Dellinger Property Management

Monon Apartments

302 W. Harrison St.
Monon, IN 47959
jeffanddonna9@hotmail.com
(219) 253-6259

Dellinger Affordable Housing Application

If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
  • 1 Dellinger Property Management - Affordable Housing Application
    Please click here to download a printable version of the Dellinger Property Management - Affordable Housing Application and fill out manually

    Affordable Housing Application


    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. Additionally, the information provided is subject to verification by the Rural Development Agency of the United States Department of Agriculture and HUD.
    Applicant's Full Name
    *
    Applicant's Date of Birth
    *
    Applicant's Social Security Number
    *
    If you have no social security number, you claim you are exempt because
    Co-Applicant's Full Name
    Co-Applicant's Date of Birth
    Co-Applicant's Social Security Number
    If you have no social security number, you claim you are exempt because
    Other Applicant's Full Name
    Other Applicant's Date of Birth
    Other Applicant's Social Security Number
    If you have no social security number, you claim you are exempt because

    Residence History

    Current Address
    City
    State
    Zip
    Current Telephone Number
    Length of time at current address
    Amount of Rent/Mortgage
    Current Landlord
    Landlord Telephone Number
    Reason for Moving
    Previous Address
    City
    State
    Zip
    Previous Landlord
    Landlord Telephone Number
    Is the Head of Household 62 years or older?
    Is the Head of Household Handicapped or disabled?

    Apartment Preference

    Desired move-in date
    Unit Size: The owner/agent will take your unit preferences/requirements into consideration. The owner/agent occupancy standards indicate a minimum of one person per bedroom and a maximum of two people per bedroom. If you request a unit size different from these standards, the owner/agent is required to verify the need for a larger or smaller unit. 

    Please indicate unit size preference below. If you require special unit features, the owner/agent may verify the need for those features. Please indicate any necessary special features below. 
    Unit Size

    Requested Special Features

    Income


    Rural Development, USDA, HUD, and Section 42 of the Internal Revenue Codes regulations require that all applicants/residents reveal all sources of income and assets.

    Applicant's Income Declaration

    SS/SSI
    Pensions
    Wages/Salaries
    Income from assets

    Co-Applicant's Income Declaration

    SS/SSI
    Pensions
    Wages/Salaries
    Income from assets

    Other Applicant's Income Declaration

    SS/SSI
    Pensions
    Wages/Salaries
    Income from assets
    Is anyone in the household entitled to child support?
    Does anyone in the household receive unemployment?

    Net Family Assets


    Please complete each blank with an amount or N/A (not applicable) if the asset is zero.
    Checking
    Savings
    C.D.'s
    Stocks & Bonds
    Annuities
    Real Estate
    Whole Life Insurance
    Other (specify)
    Do you expect any changes to your income in the next twelve months?
    If so, please specify

    Medical Expenses


    Your household qualifies for deductions based on out-of-pocket medical expenses: Please indicate if you or any household member has out of pocket expenses for the following:
    Health Insurance
    Monthly Premium
    Medicare
    Monthly Premium
    Part D
    Monthly Premium
    Prescriptions
    Monthly Cost
    Dr. visits/medical treatments (include dental and eye)
    Annual out of pocket
    Other medical expenses
    Monthly Cost
    Explain

    Pets & Assistance/Companion Animals


    Please review the property pet/assistance animal rules. The presence of any animal must be approved before the animal is allowed in the unit.
    Do you plan to house an animal in the unit?
    Animal Type
    Breed
    Height
    Weight
    Is this animal required to live in the unit to alleviate the symptom(s) of a disability for a household member?
    Please answer the following questions:
    Has applicant, co-applicant, or any other proposed occupant ever:
    Filed for bankruptcy?
    Been evicted?
    Willfully or intentionally refused to pay rent?
    Been arrested or charged with any misdemeanor or felony?
    If yes, please explain
    Been arrested for possession, sale or delivery of any illegal or controlled substance?
    If yes, please explain
    Been required to register as a sex offender?
    Where?
    If yes, are you subject to a lifetime state sex offender registration?
    Are you currently receiving housing assistance from HUD or Rural Development?
    Has any member of this household ever lived in a subsidized complex before and had tenancy or assistance terminated for fraud, nonpayment of rent or failure to cooperate with the recertification procedures? 
    Tenancy terminated
    Are you or any other proposed occupant a full time student?
    Are you or any other proposed occupant a part time student?
    Are you or any other proposed occupant in the U.S. Military or, are you a Veteran of the U.S. Military?
    Do you expect any additions to the household within the next 12 months?
    Please list all states where you or any proposed occupant have previously resided.
    Were you ever asked to allow or participate in the extermination of pests other than regularly scheduled pest control? (including roaches, bed bugs, rodents, etc.)
    Pest Control
    Do you currently have any outstanding balances owed to your present or previous landlords?
    Do you have any current outstanding balances owed to any utility provider?
    Will you be able to establish utilities in your unit in your name?
    Have you ever lived in an apartment managed by Dellinger Property Mgmt?
    Are you seeking housing as a result of a Presidentially declared disaster?

    References

    Reference 1
    Reference 2
    How did you hear about the apartments?
    Who?
    The information regarding race, national origin, and sex designation, solicited on this application is requested in order to assure that Federal Laws prohibiting discrimination against tenant applicants is complied with. In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discrimination on the basis of race, color, national origin, age, disability, religion, sex, familial status, sexual orientation, and reprisal (Not all prohibited bases apply to all programs). 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. 

    Please note, if you are approved as a Rural Development housing recipient and choose not to furnish it. the owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observations or surname. 
    Applicant Ethnicity
    Applicant Race
    Applicant Gender
    Applicant Citizenship Status
    Co-Applicant Ethnicity
    Co-Applicant Race
    Co-Applicant Gender
    Co-Applicant Citizenship Status
    Other Applicant Ethnicity
    Other Applicant Race
    Other Applicant Gender
    Other Applicant Citizenship Status

    Penalties for misusing this form

    Title 18, Section I 00 I of the U.S. Code states that a person is guilty of a felony for knowingly and wiIlingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8).** Violation of these provisions are cited as violations of 42 U.S.C. Section **408 (a) (6), (7) and (8). 

    Application certification

    By signing this document, I certify that if selected to receive assistance, the unit I/we occupy will be my/our only residence. I/We understand that the above information is being collected to determine my/our eligibility. I/We authorize the owner/manager/PHA to verify all information provided on this application and to contact previous or current landlords or other sources of credit and verification information which may be released to appropriate Federal, State, or local agencies. I/We certify that the statements made in the application are true and complete INVe understand that providing false statements of information is punishable under Federal Law. 
    Co-Applicant Name
    Co-Applicant Signature
    Applicant Name

    Please sign your name below

    04/27/2024

  • 2 Dellinger Property Management - Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants
    Please click here to download a printable version of the Dellinger Property Management - Supplemental and Optional Contact Information for HUD-Assisted Housing Applicants and fill out manually

    Supplement to Application for Federally Assisted Housing

    This form is to be provided to each applicant for federnlly assisted housing

    Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing, the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update, remove, or change the information you provide on this form at any time. You are not required to provide this contact infonnation, but if you choose to do so, please include the relevant information on this form. 
    Applicant Name
    *
    Mailing Address
    City
    State
    Zip
    Telephone Number
    Cell Phone Number
    Name of Additional Contact Person or Organization
    *
    Address
    City
    State
    Zip
    Telephone Number
    Cell Phone Number
    E-Mail Address (if applicable)
    Relationship to Applicant

    Other Reason
    Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the issues or in providing any services or special care to you. 
    Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the applicant or applicable law. 
    Legal Notification: Section 644 of the Housing and Community Development Act of 1992 ( Public Law 102-550, approved October 28, 1992) requires each applicant for federally assisted housing to be offered the option of proving information regarding an additional contact person or organization. By accepting the applican's application, the housing provider agrees to comply with the non-discrimination and equal opportunity requirements of 24 CFR section 5, 105, including the prohibitions on discrimination in admission to or participation in federally assisted housing programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on age discrimination under the Age Discrimination Act of 1975.

    Please sign your name below

    04/27/2024

If you are done filling out the forms, please click on the "Submit" button at the bottom of the screen.
Equal Housing Opportunity
This institution is an equal opportunity provider.
Handicap Accessible




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