Application

Dougert Management Corporation

SUBMIT ONLY ONE (1) APPLICATION PER HOUSEHOLD.

Learn who should apply, how to apply, and what happens after you apply

Step 1 of 11

Select the building you are applying for:(Required)

Morris Manor: 1247 Flatbush Avenue

Household Information

Applicant Name(Required)

First Last

Household Members(Required)

Complete the following information for each household member that will occupy the unit at the time of move-in. Use the plus (+) button on the right to add more people.

Name (First, Middle Initial, Last)

Relationship to Head of Household

Male/Female

Social Security Number

Birthdate (Month, Date, Year)

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Daytime Phone(Required)

Evening Phone(Required)

Do you expect any additions to the household within the next twelve months?(Required)

Yes

Household Additions(Required)

Use the plus (+) button on the right to add more people.

Name

Relationship

Explanation

Do you have full custody of your child(ren)?(Required)

Yes

Explanation of custody arrangements(Required)

Have you ever been convicted of a felony?(Required)

Yes

Explanation of felony conviction(Required)

Housing References

Housing References List(Required)

List the past THREE years of housing references. Use the plus (+) button on the right to add more references.

Landlord's Name & Address

Landlord's Phone

Rental Address

Length of Time

Have you ever been evicted from an apartment for any reason?(Required)

Yes

Explanation of eviction(Required)

Personal Reference

List a personal reference other than a relative.

Personal Reference Name(Required)

First Last

Personal Reference Address

Street Address Address Line 2 City State ZIP Code

Personal Reference Phone(Required)

Relationship(Required)

Years Known(Required)

Vehicle Identification

Vehicle List(Required)

Use the plus (+) button on the right to add more vehicles.

License #

State Issued

Make / Model / Year

Emergency Contact

List someone in the area and other than listed on the application if possible.

Emergency Contact Name(Required)

First Last

Emergency Contact Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact Phone

Relationship(Required)

Income Information

Include all income anticipated in the next 12 months. Include the dollar ($) amount in the space provided.

DO YOU OR ANYONE IN YOUR HOUSEHOLD RECEIVE OR EXPECT TO RECEIVE INCOME FROM:

1. Employment wages or salaries?(Required)

Include overtime, tips, bonuses, commissions and payments received in cash.

Yes

Employment wages or salaries list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

2. Self-employment?(Required)

Yes

Self-employment list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

3. Regular pay as a member of the Armed Forces?(Required)

Yes

Armed Forces list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

4. Unemployment benefits or workman's compensation?(Required)

Yes

Unemployment list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

5. Public Assistance, General Relief or Aid to Families with Dependent Children (AFDC)?(Required)

Yes

Public Assistance list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

6. Child support or alimony?(Required)

Any awarded amounts—collected or uncollected

Yes

Child Support list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

7. Social Security, SSI or any other payments from the Social Security Administration?(Required)

Yes

Social Security list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

8. Veteran's Benefits, pensions, retirement benefits or annuities?(Required)

Yes

Veteran's Benefits list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

9. Severance payments?(Required)

Yes

Severance list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

10. Settlements?(Required)

Yes

Settlements list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

11. Disability, death benefits or life insurance dividends?(Required)

Yes

Disability list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

12. Regular gifts or payments from anyone outside of the household?(Required)

This includes anyone supplementing your income or paying any of your bills

Yes

Regular gifts list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

13. Educational grants, scholarships, or other student benefits?(Required)

Yes

Educational income list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

14. Lottery winnings or inheritances?(Required)

Yes

Lottery list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

15. Payments from rental property, land contracts or other forms of real estate?(Required)

Yes

Rental income list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

16. Any other income sources or types not listed?(Required)

Yes

Other income list(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Asset Information

Include all assets held and the corresponding annual interest rate, dividends or any other income derived from the asset. An asset is defined as any lump sum amount that you hold and currently have access to. Include the value of the asset and corresponding income from the asset in the space provided. Include ALL assets held by ALL household members including minors.

DO YOU OR ANYONE IN YOUR HOUSEHOLD HOLD:

1. Checking or savings accounts?(Required)

Yes

Accounts List(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Account #

2. CDs, money market accounts or treasury bills?(Required)

Yes

CDs List(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Account #

3. Stocks, bonds or securities?(Required)

Yes

Stocks List(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Account #

4. Trust funds?(Required)

Yes

Trust Funds List(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Account #

5. Pensions, IRAs, KEOGH or other retirement accounts?(Required)

Yes

Retirement Accounts List(Required)

Use the plus (+) button on the right to add more items.

Source

Household Member

Amount

Account #

6. Cash on hand over $500?(Required)

Yes

Cash List(Required)

Use the plus (+) button on the right to add more items.

Household Member

Amount

7. Real estate, rental property, land contracts / contract for deeds or other real estate holdings?(Required)

This includes your personal residence, vacant land, farms, vacation homes or commercial property.

Yes

Real Estate List(Required)

Use the plus (+) button on the right to add more items.

Type

Household Member

Value

8. Personal property as investment?(Required)

This includes paintings, coin or stamp collections, artwork, collector or show cars, and antiques.

Yes

Personal Property List(Required)

Use the plus (+) button on the right to add more items.

Type

Household Member

Value

9. A safe deposit box?(Required)

Yes

Safe Deposit List(Required)

Use the plus (+) button on the right to add more items.

Household Member

Contents of Monetary Value

10. Have you or any household member disposed of or given away any assets for LESS than fair market value within the past 2 years?(Required)

Yes

Disposed of Assets List(Required)

Use the plus (+) button on the right to add more items.

Household Member

Amount

Explanation

Zero Income Verfication

1. Are you or is any other ADULT member of your household claiming zero income?(Required)

Yes

Household member(s) claiming zero income(Required)

Student Information

ARE YOU OR IS ANYONE IN YOUR HOUSEHOLD:

1. A full-time student currently or planning to be in the next 12 months?(Required)

Yes

a. Are you married AND currently filing a joint tax return?(Required)

Yes

b. Are you receiving AFDC (Aid to Families with Dependent Children)?(Required)

Yes

c. Are you enrolled in the Job Training Partnership Act (JTPA) or another similar local, county or state program?(Required)

Yes

d. Are you a single parent with minor child(ren) and neither you nor the minor child(ren) are dependents on anyone else's tax return?(Required)

Yes

e. Will you be living with someone who is not a full-time student?(Required)

Yes

Name of non-full-time student(Required)

Live-in Care Attendant

1. Will you or anyone in your household require a live-in care attendant?(Required)

Yes

Live-in Care Attendant List(Required)

Use the plus (+) button on the right to add more items.

Name of Live-in Care Attendant

Relationship (if any)

Section 8 Rental Assistance

1. Will your household be receiving Section 8 rental assistance at the time of move-in?(Required)

Yes

Section 8 Assistance List(Required)

Use the plus (+) button on the right to add more items.

Name of Agency

Contact Person Name

2. Will your household be eligible or are you applying to receive Section 8 rental assistance in the next 12 months?(Required)

Yes

Section 8 Application List(Required)

Use the plus (+) button on the right to add more items.

Explanation

Name of Agency

All questions that were answered YES will be verified through the appropriate third -party resources. It will be your responsibility to provide management with all necessary information to property process your application and verify your eligibility. This will include names, address, phone and fax numbers, account numbers where applicable and any other information required to expedite this process.

Signature Clause

I understand that management is relying on this information to prove my household's aligibility for the Low Income Housing Tax Credit Program. I certify that all information and answers to the above questions are true and complete to the best of my knowledge. I consent to release the necessary information to determine my eligibility. I understand that providing false information or making false statements may be grounds for denial of my application. I also understand that such action may result in criminal penalties.

I authorize my consent to have management verify the information contained in this application for purposes of proving my eligibility for occupancy. I will provide all necessary information and expedite this process in anyway possible. I understand that my occupancy is contingent on meeting management's resident selection criteria and the Low Income Housing Tax Credit Program requirements.

CAMBA Housing Ventures

Application

Dougert Management Corporation

Household Information

Housing References

Personal Reference

Vehicle Identification

Emergency Contact

Income Information

Asset Information

Zero Income Verfication

Student Information

Live-in Care Attendant

Section 8 Rental Assistance

Signature Clause

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