodic income (such as rent and utility payments). $

13. I receive income from real or personal property (attach signed tax return with Schedule E). $




14. I hold a contract for real estate sold. If yes, provide a copy of the contract and an amortization schedule. (Only count interest portion of payment.) $

15. I have income or sources of income, other than those listed above.

If yes, list type below:

a.) $

b.) $

ASSET INFORMATION:

Yes No Balance or Value Interest Earned

16. I have a checking account(s).

If yes, list bank(s)

a.) $ $

b.) $ $

17. I have a savings account(s).


a.) $ $

b.) $ $

18. I have a Money Market account(s).

If yes, list sources/bank names

a.) $ $

b.) $ $

19. I have treasury bills, certificate(s) of deposit (CDs), or stocks/bonds (NOT held in a retirement account).


a.) $ $

b.) $ $

20. I have a trust fund.

Revocable Non-Revocable

If yes, list bank(s)/trustee

$ $

21. I have an IRA/Keogh Account/401K.

If yes, list financial entity(ies)

a.) $ $

b.) $ $

22. I have a pension or annuity asset. (NOT receiving income currently.)


a.) $ $

b.) $ $

23. I own or am in the process of selling or

have sold real estate in the last 2 years. If yes, attach explanations and supporting documentation. $

$

24. I have a whole life or universal life insurance policy.

If yes, how many policies? $ $




25. I own personal property held strictly as investment assets (arts, coins, etc.) If “yes,” attach appraisals. $ $

26. I have disposed of assets within the last two years for less than fair-market value. If “yes,” attach explanation. $ $

27. I have funds not held in a financial institution. $ $

28. I have assets other than those listed above.


a.) $ $

b.) $ $

* This property has requested your Social Security number on this and other forms on behalf of the Washington StateHousing Finance Commission. Internal Revenue Service regulations allow us to ask for this information. Your Social Security number will be used for income eligibility verification purposes only. Equivalent identification would be a Work Visa, Alien Registration Receipt Card, Temporary Resident Card, IRS Individual Taxpayer Identification Number (ITIN), or Employment Authorization Card. Failure to provide your Social Security number or equivalent number could hinder or delay this property’s ability to review your application for housing.

I understand that any changes to my household income and/or composition after the date of my signature but prior to initial occupancy must be disclosed immediately to management staff.

Under penalty of perjury, I certify that the information presented in this application is true and accurate to the best of my knowledge and belief. I further understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of the lease agreement and/or prosecution.

Signatures must be those of the Applicant/Resident, except where Power of Attorney (POA) documentation authorizes another individual to sign legal documents. If so, copies of current POA, government-issued photo ID, and address and phone number of the POA must be included in the certification.

Applicant/Resident Signature

Print Applicant/Resident Name

Date

I certify that I have observed the above-signed Applicant/Resident complete, sign, and date this document.

Property Representative Signature

Print Property Representative Name

Date

Reasonable Accommodation: If a third party is required to assist with the completion of this document, add their signature, printed name, relationship, phone number and date to the bottom of this page.

I certify that I have assisted the above-signed Applicant/Resident complete this document as a reasonable accommodation.

Third Party Signature

Print Third Party Name

Relationship

Phone # Date

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Resident Eligibility Application (REA)

Purpose: To obtain required employment status and income information for all members of the household.

General Information:

For the purpose of completing this form, “Adult” means any household member who is currently 18 years of age or older, as well as a 17 year old who will be turning 18 within 12 months of the household’s certification. “Adult” also refers to any adults who are members of the household but who may be temporarily absent from the household.

For the purpose of completing this form, all household Adults must complete Pages 2-4 of the REA (one set of pages for each Adult).

A separate household Income/Assets questionnaire must be completed for each household member 18 years of age or older. Only one household member can appear on each questionnaire (pages 2-4).

The head of household should complete page one. All adulthousehold members must complete all sections of separate pagestwo through four, regardless of monetary contribution and havetheir signatures witnessed by on-site staff.

Birthdates of all household members must be completed. If a household adult is not working, disclose what s/he is doing,

e.g., collecting unemployment, going to school, staying at home tocare for children, etc.

Instructions 1-15 Pertain to Page One of the Rental Eligibility Application

Specific Instructions:

1. Enter property name and unit number.

2. Enter name of head of household.

3. Enter number of people in the household.

4. Enter the number of bedrooms in the unit.

5. Enter the Effective Date of Certification. This will be either thedate the lease is effective (i.e. the date the household can takeoccupancy) for new move-ins; for re-certifications the dateshould be move-in anniversary date.

6. Enter the effective date of the initial certification (the date thehousehold originally took occupancy of the unit or the date theywere first certified on a rehab).

7. Check applicable box – indicating initial certification or annualrecertification.

8. Resident enters names, birthdates, and last four digits of Social

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Security Number * of all household members occupying the unit.

9. Resident checks the applicable “Yes” or “No” box (refer toChapter 2 of the Tax Credit Compliance Procedures Manual)regarding student status.

10. Resident enters household member’s name, contact phone andcontact e-mail.

Resident Eligibility Application (REA) – con’t.

11. Resident enters source of income, or name of the company theresident is employed by and the phone number of the employer.

12. Resident enters complete address of the employer.

13. Resident enters resident’s job title and hire date.

14. Resident enters direct supervisor’s name and the monthly grossincome of resident.

15. Resident repeats steps 10-14 if more than one person in ahousehold is working or if a resident has two jobs. You may useadditional pages when needed to list additional employers orsources of income such as Social Security.

Instructions 16-21 pertain to the REA (Income/Assets Questionnaire)

16. Enter property name and unit number (will auto fill).

17. Enter household member name.

18. Resident checks appropriate box.

19. Resident checks boxes to answer questions 1 through 28. If theresident checks “Yes” s/he must enter amount(s) in column.

Special Note about Question #6: If applicant/resident hasindicated “No” and there is no court-ordered support the ChildSupport Affidavit is not required.

20. Resident prints name, signs, and dates form.

21. Management’s representative must sign as a witness, printname, and date for each resident/applicant form.

* Note: For privacy reasons, a resident may elect to not provide his/herSocial Security number on this form. Residents who do not provide their Social Security number should sign Certification #2 on the Identification Certification form.


RESIDENT ELIGIBILITY APPLICATION (REA)

Property Name: (1)

Unit #: (1)

Household Name: (2)

Certification Type: (7)

Current HH Size: (2) Effective Date of Certification: (5) Initial Certification Number of Bedrooms: (4) Original Certification Date: (6) Re-Certification

THE FOLLOWING SECTION IS TO BE COMPLETED ENTIRELY BY THE APPLICANT/RESIDENT

HOUSEHOLD COMPOSITION:

(8) (8) (8) (8) (8) (9) Hshld Mbr First Name Last Name MI

Date of Birth mm-dd-yyyy

SSN *See page 4 Last 4 digits

Fulltime Student Status **

Head Yes No

2. Yes No

3. Yes No

4. Yes No

5. Yes No

6. Yes No

7. Yes No

** Have you in this calendar year or will you in the next calendar year, be a fulltime student for five months or more?

Household Member’s Name: (10) Contact Phone: (10) Contact E-mail: (10) Income Source or Employer: (11) Phone: (11) Address: (12) Position: (13) Hire Date: (13) Supervisor: (14) Income/Salary: $ (14)

Household Member’s Name: (15) Contact Phone: Contact E-mail: Income Source or Employer: Phone: Address: Position: Hire Date: Supervisor: Income/Salary: $


RESIDENT ELIGIBILITY APPLICATION (REA) An Adult household members (see Instructions page for definition of Adult) must complete an REA. Adults should list all their income/assets

for the next 12 month period beginning on the anticipated date of move-in or recertification.

Property Name: (16) Unit #: (16)

Household Member Name: (17)

HOUSEHOLD MEMBER: (please check one) (18) 1 (Head) 2 3 4 5 6 7

INCOME INFORMATION:

Yes No (19) Annual Gross Income

1. I have a job or a verifiable start date within the next 12 months and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation:

Annual Gross Wages/Salary $

Annual Overtime $

Annual Bonus/Commission/Tips $

2. I am presently employed at an additional job. (NOT self-employed) $

3. I am self employed. (Attach signed tax return and appropriate schedules)

Name of Business:

$ (use net income from business)

4. I am receiving or I have applied or will apply in the next 12 months: (check all that apply) Social Security (SSA);

Supplemental Social Security (SSI); or WA State (SSI). $

5. The household receives unearned income from family members age 17 or under (example: Social Security, trust fund disbursements, bank accounts, etc.).

Name of Member(s):

$

6. Do you receive child support? If no and there are children in the household, are you eligible for child support or is there a court order for child support? Yes No $

Number of court-ordered child support cases:

7. I receive alimony/spousal payments. $

8. I receive Public Assistance Income (TANF, GAU, FIP, ADATSA). $

9. I receive unemployment, Labor & Industries or disability benefits (not SSI). $

10. I am a member of the Armed Forces (Active, National Guard or Reserves). $

11. I am receiving income from a pension, annuity, retirement fund, insurance policy payments, death benefits or Veteran’s Benefits (not GI Bill benefits).

Source of Benefits:

a.) $

b.) $

12. I am receiving money regularly from family, church, friends, or any other form or regular/periodic income (such as rent and utility payments). $

13. I receive income from real or personal property (attach signed tax return with Schedule E). $




14. I hold a contract for real estate sold. If yes, provide a copy of the contract and an amortization schedule. (Only count interest portion of payment.) $

15. I have income or sources of income, other than those listed above.


a.) $

b.) $

ASSET INFORMATION:

Yes No (19) Balance or Value Interest Earned

16. I have a checking account(s).


a.) $ $

b.) $ $

17. I have a savings account(s).


a.) $ $

b.) $ $

18. I have a Money Market account(s).


a.) $ $

b.) $ $

19. I have treasury bills, certificate(s) of deposit (CDs), or stocks/bonds (NOT held in a retirement account).


a.) $ $

b.) $ $

20. I have a trust fund.

Revocable Non-Revocable

If yes, list bank(s)/trustee

$ $

21. I have an IRA/Keogh Account/401K.

If yes, list financial entity(ies)

a.) $ $

b.) $ $

22. I have a pension or annuity asset. (NOT receiving income currently.)


a.) $ $

b.) $ $

23. I own or am in the process of selling or

have sold real estate in the last 2 years. If yes, attach explanations and supporting documentation. $

$

24. I have a whole life or universal life insurance policy.

If yes, how many policies? $ $




25. I own personal property held strictly as investment assets (arts, coins, etc.) If “yes,” attach appraisals. $

$

26. I have disposed of assets within the last two years for less than fair-market value. If “yes,” attach explanation. $

$

27. I have funds not held in a financial institution. $ $

28. I have assets other than those listed above.


a.) $ $

b.) $ $

* This property has requested your Social Security number on this and other forms on behalf of the Washington State Housing Finance Commission. Internal Revenue Service regulations allow us to ask for this information. Your Social Security number will be used for income eligibility verification purposes only. Equivalent identification would be a Work Visa, Alien Registration Receipt Card, Temporary Resident Card, IRS Individual Taxpayer Identification Number (ITIN), or Employment Authorization Card. Failure to provide your Social Security number or equivalent number could hinder or delay this property’s ability to review your application for housing. I understand that any changes to my household income and/or composition after the date of my signature but prior to initial occupancy must be disclosed immediately to management staff. Under penalty of perjury, I certify that the information presented in this application is true and accurate to the best of my knowledge and belief. I further understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of the lease agreement and/or prosecution.

Signatures must be those of the Applicant/Resident, except where Power of Attorney (POA) documentation authorizes another individual to sign legal documents. If so, copies of current POA, government-issued photo ID, and address and phone number of the POA must be included in the certification.

(20) (20) (20)

Applicant/Resident Signature

Print Applicant/Resident Name

Date I certify that I have observed the above-signed Applicant/Resident complete, sign, and date this document.

(21) (21) (21)

Property Representative Signature

Print Property Representative Name

Date Reasonable Accommodation: If a third party is required to assist with the completion of this document, add their signature, printed name, relationship, phone number and date to the bottom of this page. I certify that I have assisted the above-signed Applicant/Resident complete this document as a reasonable accommodation.

Third Party Signature

Print Third Party Name

Relationship

Phone #

Date

Date post:	13-Aug-2020
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APPLICATION PACKET · Letters of Recommendation, meeting all requirements (see Artist Eligibility...

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