The Preserve at Smithtown Senior (55 and Over) First-Come First-Served Application Form 

PROGRAM GUIDELINES

 

THE PRESERVE AT SMITHTOWN

SENIOR (55 AND OVER) AFFORDABLE RENTAL HOUSING PROGRAM

FIRST-COME FIRST-SERVED

 

PLEASE READ CAREFULLY

 

 

The Long Island Housing Partnership (LIHP), in cooperation with The Preserve at Smithtown LLC (the ā€œOwnerā€) is pleased to announce that it is accepting First-Come First-Served Applications for twenty

2-bedroom affordable rental units (the ā€œAffordable Unitā€) located within the complex known as ā€œThe Preserve at Smithtownā€.  The Preserve at Smithtown is located in Nesconset, New York and is part of a larger senior community containing 180 units.

  

LIHPā€™s limited role is to administering the program qualification process for the Affordable Units on behalf of the Owner. Set forth herein are the Program Guidelines with respect to eligibility for the units.  LIHP strictly complies with these Program Guidelines and applicants are urged to read them thoroughly.  Documentation will be reviewed for compliance and completeness.  LIHP staff is available to assist with the process, address questions or provide any assistance regarding eligibility.

 

If you have any questions regarding any of the Program Guidelines, or need any assistance including language assistance such as translation and/or oral interpretation services, please email LIHP at info@lihp.org before applying. Employees of LIHP and their immediate family members are precluded from participating in the program.

 

Si tiene alguna pregunta con respecto a cualquiera de las Pautas del Programa, o necesita asistencia lingĆ¼Ć­stica o de otro tipo, incluidos servicios de traducciĆ³n y/o interpretaciĆ³n oral, por favor envĆ­e un correo electrĆ³nico a LIHP a info@lihp.org antes de presentar la solicitud.

 

LIHP IS NEITHER THE OWNER, MANAGER, LANDLORD OR LEASING AGENT.  LIHPā€™S LIMITED ROLE WILL BE TO INCOME QUALIFY POTENTIAL APPLICANTS. ANY REQUEST FOR A REASONABLE ACCOMMODATION REGARDING ANY UNIT MUST BE CONVEYED TO AND PROCESSED BY THE OWNER/MANAGER.  


SUBMISSION OF REQUIRED DOCUMENTATION OR DETERMINATION OF INCOME ELIGIBILITY DOES NOT GUARANTEE ELIGIBILITY FOR A UNIT.

                                                                                                            

THE PRESERVE AT SMITHTOWN RENTAL PROGRAM

 

The Preserve at Smithtown is a new boutique apartment community located in the picturesque hamlet of Nesconset. Situated on 23 park-like acres, The Preserve at Smithtown will offer secure, modern living, featuring a plethora of fabulous amenities and extraordinary finishes that will complement an active lifestyle. And, as a member of this luxury rental community, residents will enjoy complimentary continental breakfast with coffee every Monday thru Friday in the clubhouse. The clubhouse will also feature a state-of-the-art fitness center, lounge and games/billiard rooms, and an outdoor pool and patio with gas fire pits.  The community will also feature two pickle ball courts, electric car charging stations, basement storage spaces for every unit in their respective buildings, and a 50- inch flat screen television with an electric fireplace in every unit.

MAXIMUM & MINIMUM INCOME GUIDELINES

The Affordable Units are available to households with incomes at or below 80% of the HUD Area Median Income for Nassau/Suffolk Counties (AMI), adjusted for household size.  The 2024 income limits are as follows:

 

                                                                                80% AMI             

                                                                               2 BEDROOM


HOUSEHOLD SIZE                      *MAXIMUM ANNUAL INCOME                 **MINIMUM ANNUAL INCOME

            1                                                              $87,500                                                  $69,744

            2                                                              $100,000                                                $69,744

            3                                                              $112,500                                                $69,744

            4                                                              $124,950                                                $69,744

            5                                                              $134,950                                                $69,744                                              6                                                              $144,950                                                $69,744


*Includes all income ā€“ overtime, bonuses, pensions, social security, 401K distributions, tips, etc.  Your gross income cannot exceed the maximum annual income for your household size.  The limits above are based on the estimated 2024 HUD ā€œuncappedā€ income limits.  Income limits are subject to confirmation and adjustment by HUD and may be adjusted for rounding. Income limits are also adjusted annually. **Minimum income guidelines do not apply to those applicants with an approved rental assistance subsidy.  Minimum incomes are set exclusively by the Owner and may not apply if sufficient liquid assets or other mitigating factors and/or guarantees are available as determined and approved solely by the owner.  If the Owner requires a guaranty, please be advised that the Owner may independently verify the income and credit/background of the guarantor and make determination whether it is acceptable.  The determination as to whether to the guarantor meets the income and credit/background requirements and whether to accept the guaranty is the sole and exclusive determination of the Owner and LIHP has no authority to review, accept or reject a guarantor.  The Owner will determine whether to accept or decline the guarantor and will notify LIHP who will then notify the applicant. Minimum incomes are based on 2x the gross rent (before the utility allowance).


Age-Restricted Occupancy Requirement as per the Municipality

Occupancy of a unit is limited to persons who are fifty-five (55) years of age or over, with the following exceptions:

(a)    A couple, in which one of the individuals is under the age of fifty-five (55), but who resides together with the other individual who is fifty-five (55) years of age or older.

(b)    Children and grandchildren residing with their parents or grandparents where one of said parents or grandparents with whom the child or children or grandchild or grandchildren is/are residing is fifty-five (55) years of age or older, provided that said child or children or grandchild or grandchildren are over the age of 19.

(c)     Adults under fifty-five (55) years of age may be admitted as permanent residents if it is established to the satisfaction of the Town Board that the presence of such person is essential for the physical care and economic support of the eligible older persons.  This decision is not within the discretion of the Owner or LIHP.  The ordinance does not set forth any criteria time frame or procedures for determination by the Town Board as to whether a person will qualify to reside in a home because he or she is essential to the physical care or economic support of the eligible older person

 

Proof of age (license, ID card etc.) is required.


RENTS

Pursuant to Owner/municipal requirements, the initial rents for each unit are set forth below.  Rents are adjusted annually and rents are subject to increase accordingly.  Tenants are responsible for paying all utilities.  The rents are set as follows:

 

80% AMI

2 Bedroom:                      $ 2,720


ANNUAL RECERTIFICATION

The maximum household income requirements are adjusted annually by HUD.  Recertification of income will be required annually to remain eligible for the Program and to preserve the units as affordable for occupants who meet the income guidelines.  Pursuant to Town requirements, occupants will meet the income guidelines on recertification as long as their household income does not exceed 80% of the Nassau/Suffolk AMI as determined by HUD and adjusted for household size.  Occupants of the Affordable Units whose income exceeds this amount will no longer be eligible for the Program and will be required to vacate.


FEES

The Owner requires tenants to obtain Renters Insurance with $500,000 in general liability coverage. Additional fees may be imposed by the Owner for such items as a security deposit, credit and background assessments, trash collection, pets, parking, water, renterā€™s insurance, or other items.  The fees are set exclusively by the Owner and are subject to change by the Owner without notice.  LIHP has no responsibility for such fees. A Fee Schedule may be obtained by contacting the Owner at  james@northwindgroup.com


CREDIT/MINIMUM INCOME/ BACKGROUND CHECK

The Owner, and/or its agents, will conduct a credit/minimum income and background check on applicants and applicants must meet the Owner requirements. Any determination with respect to credit/minimum income/background rests solely with the Owner and LIHP has no responsibility for such assessments or determinations.

 

OCCUPANCY/UNIT SELECTION

Unit selection and occupancy requirements are established solely by the Owner and eligible applicants must work directly with the Owner to select a unit.  Any determination with respect to available units or occupancy restrictions rests solely with the Owner and LIHP has no responsibility for such assessments or determinations. 

 

PETS

The complex is a pet friendly community; however, certain restrictions apply. Please consult with the Owner/property management for their restrictions and pet policy.  Additional fees may apply as stated on the Fee Schedule as provided by the Owner.  Service and/or assistance animals are not subject to the pet policy.


SMOKE-FREE FACILITY

No smoking is permitted within the complex.


ELIGIBILITY PROCESS

All applicants will be ranked and considered for the program on a first-come, first-served basis.  Eligibility for the Program involves a five-step process.

 

STEP 1:                  Applicant submits a First-Come First-Served Application to LIHP

STEP 2:                  Once your ranking number is reached, LIHP will forward the First-Come First-Served                            Application to Owner

STEP 3:                  Owner conducts a credit/minimum income/background review

STEP 4:                  If approved by Owner, applicant submits a Formal Program Application, together                                                               with required documentation, to LIHP

STEP 5:                  LIHP assesses Program eligibility and, if eligible, applicant works directly with Owner for                                                  lease-up


FIRST-COME FIRST-SERVED APPLICATION 

 

First-Come First-Served Applications are available through LIHPā€™s website at www.lihp.org/rentals.html. First-Come First-Served Applications must be completed and submitted online at www.lihp.org/rentals.html.                            

 

CREDIT/MINIMUM INCOME/BACKGROUND REVIEW

Once your ranking number is reached, LIHP will forward your FCFS Application to the Owner and/or its agents, who will conduct a credit, minimum income and background assessment on the household.  Applicants will be reviewed in the order they are ranked on the Ranked Waitlist.  The credit/minimum income/background checks, and any fee, are performed and required solely by the Owner and/or its agents based upon their internal requirements for tenant occupancy and LIHP is not responsible for the conduct or results of such review.  The Owner and/or its agents will advise LIHP whether the applicant meets the requirements.  LIHP will advise applicants as to their approval or rejection, via email. If an applicant is deemed ineligible, the applicant will be removed from the Ranked Waitlist.


FORMAL PROGRAM APPLICATIONS/INCOME ELIGIBILITY

If an applicant has met the credit/minimum income/ background requirements of the Owner, as an applicantā€™s name is reached on the Ranked Waitlist, LIHP will send notice to the applicant, by email, to submit a Formal Program Application and supporting documents.  The email will provide instructions on how to submit. LIHP will provide the applicant with a Checklist of required documentation.  The Formal Program Application and required documentation must be completed and received by LIHP within seven (7) calendar days of the notice date.  If the Formal Program Application is not received within such 7-day period, the applicant will be deemed ineligible, with no right of appeal.  If required documentation is missing, LIHP will provide applicant notice, by email, of what is missing and applicant will be required to submit such documentation within three (3) calendar days of the notice date.  If all the documentation is not received within such three (3) day period, the applicant will be deemed ineligible, with a right of appeal. 

 

If all documentation is received as required, LIHP will then conduct an income and eligibility review to determine if the applicant meets all Program Guidelines.  If an applicant meets the eligibility requirements, LIHP will provide notice, by email, to the applicant and the Owner advising them of the applicantā€™s eligibility.  The applicant will then work directly with the Owner to select a unit and execute a lease.  If the applicant does not comply with the Owner requirements for lease execution, the Owner will advise LIHP that the applicant is no longer eligible for the Program.  Should the applicant be deemed ineligible, LIHP will move on to the next name on the Waitlist, with no right of appeal. 

 

APPEALS

Under some circumstances as provided herein, applicants who are deemed ineligible may appeal the determination by submitting a request to LIHP. The appeal request must be in writing and must be received (together will all documentation) by LIHP within three (3) calendar days of the date of LIHPā€™s notice to applicant of the determination of ineligibility. The appeal must state the basis of the appeal and contain documentation to support the appeal. Please note that, if the applicant was deemed ineligible due to failure to submit required documentation within the required time frame, then, no appeal will be granted unless the applicant submits the remaining required documentation with the appeal request within the timeframe required. The appeal will be promptly reviewed and the applicant advised of the final determination by email. Notice to LIHP of an appeal request can ONLY be submitted via a file-specific link that will be provided by LIHP.


PROCEDURE TO PROMOTE FAIR AND EQUITABLE WAITLIST PROCESS

First-Come First-Served Waitlist: To be included and ranked on a waitlist, applicants will only be permitted to submit one application or intake form, as applicable.  To this end, LIHP will endeavor, but is not required to, review all submissions. If it appears that an applicant has submitted more than one application or intake form, then LIHP may reject the additional subsequent submission(s) and the applicant will retain the earliest ranking number.  Items to be reviewed include, but are not limited to, (1) submissions from the same address; (2) submissions that list the same household members; (3) submissions that list the same names but with different addresses; (4) submissions that utilize the same email address; (5) submissions that utilize the same phone numbers (home and cell); and (6) such other items as may be determined in LIHPā€™s sole discretion.


General Provisions:


LIHP may contact the applicant regarding any uncertainty as to whether more than one application or intake form has been submitted.  LIHP may rely upon such certifications, documentation or other information as it deems reasonable, in its sole discretion, in assessing whether more than one submission has been made. If LIHP, in its sole discretion, determines that a submission is to be rejected, LIHP may, but is not required to, notify the applicant of same.  The Program Guidelines advise applicants of the above and, accordingly, applicants have prior notice of such procedures. Nothing herein shall preclude more than one application from the same address provided the applicants will not be part of the same household for purposes of the program applied for.  LIHP makes no guarantee that each duplicate will have been identified and removed from the program.  


FAIR HOUSING AND NON-DISCRIMINATION

LIHP is committed to promoting fair housing, equal opportunity, and non-discrimination in compliance with all federal, state and local laws, including, but not limited to, the Fair Housing Act, as amended by the Housing for Older Americans Act, the Americans with Disabilities Act, the Civil Rights Act, and the New York State Human Rights Law.  The LIHP staff is available to assist with the application, and answer questions about eligibility requirements.  In furtherance of this policy, LIHP shall not discriminate on the basis of race, creed, color, national or ethnic origin, sex, sexual orientation, gender identity, familial status, source of income, religion, disability, veteransā€™ status, age, or any other basis prohibited by law.

 

LIMITED ENGLISH PROFICIENCY AND ACCOMMODATIONS

LIHP will take reasonable steps to ensure that persons with Limited English Proficiency (LEP) and persons who need assistance or who have a limited ability to speak, read, or write English, will have meaningful access and an equal opportunity to participate in the Program.  Interpreters, translators and other aids needed to comply with this policy shall be provided as reasonably necessary.  If you have any questions regarding the guidelines, or need assistance including language assistance such as translation and/or oral interpretation services, please contact the LIHP at info@lihp.org.

 

                                ****************************************************************

Disclaimer: It is understood that this is not an offer and that the processes, terms and conditions may be changed at any time by the Village or Long Island Housing Partnership, Inc., and Affiliates.  It is further understood that notices by the Long Island Housing Partnership, Inc., and Affiliates may be made in such manner as Long Island Housing Partnership, Inc., and Affiliates may determine, including solely by email or advertisement.

 

THIS FORM MUST BE COMPLETED AND SIGNED BY
 EACH OCCUPANT OVER THE AGE OF 19.

Two Bedroom 80% AMI 1st Floor Two Bedroom 80% AMI 2nd Floor
APPLICANT











Your Vehicle




Driver's License



Applicant Residence Information:







Email Verification



Dates of Residency






Applicant Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


Applicant

ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 




FIRST ADDITIONAL HOUSEHOLD MEMBER










Your Vehicle




Driver's License



Residence Information:









Dates of Residency






Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


First Household Member

ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 




SECOND ADDITIONAL HOUSEHOLD MEMBER










Your Vehicle




Driver's License



Residence Information:









Dates of Residency






Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


Second Household Member

                                                                                ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 




THIRD ADDITIONAL HOUSEHOLD MEMBER










Your Vehicle




Driver's License



Residence Information:









Dates of Residency






Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


Third Household Member

ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 




FOURTH ADDITIONAL HOUSEHOLD MEMBER










Your Vehicle




Driver's License



Residence Information:









Dates of Residency






Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


Fourth Household Member

ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 




FIFTH ADDITIONAL HOUSEHOLD MEMBER










Your Vehicle




Driver's License



Residence Information:









Dates of Residency






Employment Information/Additional Income:











Dates of Employment


If there are other sources of income you would like us to consider such as social security, pension, etc., please list source and income amount.


Fifth Household Member

ACKNOWLEDGEMENT

By signing this First-Come, First-Served Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 19 years of age have completed and signed this Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by The Preserve at Smithtown LLC, their affiliates, property managers, employees, or agents (the "Owner/Manager"), if you are deemed eligible.

 

You authorize Owner/Manager, themselves or through its designated affiliates, agent or employees, to obtain a Consumer Report and (1) conduct a background search on you which will include, but not be limited to, a credit and criminal records check, and (2) obtain and verify all income, employment, credit,  and related information,  for the purpose of determining whether or not to lease the Apartment to you.  You understand that should you enter into the Lease for the Apartment, Owner/Manager and their designated affiliates, agents and employees will have a continuing right to review your credit information, rental application, and related information, for account review purposes and for improving application methods.

 

By signing this Application, you certify that all information contained in this Application is true, correct and complete.  You agree, and it is your intent, to sign this record/document by inserting/typing your name below and by electronically submitting this record/document. You understand that by signing and submitting this record/document in this fashion, you are affirming the truth of the statements contained therein and that it is the legal equivalent of having placed your handwritten signature on the submitted record/document and all parties may rely on same.

 

It is unlawful to discriminate against an applicant or tenant because of their race, color, national origin, source of income, religion, gender, familial status, disability, or any other basis that may be protected under applicable state or local law. 





EACH OCCUPANT OVER 19 YEARS OF AGE MUST COMPLETE AND SIGN THIS FORM.

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