Rental Application - Supportive Housing Coalition of New Mexico

Please check the property that this application is for

Chuska (Gallup, NM)

Sunport Plaza (Albuquerque, NM)

Redlands (Albuquerque, NM)

Vista Gallinas (Las Vegas, NM)

The Supportive Housing Coalition operates these properties under the rules and regulations of the Low Income Housing Tax Credit Program within Section 42 of the Internal Revenue Code, HOME, and/or HUD CoC guidelines which require that we obtain written confirmation of the income of all applicants and other household members.

In order to comply with federal regulations requesting verification of all income, assets and allowances for residents housing, please complete the following form in full and return it to the office at your earliest convenience. Please write “N/A” for not applicable if the question does not pertain to you.

Household Information

Please list all persons who will be living in your unit

Race and Ethnicity:

I/We prefer not to answer or disclose

Please add each member of the household

Household Member's Full Name

Relationship to Head of Household

If you are head of household enter 'self' in this field.

DOB

Race

Ethnicity

Disabled?

Full time Student?

Social Security Number

Add Household Member Remove Household Member

Homelessness

Are you currently experiencing homelessness?

Yes

No

Contact Information

Current Mailing Address

Address One

Address Two

City

State/Province

Zip/Postal

Home Phone

Cell Phone

Email

Identification

Please list all persons who will be living in your unit

Household Member's Full Name

Identification Card/Driver's License Number and State

Add Household Member Remove Household Member

Marital Status

Automobile(s)

Make

Model

Year

License Plate/State

Add Automobile Remove Automobile

Reasonable Accommodations

The Supportive Housing Coalition complies with Fair Housing Act and offers reasonable accommodations/modifications to persons with disabilities.

Do you or a household member require any modifications or accommodations?

Yes

No

Please explain

Pet and/or Service Animal Declaration

Do you or any member of your household have a pet?

Yes

No

Service/Companion Animal?

Yes

No

Pets

Type of pet

Breed

# of lbs

Height in inches

Add Pet Remove Pet

Household Income

Identify each source of income currently received or anticipated to receive in the next 12 months.

Wages, bonuses, tips from employment

$

Self-employment

$

Not Employed

$

Unemployment Compensation

$

Disability/Worker's Compensation/Severance Pay

$

Social Security/SSI Benefits

$

VA Benefits

$

Pension/Annuity

$

Military Pay

$

Public Assistance (i.e. GA/AFDC/TANF)

$

Recurring Gift/Contribution

$

Child Support/Alimony/Family Maintenance

$

Rental Income

$

Lottery Winnings Paid Periodically

$

Adoption Assistance

$

Trust Income

$

Other Income (i.e. inheritance, insurance policies)

$

Zero Income From Any Source

Yes

Does anyone pay any of your bills for you?

No

Yes

Amount

$

Assets

Identify each source of income currently received or anticipated to receive in the next 12 months.

Do you or any household members have income from assets?

Yes

No

(Assets include, but are not limited to checking, savings, CDs (certificates of deposit) real estate, stocks, bonds, treasury bills, annuities, pensions,
personal property held as investments (antique cars, art or coins), 401K, 403b, IRA, Keogh accounts, or cash value of life insurance policies, etc.)

Asset Details

Type of Asset

Current Balance /Value

$

Held Jointly

Yes

No

Name of Financial Institution

Add Asset Remove Asset

Are the assets listed above for the entire household more than $5,000?

Yes

No

Other Assets

Do you or any household members own any real property?

Yes

No

If yes, please list type and address

Do you or any household member have any other assets not listed?

Yes

No

If yes, please list below

Other Assets Not Listed

Source

Type of Account

Balance

$

Add Asset Remove Asset

Have you or any household member sold/disposed of any property/assets within the last two (2) years?

Yes

No

If yes, please list below

Past Property Assets

Type of Asset

Market Value When Sold

$

Amount Sold/Disposed For

$

Date of transaction

Add Asset Remove Asset

Rental History

Please list last 3 rental addresses, current address first. NOTE: Lack of rental history is not a reason for denial of application.

Rental History

Address

City

State/Province

Zip/Postal

Move-in date

Owner/Manager

Phone

Add Previous Address Remove Previous Address

Have you or anyone in your household ever been evicted?

Yes

No

If yes, please explain:

Have you or your co-head/spouse been used for nonpayment of rent or damages to a rental property?

Yes

No

If yes, please explain:

Have you notified your current landlord/manager you are planning on moving?

Yes

No

If yes, please explain:

Other Information

Have you or any member of your household ever engaged in drug-related activity, such as use, possession, distribution, trafficking, or manufacturing of an illegal drug?

Yes

No

If yes, explain circumstances, outcome and present status:

Have you or any member of your household ever engaged in, been arrested, and/or convicted of any other criminal activity?

Yes

No

If yes, explain circumstances, outcome and present status:

Are you or any member of your household required to register as a Lifetime Sex Offender?

Yes

No

Will your household be receiving Section 8 rental assistance at the time of move-in?

Yes

No

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

Yes

No

Please explain

Have you ever received rental assistance?

Yes

No

If yes, please explain

Are you or anyone in your household a veteran of the United States Armed Forces?

Yes

No

If yes, please indicate which branch

Emergency Contact

Name

First

Last

Phone

Relationship

Address

City

State/Province

Zip/Postal

Application Agreement

The Owner or agents and the Applicant (including all co-applicants) agree as follows:
1. APPLICATION TO RENT. The Applicant hereby applies to rent the Unit in accordance with the terms and conditions contained in Owner’s customary form of Rental Agreement.
2. SERVICE FEE & BACKGROUND CHECK. The Applicant agrees to pay any service fees/background check fees if applicable at the time of processing. The Applicant will be contacted by the property manager if the fees are applicable. All fees will not exceed $21.00.

CERTIFICATION OF ACCURACY AND COMPLETENESS

I/We certify that all information provided in this rental application is true and complete to the best of knowledge and
understand that this information will be used to verify income eligibility for the low income housing tax credit, HOME, or
HUD 811 program under which I/we applied. I further understand and agree that the owner/management agent will use
this information to investigate my/our credit worthiness through credit bureau, criminal checks and landlord
verification. I/we further understand that any applicant who purposefully falsifies, misrepresents or withholds any
information related to program eligibility or submits inaccurate and/or incomplete information on this application will
not be considered for housing. Furthermore, if such misrepresentation or omission is discovered after tenancy has
begun, I/we understand that we may be subject to eviction or punishable by law. I/we further understand that
acceptance of the application is not binding on apartment owner or agent until approved in writing.

Type your full name

Today's Date

The Supportive Housing Coalition is an equal housing opportunity provider. We do not discriminate against applicants on the basis of race, color, creed, national origin, religion, sex, sexual orientation, gender identity, familial status (includes marital status), or disability condition in any phase of the occupancy process.