Biggs Property Management - Rental Application

1 Application Cover Letter
Form 1 | Application Cover Letter
Dear Applicant,

Thank you for your interest in our community! We take pride in our management and in our apartment communities. We screen all of our applicants carefully and verify all information provided to us.
Anyone 18 years and older must fill out a rental application.
We run a credit check on EVERY applicant.
We run criminal checks on ALL applicants and require all applicants provide us with a local.
We run a sexual predator check on ALL applicants.
We check previous rental history.
We verify income and assets (where applicable).
We verify medical expenses (where applicable).
The same screening and verification process is implemented for every applicant. By submitting an application to our community, you acknowledge that these checks and verifications will be done and give us your permission to do so by signing your application.

Please, sign and fill out your application completely. If you do not, we will NOT be able to process the application successfully. Please, leave NO question unanswered. If you have any questions when filling out the application please ask for assistance, we are here to be of service to you. We do charge an application fee, the amount is located at the top of your application. Please note if you are applying for an apartment in a HUD property and you paid an application fee, the fee will be returned to you.

If applicable- Please note that we will assist you in filling out an application to request a housing voucher from the local housing authority and will fax it to them. After faxing, it will be your responsibility to follow up with the housing authority as to where you might be in their process. This does NOT in any way guarantee that you will receive a housing voucher, and we are just happy to help you with submitting an application.

Please return along with your completed application:
A local Sheriff's or Police Department (depending on area) background report for all applicants 18 or older
Application fee per application – We ONLY accept check/money order (NO CASH)
6-Current/consecutive Pay Stubs – if applicable
6-months' Current/Consecutive bank statements for all "Checking" accounts
Current bank statement for all "Savings" accounts
Approximately one (1) month of pay history for a Conventional application
Copy of Social Security card for ALL members of the household
Copy of Birth Certificate for ALL members of a household for a Subsidized application
Social Security Award Letter – if applicable
Court Orders for all Child support awarded, custody/or guardianship – if applicable

If you are applying for an apartment in a HUD property, you are asked to self-certify you race and ethnicity on the application. If you choose not to provide the requested information, management will make a notation of this in your file. However, if you are applying for an apartment in an RD Section 515 property, and choose not to provide the requested information, management is required to note the race/national origin and sex of each applicant based on visual observation or surname.

We will do our best to process your application quickly and notify you in writing within 10 business days the status of your application. Once again, thank you for your interest in our community.
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2 Rental Application Affordable Housing

Form 2 | Rental Application Affordable Housing

Please click here to download a printable version of the Biggs Property Management - Rental Application - Affordable Housing and fill out manually

Rental Application
Affordable Housing

Please fill out one application for each household member over the age of 18
Note: An application fee of $8.00 per application will be due at the time the application is returned
Applicant must be over 18 and have the legal capacity to sign a lease.
If you are applying at a HUD property, no application fee will be required due to program regulations.

This application is to be completed fully and in detail. If additional pages are necessary, please attach them. The information provided will be used in the tenant selection process by Landlord and is subject to verification by Landlord. In the event any information provided is later determined to be false, Landlord may, in Landlord’s sole discretion, terminate any lease. Landlord’s gathering of information from and about prospective tenants is for the benefit of the Landlord, only, and does not create any right of reliance on the part of any tenant or occupant part regarding the behavior or character of any other tenant or occupant of the community. Additionally, the information provided can be subject to verification by the Rural Development Agency of the United States Department of Agriculture. Please note, Limberlost I, and Village Green II are HUD properties, in which eligibility is determined by federal statute and HUD regulations.

Applicant’s Full Name

*

Applicant’s Full Name

Date of Application

*

Date of Application

Apt. Community Desired

*

Apt. Community Desired

Desired Move-In Date

*

Desired Move-In Date

Type and Size of Apartment Desired

*

Type and Size of Apartment Desired

Current Residence Information

Address

*

Address

Address (Line 2)

Address (Line 2)

City

*

City

State

*

State

Zip

*

Zip

Telephone

*

Telephone

Lived There From

*

Lived There From

To

*

To

Monthly Payment

*

Monthly Payment

Reason for Moving

Reason for Moving

Do you have a landlord?*
Yes
No

Please explain why you do not have a landlord

Please explain why you do not have a landlord

Current Residence - Landlord Information

Landlord Name

*

Landlord Name

Landlord Telephone

*

Landlord Telephone

Landlord Address

Landlord Address

Landlord Address (Line 2)

Landlord Address (Line 2)

City

City

State

State

Zip

Zip

Previous Residence

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Telephone

Telephone

Lived There From

Lived There From

To

To

Monthly Payment

Monthly Payment

Reason for Moving

Reason for Moving

Did you have a landlord at this Previous Residence?
Yes
No

Landlord Name

*

Landlord Name

Landlord Telephone

*

Landlord Telephone

Landlord Address

Landlord Address

Landlord Address (Line 2)

Landlord Address (Line 2)

City

City

State

State

Zip

Zip

Please explain why you did not have a landlord at this Previous Residence

Please explain why you did not have a landlord at this Previous Residence

Household Members

Name

*

Name
(First, Middle Initial, Last)

Relationship to Head of Household

Relationship to Head of Household

Social Security Number

Social Security Number

Place of Birth

Place of Birth

Date of Birth

Date of Birth

Are you a student?*
Yes
No

***Social Security Number exceptions are as follows:
a. A household member who is 62 or older as of January 31, 2010 and eligibility determination started before January 31, 2010
b. A household member who is ineligible non-citizen. This household member does not qualify for assistance, therefore household assistance will be
prorated.
c. A child under age six added to the applicant’s household within the 6-month period prior to the household’s date of admission.

Do any of these exceptions apply to your household?*
Yes
No

Disability Status

Would you or anyone in your household benefit from the features of a handicap-accessible unit?*
Yes
No

Would you like to be placed on a priority waiting list for a handicap-accessible unit?*
Yes
No

Do you require any accommodation for any disability?*
Yes
No

If you are disabled do you require any modifications to the unit for any disability?*
Yes
No

If so, please list the specific modification needed

If so, please list the specific modification needed

Do you have any handicap assistance expenses you incur due to disability?*
Yes
No

Student Status

Are you or anyone in your household currently a student or planning to be one within the next 12 months?*
Yes
No

Please explain

Please explain

Full-Time
Part-Time

# of Credit Hours Taken

# of Credit Hours Taken

Name of Institution

Name of Institution

Receiving assistance under the Title IV of the Social Security Act (AFCD/TANF)?
Yes
No

Receiving assistance through the Job Training Participation Act (JTPA) or other similar program?
Yes
No

Married and filing a joint tax return?
Yes
No

Single parent with a dependent child and neither you nor your child are dependent of another?
Yes
No

A person formerly in foster care?
Yes
No

General Information
Have you, your spouse, or any other proposed occupant ever:

Filed for Bankruptcy?*
Yes
No

Year

*

Year

Been evicted from any residence?*
Yes
No

Willfully or intentionally refused to pay rent?*
Yes
No

Do you owe a current balance?*
Yes
No

Amount

*

Amount

To whom (contact info)

*

To whom (contact info)

What steps have you taken to rectify?

*

What steps have you taken to rectify?

Is any member of the household a US military veteran?*
Yes
No

Are you seeking housing as a result of a Presidentially declared disaster?*
Yes
No

Been charged & convicted with any misdemeanor or felony?*
Yes
No

Please explain

*

Please explain

Been charged & convicted for possession, sale or delivery of any illegal or controlled substance?*
Yes
No

Please explain

*

Please explain

Been required to register as a sex offender?*
Yes
No

Are any household members subject to any state’s lifetime sex offender registration program?*
Yes
No

Who and what state?

*

Who and what state?

Are you currently living in subsidized housing?*
Yes
No

Have you or any other proposed occupant ever, while living in a subsidized community, had tenancy or assistance terminated for fraud, nonpayment of rent or failure to cooperate with the recertification procedures?*
Yes
No

Do you pay any childcare expenses in order to be gainfully employed or to further your education?*
Yes
No

Please provide contact information of childcare provider:

Name

Name

Phone

Phone

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Do you have any pets?*
Yes
No

Please describe (include breed and weight):

Please describe (include breed and weight):

Vehicles
List any cars, trucks, or other vehicles owned.

Type of Vehicle

*

Type of Vehicle

Yr./Make

*

Yr./Make

Color

*

Color

License Plate #

*

License Plate #

Monthly Payment

Monthly Payment

Loan Payable To

Loan Payable To

References

Personal Reference

*

Personal Reference

Relationship

*

Relationship

Telephone

*

Telephone

Personal Reference

*

Personal Reference

Relationship

*

Relationship

Telephone

*

Telephone

Income
RURAL DEVELOPMENT-USDA, HUD and Section 42 of the Internal Revenue Code regulations require that all applicants/residents reveal all sources of income and assets. Applicants/residents for housing in this RURAL DEVELOPMENT-USDA / HUD / Section 42 property must complete this disclosure form by filling in the requested information and certifying this form. This form must be completed in its entirety. Please provide the mailing address and phone number for each of these sources in the area provided. Should you need assistance completing this form, feel free to ask your Resident Manager for assistance, he/she would be more than happy to help.

To determine your eligibility to occupy a unit in this project, we need the total amounts of all income sources earned by your household. You must list any income in which you and your household members receive.

Do you or any member of the household have any income from the following sources?

Salary / Wages / Employment Tips / Bonuses*
Yes
No

Self Employment / Unearned Income Workers Compensation*
Yes
No

Social Security Benefits*
Yes
No

SSI*
Yes
No

Disability Pension / Death Benefits*
Yes
No

Pension / Retirement Funds*
Yes
No

Welfare (not including food stamps)*
Yes
No

AFDC / TANF*
Yes
No

Annuity Payments*
Yes
No

Child Support / Unearned income from a family member under 17 years of age*
Yes
No

Military Payments / GI Bill / VA*
Yes
No

Unemployment*
Yes
No

Net Farm/Business Income*
Yes
No

Payment Received on Real Estate / Rental Income or Income from a Contract sale of Real Estate*
Yes
No

Interest on Check/Savings Acct.*
Yes
No

Interest on Bonds/CDs*
Yes
No

Investment Dividends*
Yes
No

Stock Dividends / Annuities / Trusts*
Yes
No

Recurring gifts/monetary or not*
Yes
No

Other*
Yes
No

Income Type - Salary / Wages / Employment Tips / Bonuses

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Self Employment / Unearned Income Workers Compensation

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Social Security Benefits

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - SSI

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Disability Pension / Death Benefits

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Pension / Retirement Funds

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Welfare (do not include food stamps)

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - AFDC / TANF

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Annuity Payments

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Child Support / Unearned income from a family member under 17 years of age

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Military Payments / GI Bill / VA

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Unemployment

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Net Farm/Business Income

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Payment Received on Real Estate / Rental Income or Income from a Contract sale of Real Estate

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Interest on Check/Savings Acct.

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Account #

Account #

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Interest on Bonds/CD’s

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Account #

Account #

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Investment Dividends

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Stock Dividends / Annuities / Trusts

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Recurring gifts/monetary or not

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Income Type - Other

Please describe the Other income type

Please describe the Other income type

Household member who receives the income

Household member who receives the income

Monthly GROSS amount received

*

Monthly GROSS amount received
(Enter a value of '0' if you do not receive income from source)

Account #

Account #

Please provide organization information to send verification form.

Organization Name

Organization Name

Phone Number

Phone Number

Other Income Related Issues

Did you or any other members of the household file a federal tax return last year?*
Yes
No

If not, why?

If not, why?

Do you anticipate any changes in income during the next 12 months?*
Yes
No

Explanation

Explanation

Are any members of the household under 18 years old receiving income not listed above?*
Yes
No

Explanation

Explanation

Monetary / NonMonetary Household Contributions
(These include money for or expenses paid on your behalf such as rent, utilities, telephone, groceries, clothing, household supplies, insurance, car expenses and gas)

Does anyone outside of your household pay for any of your bills or give you money?*
Yes
No

If yes, please explain

If yes, please explain

Child Support
(We must count court-ordered support whether or not it is received, unless legal action has been taken to remedy. We must also count support that is not court-ordered, rather received directly from payor)

Are you or any member of your household entitled to receive child support payments?*
Yes
No

If yes, are you currently receiving any child support payments?*
Yes
No

If yes, are your child support payments court ordered?*
Yes
No

Is there a divorce or separation agreement that state you are entitled to periodic support?*
Yes
No

If money is not actually received, are you taking legal action to remedy?
Yes
No

Explanation

Explanation

Other Information and/or Deductions

Do you have disability expenses or attendant care expenses that are not paid by an outside source?*
Yes
No

If yes, is this service necessary to enable a family members (including a member with a disability) to be employed?*
Yes
No

Please explain

Please explain

Are any foster children, foster adults or live-in attendants living with or going to be living with you?*
Yes
No

Who?

Who?

Are any members of your household temporarily absent?*
Yes
No

If so, list who and why

If so, list who and why

Are there any expected changes in the household membership in the next 12 months?*
Yes
No

(For instance: baby due, adopting a child, obtaining custody of a child, receiving a foster child or adult member of the household moving out)

Will all household members reside with you full time (including yourself)?*
Yes
No

If not what percentage will they reside at this residence? (%)

If not what percentage will they reside at this residence? (%)

How did you hear about our apartments?

*

How did you hear about our apartments?

Referred by

Referred by

Emergency Contact
(Please provide information for two people not planning to occupy the Premises whom we may contact in the event of an emergency, or to locate you)

Emergency contact 1

Name

Name

Relationship

Relationship

Telephone

Telephone

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Emergency contact 2

Name

Name

Relationship

Relationship

Telephone

Telephone

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Assets
Do you or any member of the household have any of the following types of asset?

Checking Account*
Yes
No

Savings Account*
Yes
No

Cash on Hand/At Home*
Yes
No

Balance on Direct Express Card*
Yes
No

Trust Accounts/Revocable or Irrevocable*
Yes
No

CDs*
Yes
No

Annuities*
Yes
No

IRAs/Pensions/401K/Mutual funds*
Yes
No

Stocks*
Yes
No

Money Market*
Yes
No

Whole Life*
Yes
No

Money in a safety deposit box*
Yes
No

Savings Bonds*
Yes
No

Personal property held as an investment*
Yes
No

Other Assets*
Yes
No

Checking Account

Checking Account Value

*

Checking Account Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Savings Account

Savings Account Value

*

Savings Account Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Cash on Hand/At Home
(must list amount of cash)

Available Cash Value

*

Available Cash Value

Balance on Direct Express Card

Direct Express Card Balance

*

Direct Express Card Balance

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Trust Accounts/Revocable or Irrevocable

Trust Accounts Value

*

Trust Accounts Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

CD’s

CDs Value

*

CDs Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Annuities

Annuities Value

*

Annuities Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

IRA’s/Pensions/401K/Mutual funds

Retirement Accounts Value

*

Retirement Accounts Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Stocks

Stocks Value

*

Stocks Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Money Market

Money Market Accounts Value

*

Money Market Accounts Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Whole Life

Whole Life Insurance Policy Value

*

Whole Life Insurance Policy Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Money in a safety deposit box

Safety Deposit Box Value

*

Safety Deposit Box Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Savings Bonds

Savings Bonds Value

*

Savings Bonds Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Personal property held as an investment

Investment Property Value

*

Investment Property Value

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Other Assets

Describe

Describe

Value of Other Assets

*

Value of Other Assets

Account #

Account #

Organization Name

Organization Name

Phone

Phone

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Other Asset Information
Real Estate

Do you own any property?*
Yes
No

If yes, type of property

*

If yes, type of property

Appraised Market Value

*

Appraised Market Value

Location

*

Location

Do you have any land contracts?*
Yes
No

If yes, type of property

*

If yes, type of property

Terms of Contract

*

Terms of Contract

Location

*

Location

Do you receive any rent from your property?*
Yes
No

If yes, type of property

*

If yes, type of property

Amount received per month

*

Amount received per month

Location

*

Location

Assets Disposed Of
Applicants/residents must also disclose any assets disposed of for less than fair market value in the two years preceding the effective date of the certification/recertification. This includes but is not limited to assets or money given away or sold for less than their true value if offered for sale to the public.

Did you have any assets (excluding personal assets) in the last two years not listed above?*
Yes
No

If yes, did you dispose of any assets for less than fair market value?*
Yes
No

Please list assets disposed of

Asset

*

Asset

Market Value

*

Market Value

Amount Received

*

Amount Received

Date Disposed Of

*

Date Disposed Of

Demograhics
Please review the statement below and provide the requested information, if you are willing:

Status
"The information regarding race, ethnicity, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age, and disability are complied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of individual applicants on the basis of visual observation or surname." For Rural Development and Tax Credit Properties ONLY. Not applicable for HUD properties.

Ethnicity
Hispanic or Latino
Not Hispanic or Latino

Race
American Indian/Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Gender
Male
Female
Prefer Not Respond

**Please list ALL states in which ALL household members have lived. Failure to provide accurate information to management is grounds to deny the application. Please write N/A on any line that is left blank.

State

*

State

Name

Name

Medical

Do you qualify for housing as an elderly household as described by RD or HUD?*
Yes
No

If you answered yes to the above question, please complete the boxes below regarding the medical expenses your household anticipates incurring in the next 12 months. Please provide receipts for non-prescription medicine and hearing aid batteries.

Medicaid?*
Yes
No

Monthly Spenddown

Monthly Spenddown

Medicaid Office Phone Number

Medicaid Office Phone Number

Medicare Premiums?*
Yes
No

Monthly Amount

Monthly Amount

Type

Type

Do You Have a Live-In Resident-Assistant?*
Yes
No

Cost Per Month

Cost Per Month

Name of Resident Assistant

Name of Resident Assistant

Phone Number of Resident Assistant

Phone Number of Resident Assistant

Do You Pay For Your Spouses Nursing Home Care?*
Yes
No

Cost Per Month

Cost Per Month

Name of Nursing Home

Name of Nursing Home

Phone Number of Nursing Home

Phone Number of Nursing Home

Other Medical Insurance-not Medicare or Medicaid?*
Yes
No

Monthly Premium

Monthly Premium

Annual Deductible Amt.

Annual Deductible Amt.

Carrier Name

Carrier Name

Carrier Phone Number

Carrier Phone Number

Outstanding Medical/Dental Balance Due Not Covered By Insurance?*
Yes
No

Monthly Payment

Monthly Payment

Balance Due

Balance Due

Name of Organization

Name of Organization

Organization Phone Number

Organization Phone Number

Pharmacy #1: Do You Pay for Your Prescriptions?*
Yes
No

Monthly Amount

Monthly Amount

Name of Pharmacy #1

Name of Pharmacy #1

Pharmacy #2: Do You Pay for Your Prescriptions?*
Yes
No

Monthly Amount

Monthly Amount

Name of Pharmacy #2

Name of Pharmacy #2

Physician #1: Do You Have Regular Physicians Visits?*
Yes
No

Cost Per Visit

Cost Per Visit
**After Insurance

# Visits Per Year

# Visits Per Year

Name of Physician

Name of Physician

Phone Number of Physician

Phone Number of Physician

Address of Physician

Address of Physician

Address of Physician (Line 2)

Address of Physician (Line 2)

City

City

State

State

Zip

Zip

Physician #2: Do You Have Regular Physicians Visits?*
Yes
No

Cost Per Visit

Cost Per Visit
**After Insurance

# Visits Per Year

# Visits Per Year

Name of Physician

Name of Physician

Phone Number of Physician

Phone Number of Physician

Address of Physician

Address of Physician

Address of Physician (Line 2)

Address of Physician (Line 2)

City

City

State

State

Zip

Zip

Eye Doctor: Do You Have Eye Doctor Visits?*
Yes
No

Cost Per Visit

Cost Per Visit
**After Insurance

# Visits Per Year

# Visits Per Year

Name of Physician

Name of Physician

Phone Number of Physician

Phone Number of Physician

Address of Physician

Address of Physician

Address of Physician (Line 2)

Address of Physician (Line 2)

City

City

State

State

Zip

Zip

Dentist: Do You Have Regular Dental Visits?*
Yes
No

Cost Per Visit

Cost Per Visit
**After Insurance

# Visits Per Year

# Visits Per Year

Name of Physician

Name of Physician

Phone Number of Physician

Phone Number of Physician

Address of Physician

Address of Physician

Address of Physician (Line 2)

Address of Physician (Line 2)

City

City

State

State

Zip

Zip

Specialist: Do You Have Regular Specialists Visits?*
Yes
No

Cost Per Visit

Cost Per Visit
**After Insurance

# Visits Per Year

# Visits Per Year

Name of Physician

Name of Physician

Phone Number of Physician

Phone Number of Physician

Address of Physician

Address of Physician

Address of Physician (Line 2)

Address of Physician (Line 2)

City

City

State

State

Zip

Zip

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3 Certification and Consent for Release of Information
Form 3 | Certification and Consent for Release of Information

Please click here to download a printable version of the Biggs Property Management - Certification and Consent for Release of Information and fill out manually
Certification & Consent for Release of Information
NOTE: In considering this application from you, Landlord will rely heavily on the information which you have supplied. It is most important that the information be accurate and complete. By signing this application, you represent and warrant the accuracy of the information and you authorize Management to verify any references that you have listed. Your signature on this form also authorizes Landlord to obtain any information that is pertinent to eligibility, according to federal law, for residency at the housing complex in which you reside/have applied. Any individual or organization may be asked to release information.

Inquiries including, but not limited to, the following information may be made:
Employment Income
Self-Employment Income Pension Income
Assets of Any Kind
Family Composition
Federal, State, Tribal, and Local Benefits
Student Status
Credit References
Prescriptions
Social Security Income
Disability Income
Other Sources of Income
Medical/Pharmaceutical Expenses
Childcare Expenses
Handicap Apparatus Expenses
Other Qualifying Expenses
Landlord References
Personal References
Criminal History
Photocopies of this authorization may be used for the purpose indicated above. The original is retained by the requesting organization.

Please Complete This Section:
I understand that failure to consent to the release of this information will render me ineligible for housing complex at which I have applied. I give my permission for Landlord, as mentioned above, to obtain any information that is pertinent to my eligibility, and to any reference or entity I have identified to release such information to Landlord. I also hereby certify that all of the information disclosed on this form is accurate and true. By signing this document, I do hereby certify that the information listed on this form and the questions answered are true and complete to the Best of my knowledge. I further certify that I have revealed all assets currently held or previously disposed of and that I have no other assets than those listed on this form (other than personal property). I realize that false statements are fraudulent and are a criminal offense which is punishable by fine or imprisonment or both. Rural Development has also established a process to match resident wage and benefit date with federal and state records to assure that applicants/residents are fully disclosing income. I hereby consent to release wage matching data to Rural Development and Landlord. I hereby certify that if I am applying for a federally subsidized apartment, it will serve as my permanent residence, and that I will not maintain a separate subsidized rental unit in a different location.
Applicant Information:

Name

*

Name

Phone

*

Phone

Email

*

Email

Address

*

Address

Address (Line 2)

Address (Line 2)

City

*

City

State

*

State

Zip

*

Zip

Social Security #

*

Social Security #

Birthdate

*

Birthdate

Driver’s License #

Driver’s License #

State Issued

State Issued

Applicant Signature

*

Applicant Signature

Date

*

Date

Co-Applicant Information:

Name

Name

Phone

Phone

Email

Email

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Social Security #

Social Security #

Birthdate

Birthdate

Driver’s License #

Driver’s License #

State Issued

State Issued

Co-Applicant Signature

Co-Applicant Signature

Date

Date

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Rental Application - Affordable Housing

Form 1 | Application Cover Letter

Form 2 | Rental Application Affordable Housing

Rental Application

Affordable Housing

Applicant’s Full Name

Date of Application

Apt. Community Desired

Desired Move-In Date

Type and Size of Apartment Desired

Current Residence Information

Address

Address (Line 2)

City

State

Zip

Telephone

Lived There From

To

Monthly Payment

Reason for Moving

Please explain why you do not have a landlord

Current Residence - Landlord Information

Landlord Name

Landlord Telephone

Landlord Address

Landlord Address (Line 2)

City

State

Zip

Previous Residence

Address

Address (Line 2)

City

State

Zip

Telephone

Lived There From

To

Monthly Payment

Reason for Moving

Landlord Name

Landlord Telephone

Landlord Address

Landlord Address (Line 2)

City

State

Zip

Please explain why you did not have a landlord at this Previous Residence

Household Members

Name

Relationship to Head of Household

Social Security Number

Place of Birth

Date of Birth

Disability Status

If so, please list the specific modification needed

Student Status

Please explain

# of Credit Hours Taken

Name of Institution

General Information

Year

Amount

To whom (contact info)

What steps have you taken to rectify?

Please explain

Please explain

Who and what state?

Name

Phone

Address

Address (Line 2)

City

State

Zip

Please describe (include breed and weight):

Vehicles

Type of Vehicle

Yr./Make