Lottery Application Form - The Lofts at Maple and Main
Affordable Rental Housing Program

PROGRAM GUIDELINES

 

THE LOFTS AT MAPLE AND MAIN

AFFORDABLE RENTAL HOUSING PROGRAM

 

 

PLEASE READ CAREFULLY

 

LOTTERY APPLICATION DEADLINE:  JULY 22, 2024

 

The Long Island Housing Partnership (LIHP), in cooperation with North Fork Management & Maintenance, LLC (the “Owner”) and the Town of Smithtown (the “Town”), is pleased to announce that it is accepting Lottery Applications for six (6) new affordable rental units (the “Affordable Units”) in Smithtown, New York within the rental complex known as “The Lofts at Maple and Main.”

 

LIHP’s limited role is to administer 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 lingüística o de otro tipo, incluidos servicios de traducción y/o interpretación oral, por favor envíe un correo electrónico a LIHP a info@lihp.org antes de presentar la solicitud.

 

LIHP IS NEITHER THE OWNER, MANAGER, LANDLORD OR LEASING AGENT.  FINAL ELIGIBILITY FOR TENANCY AND OCCUPANCY IS THE SOLE DETERMINATION OF THE OWNER.  LIHP’S ROLE IS LIMITED TO INCOME QUALIFYING APPLICANTS. ANY REQUEST FOR A REASONABLE ACCOMMODATION REGARDING ANY UNIT MUST BE CONVEYED TO AND PROCESSED BY THE OWNER.  

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

 

                                                                                                             

THE LOFTS AT MAPLE AND MAIN RENTAL PROGRAM

The Lofts at Maple and Main is a 62-unit mixed use development located at 48 Maple Avenue.  in the heart of downtown Smithtown. It is conveniently located just a short walk from the train station, local shops, and restaurants. Please consult the Owner’s website at theloftsatmapleandmain.com for more information.

 

Under the program, six (6) one and two--bedroom rental units are being made affordable to households with incomes at or below 100% of the Nassau/Suffolk area median income (“AMI”), as established by the U.S. Department of Housing and Urban Development (“HUD”). The affordable rents are capped based on requirements set by the Town and include a utility allowance.


MAXIMUM & MINIMUM INCOME GUIDELINES

Pursuant to Town requirements, the Affordable Units will be available to households with incomes that do not exceed 100% of the HUD AMI as set forth below based upon unit type.

 

 

                                                                                100% AMI          

 

                                                                                1 BEDROOM


HOUSEHOLD SIZE                 *MAXIMUM ANNUAL INCOME                             **MINIMUM ANNUAL INCOME

                1                                                  $109,350                                                                   $84,000

                2                                                  $124,950                                                                   $84,000

                3                                                  $140,600                                                                   $84,000

 

                                                                               

                                                                                2 BEDROOM

 

HOUSEHOLD SIZE             *MAXIMUM ANNUAL INCOME                                 **MINIMUM ANNUAL INCOME

                1                                                   $109,350                                                                  $105,000

       2                                                    $124,950                                                                  $105,000

       3                                                    $140,600                                                                  $105,000

       4                                                    $156,200                                                                  $105,000

       5                                                    $168,700                                                                  $105,000

 

 

*Includes all income – overtime, bonuses, pensions, social security, 401K distributions, tips, etc.    The limits above are based on the 2024 HUD “uncapped” income limits as adjusted based on Town requirements.  Income limits are also adjusted annually by HUD. **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 a 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 2.5x the rent.


AVAILABLE UNITS

One Bedroom:

3 units

Two Bedroom:

3 units


RENTS

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

 

1 Bedroom:

$2,800

2 Bedroom:

$3,500


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 100% of the Nassau/Suffolk AMI based upon unit type.  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

Additional fees may be imposed by the Owner for such items as a security deposit, credit and background assessments, trash collection, pets, parking, water, renter’s insurance, or other items.  The fees are set exclusively by the Owner and are subject to change by the Owner without notice.  Any determination with respect to fees rests solely with the Owner and LIHP has no responsibility for such assessments or determinations. Applicants should contact the Owner directly for information on Fees at info@thegittogroup.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 as determined solely by the Owner. Additional fees may apply as required by the Owner.  Service and/or assistance animals are not subject to the pet policy. Applicants should contact the Owner directly for information on Fees at info@thegittogroup.com


ELIGIBILITY PROCESS

 

All applicants will be ranked and considered for the program through the use of an electronic Lottery and not on a first-come, first-served basis unless the number of applications received during the initial Lottery Intake Form period is less than the total number of units available.  Eligibility for the Program involves a five-step process.

 

STEP 1:                  Applicant submits a Lottery Application to LIHP to be included in the Lottery

STEP 2:                  Applicants names are randomized through use of a Lottery

STEP 3:                  Following the lottery, the Owner conducts a credit/minimum income/background review in                     ranking order.

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

STEP 5:                  If eligible, applicant works directly with Owner for lease-up


LOTTERY APPLICATION 

Lottery Applications are available through LIHP’s website at www.lihp.org/rentals.html. Lottery Applications can be completed and submitted online at www.lihp.org/rentals.html.


Lottery Applications must be received by 5:00 pm on JULY 22, 2024

                                                               

Only one Lottery Application is allowed per household.

 

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

 

THE LOTTERY/WAITLIST

As soon as possible following the close of the application period, LIHP will conduct the lottery which may be through the use of an electronic random number generator.  The lottery may be in-person, virtual or a hybrid.  Applicants will be notified, by email of the date, time, location, and manner of the Lottery. Applicants are encouraged to attend either in-person, if permissible, or by logging-in.  Applicants are advised that their names will be publicly announced at the Lottery. Names will be randomly ranked and placed on a Waitlist in ranked order (the “Ranked Waitlist”).  LIHP will notify each applicant, by email of their ranking from the Lottery.  Applicants will be reviewed for eligibility in the order in which they are randomly ranked from the Lottery.


CREDIT/MINIMUM INCOME/BACKGROUND REVIEW

Following the Lottery, LIHP will forward the Lottery 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 applicant’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 applicant’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 LIHP’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 LOTTERY PROCESS

Prior to Lottery:

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 prior to the lottery. If it appears that an applicant has submitted more than one application or intake form, then LIHP may reject the additional submission(s).  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 LIHP’s sole discretion.  


Following a Lottery:

Applicants will only be assigned one ranking number from the lottery.  Therefore, if, for whatever reason whatsoever, LIHP becomes aware that more than one submission by an applicant has been entered into the lottery and been assigned a ranking number, then the applicant’s ranking will automatically default to the highest ranked number and the applicant will lose the lower ranked position. For example, if an applicant’s ranking is #10 and #100 from the lottery, the applicant’s position at #10 will be rejected and the applicant will remain ranked as #100. 


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 or ranked position is to be rejected, LIHP may, but is not required to, notify the applicant of same.  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, veterans’ 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 OF LIABILITY/RELEASE

APPLICANT ACKNOWLEDGES THAT LIHP IS NEITHER THE OWNER, MANAGER, LANDLORD OR LEASING AGENT.  LIHP’S ROLE IS LIMITED TO REVIEWING YOUR HOUSEHOLD INCOME TO DETERMINE IF YOU MEET THE MAXIMUM INCOME QUALIFICATIONS FOR THE PROGRAM. THE COMPLEX IS/WAS CONSTRUCTED AND IS OPERATED INDEPENDENTLY BY THE OWNER/MANAGER AS LANDLORD AND LIHP HAS NO ROLE IN UNIT OCCUPANCY, UNIT SELECTION, REVIEW OF YOUR SUITABILITY FOR TENANCY, FEES ASSESSED, THE LEASE TERMS, THE LEASE-UP PROCESS BY OWNER/MANAGER, THEIR AFFILIATES OR AGENTS, PROCESSING OF ANY HOUSING VOUCHER, UNIT LAYOUT AND LOCATION, OR THE OPERATIONS, STATEMENTS, ACTS OR OMMISSIONS, AND POLICIES/PROCEDURES, OF THE COMPLEX OR THE OWNER/MANAGER AND ITS AFFILIATES OR AGENTS WHATSOEVER, INCLUDING, WITHOUT LIMITATION, IN CONNECTION WITH ANY REQUEST FOR REASONABLE ACCOMMODATION (THE “OWNER RESPONSIBILITIES”). WITHOUT LIMITING THE FOREGOING, YOU ACKNOWELDGE THAT LIHP HAS NO ABILITY OR RESPONSIBILITY TO ADDRESS ANY REQUEST YOU MAY HAVE FOR A REASONABLE ACCOMMODATION/MODIFICATION REGARDING A UNIT AND ANY SUCH REQUEST WILL BE MADE BY YOU DIRECTLY TO THE OWNER/MANAGER FOR PROCESSING. 

ACCORDINGLY, YOU AGREE THAT LIHP, ITS AFFILIATES, EMPLOYEES, AGENTS, OFFICERS, MEMBERS, AND DIRECTORS (COLLECTIVELY, “LIHP”) ARE NOT LIABLE FOR ANY CLAIMS OR CAUSES OF ACTIONS ARISING FROM ANY OF THE OWNER/MANAGER RESPONSIBILITIES AND, FOR GOOD AND VALUABLE CONSIDERATION, YOU HEREBY RELEASE AND WAIVE ALL CLAIMS OR CAUSES OF ACTION YOU NOW HAVE OR MAY HAVE AGAINST LIHP ARISING OUT OF OR RELATED TO THE OWNER RESPONSIBILITIES.

YOU HAVE READ THIS DOCUMENT, UNDERSTAND THAT YOU MAY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. IF ANY PROVISION OF THIS DOCUMENT IS UNENFORCEABLE, IT SHALL BE MODIFIED TO THE EXTENT NECESSARY TO MAKE THE PROVISION VALID AND BINDING, AND THE REMAINDER OF THIS DOCUMENT SHALL REMAIN ENFORCEABLE TO THE FULL EXTENT ALLOWED BY LAW.

 

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

Disclaimer: It is understood that this is not an offer and that the processes, terms and conditions may be changed at any time, without notice, by the municipality, the Owner, HUD, 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 18.

THIS FORM MUST BE RECEIVED By July 22, 2024 
                                                                                     TO BE ELIGIBLE
 FOR ENTRY INTO THE LOTTERY.
One Bedroom 100% AMI Two Bedroom 100% AMI
APPLICANT











Your Vehicle




Driver's License



Applicant Residence Information:







Email Verification



Dates of Residency






Applicant Employment Information/Additional Income:












Dates of Employment














Dates of Employment














Dates of Employment






ALL LAWFUL SOURCES OF INCOME WILL BE ACCEPTED EQUALLY.

Applicant

ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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














Dates of Employment














Dates of Employment





First Household Member

ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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














Dates of Employment














Dates of Employment





Second Household Member

                                                                                ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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














Dates of Employment














Dates of Employment





Third Household Member

ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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














Dates of Employment














Dates of Employment





Fourth Household Member

ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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














Dates of Employment














Dates of Employment





Fifth Household Member

ACKNOWLEDGEMENT

By signing this Lottery Application, you certify (1) that you have read and understand the Program Guidelines, (2) that all intended occupants over the age of 18 years of age have completed and signed this Lottery Application, and (3) that each such occupant of the Apartment will sign the Lease at the time required by North Fork Management & Maintenance, 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 Lottery Application, you certify that all information contained in this Lottery 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. 




THIS FORM MUST BE RECEIVED BY
5 PM on JULY 22, 2024
TO BE ELIGIBLE FOR ENTRY INTO THE LOTTERY


EACH OCCUPANT OVER 18 YEARS OF AGE MUST COMPLETE AND SIGN THIS FORM.

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