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Application for Affordable Housing - Cardinal Ritter Senior Services

Application for Affordable Housing - Cardinal Ritter Senior Services

Application for Affordable Housing - Cardinal Ritter Senior

HOUSING APPLICATION FOR:_________________Head of Household Last Name First Name Middle InitialSocial Security Number____________Birthdate____Female____Male____UndisclosedCo-Head Last Name First Name Middle InitialSocial Security Number____________Birthdate____Female____Male____UndisclosedTelephone Number (___)________________ Marital Status _________________Address_____________________ _________Number and Street City and State ZipHow long have you lived at this address? ______________________________________________Are you currently receiving subsidy or a section 8 voucher?___________Yes_______NoWhat was your previous address?Landlords’ names, addresses and phone numbers (please list the current and the one prior to whereyou are currently living)_____________________________________________________________Have any of the properties that you lived had an infestation problem of bedbugs? _____Yes_____NoHave you ever received HUD financial assistance before?________Yes________NoHave you ever lost assistance or been evicted? Yes___ No If so when?(date)_________Do you have any felonies on your record? ________Yes ________No If so, when?(date)_________List ALL the states that Head of Household and Co-Head have lived in_________________________________________________________________________________________________________Are you subject to a lifetime state sex offender registration program in any state?____Yes ____NoWhat type of unit size do you need?____ Bedroom___ __Efficiency_______AccessibleAnswer this question only if you are applying for one of the following projects: St. Patrick I,St. John Neumann, St. William I, St. Joseph and/or Holy Infant Apartments. Are you a citizen ofthe United States of America? Yes No

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