Intervest Corp

Bayside Village Apartments

2903 Pascagoula Street
Pascagoula, MS 39567
baysidevillage2021@gmail.com
(228) 202-5076

Intervest - Tenant Application for Rural Development and/or Tax Credit Properties

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 Application Checklist
    Please click here to download a printable version of the Intervest - Application Checklist and fill out manually

    Application Checklist


    Property Name
    Date
    Name
    The following items are required by management in order for your application to be processed. Your application cannot be processed without the following items:
    • Application: All items completed
    • Copy of Driver's License and Social Security Card
    • Money order for $20.00 per adult household member
    • Signed tenant Release and Consent Form
    • Under $5,000.00 asset form
    • Verification of employment. (Last 4 check stubs) if applicable
    • Non- Employment Affidavit (if applicable)
    • Verification of Other Income : Social Security, SSA, SSD, SSI, Pension statement, Unemployment Statement
    • Child Support Verification for household members with minor children
    • Request for Student Status Form
    • HTC Lease addendum student status
    The items checked are necessary to determine eligibility at this complex. Please make sure you have attached all items checked prior to submitting the tenant application. 

    Thank you for your cooperation.
  • 2 Tenant Application for Rural Development and/or Tax Credit Properties
    Please click here to download a printable version of the Intervest - Tenant Application for Rural Development and/or Tax Credit Properties and fill out manually

    TENANT APPLICATION 

    Rural Development and/or Tax Credit Properties

    Project Name
    Type Apartment
    The information solicited on this application is requested by the apartment owner in order to assure the Federal Government, acting through its agency, that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age and handicap are compiled with.

    ALL ITEMS ON THIS APPLICATION SHOULD HAVE A RESPONSE. PLEASE PUT "NO"/" NA"/OR "NONE" RATHER THAN LEAVING THE ITEM BLANK.

    I. APPLICANT'S INFORMATION

    Applicant's Name
    *
    Telephone Number
    *
    Present Address
    *
    Present Address (Line 2)
    City
    *
    State
    *
    Zip
    *
    How Long Have You Been at the Present Address?
    *
    Do You?
    *

    Nearest relative not living with you

    Name
    Phone Number
    Address
    Address (Line 2)
    City
    State
    Zip

    Present Landlord

    Name
    Phone Number
    Address
    Address (Line 2)
    City
    State
    Zip

    Prior Landlord

    Name
    Phone Number
    Address
    Address (Line 2)
    City
    State
    Zip

    Prior Landlord

    Name
    Phone Number
    Address
    Address (Line 2)
    City
    State
    Zip
    Applicants for Tax Credit properties answer the following. If not TC Property, go to Part II
    Are you or co-applicant a full time student?
    If all members of the household are full time students, then one of the following conditions must be met: check the appropriate line
    At least one member of the household receives assistance u n d e r title IV of the Social Security Act (for example,payments under TANF or AFDC).
    At least one member of the household is currently enrolled in a job-training program under the Job Training program or similar federal, state or local program.
    The head of the household is a single parent with child(ren)a n d neither the parent or the child(ren) is/are dependents of a third party.
    The members of the household are married and file a joint federal tax return (or are eligible to file a joint return).
    The student(s) was (were) previously under the care and placement of the state agency responsible for administering a plan under Part B, or Part E, of Title VI (ie., a former foster care participant.)

    II. Family or Household Composition

    (List all members who will live in dwelling.) Head ofHousehold mustbe listed first. (m - married; s-single; sp-separated; d-divorced; w-widowed)
    Household Member
    Name
    Relationship
    Date of Birth
    Marital Status
    Social Security Number
    Household Member
    Name
    Relationship
    Date of Birth
    Marital Status
    Social Security Number
    Are you or any member of your household a lifetime sex offender?
    Which household member
    List below all states where all household members have resided. List name and states resided in
    Do you have a household member who is or will be absent from the home?
    Reason for Absence
    Do you have a live-in attendant?
    I understand that if I do have a live-in attendant, she/he will be screened for criminal and/or sex offender history as all other persons applying for residency & I understand that a cost may be charged for this screening.
    Do you expect any changes of household composition?
    Baby due on
    Adopting a child(ren) on
    Obtaining custody of child(ren) on
    Obtaining joint custody of a child(ren) on
    Receiving a foster child(ren) on

    III. Family or Household Income

    Income for all persons 18 & older must be listed. 
    Planned next 12 months

    Employment Earnings

    Applicant
    Co-Applicant
    Other Adult
    Other Adult
    Include employment wages earned through a government program such as Senior Aides, Older American CommunityService Employment Program, AmeriCorps. 

    List the name of the program below under name and address of employer. If employed, list present employment:

    (Include estimated overtime pay, tips and bonuses)
    Date of Employment
    Name of Employer
    Address of Employer
    Address of Employer (Line 2)
    City
    State
    Zip
    Phone No. of Employer
    Annual Gross Salary

    Other Business Income

    (Social Security, disability, death benefits, pensions, retirement funds,trusts, public assistance / TANF, child support, VA, interest and dividends, alimony,etc, workers' comp., periodic lottery payments, regular contributions from persons or agencies outside of the household, insurance policies, unemployment o rseverance pay, etc. -list below where indicated)
    Applicant Earnings
    Type of Income
    Co-Applicant Earnings
    Type of Income
    Other Adult Member Earnings
    Type of Income
    Other Adult Member Earnings
    Type of Income

    Self Employment Income

    (Gross income less business expense. Attach latest annual operating statement)
    Applicant Net business income
    Co-Applicant Net business income
    Other Adult member Net business income
    Other Adult member Net business income

    Total Income

    Applicant
    Co-Applicant
    Other Adult member
    Other Adult member

    IV. Deductions

    Are there any full-time students 18 years of age or older in the household.
    Does any household member qualify for an elderly deduction?
    (This would be a person 62 years of age or older or a person disabled or handicapped.)
    Is there a dependent over the age of 18, who is considered handicapped or disabled that may qualify for a handicap/disable deduction?
    Does the applicant require a special handicapped accessible unit?
    Do you or the co-applicant have any medical expenses that are not paid for by an outside source such as insurance?
    (For elderly/handicapped/disabled households only)
    Do you or the co-applicant have disability expenses that are not paid for by an outside source?
    is this service necessary to enable a household member, including the member with the disability to be employed?
    Do you have attendant care expenses?
    is this service necessary to enable a household member to be employed?
    Do you currently pay for childcare services for any children under the age of 13 residing in the household?
    is this service necessary in order for you to be employed or to attend school?
    what part of the expense is not reimbursed by an outside source?

    IV. Assets

    The following financial information may be completed jointly by tenant and co-tenant applicants fi their assets and liabilities are sufficientlyjoined so that the statementcan be meaningful and fairly presented on a combined basis. Otherwise a separate statement isrequired.
    Type of financial statement

    B. Real Property Owned

    Dwelling
    Item
    Market Value
    Unpaid Debt
    Monthly Payment
    Name of Creditor
    Account Number
    Address of Creditor
    Address of Creditor (Line 2)
    City
    State
    Zip
    Other Real Estate
    Item
    Market Value
    Unpaid Debt
    Monthly Payment
    Name of Creditor
    Account Number
    Address of Creditor
    Address of Creditor (Line 2)
    City
    State
    Zip

    C. 

    List all cash on hand or in safety deposit box, assets in another state or foreign country, checking, savings account, money market funds, IRA / Keogh accounts, stocks, bonds, treasury bills, trust funds, whole life or universal life insurance policy, and certificates of deposits, lump sum receipts of lottery winnings, inheritance, insurance settlements, etc. of all household members:

    (If you have a direct deposit as a requirement of the social security administration, you must list this account and section D of part VIl of this application must be completed.)
    Family Member
    Bank Name
    Account Number
    Current Balance

    D.

    List the average checking / savings account balances for the past six(6) months as follows:
    Family Member
    Average 6-Month Balance

    E.

    Last current value of all stocks, bonds, trusts, pension contributions or other assets:
    Family Member
    Type of Asset
    Value

    F.

    Please list below any assets (such as real estate, cash gifts, stock, bonds, etc.) which were disposed of within the last 2 years. If none have been disposed of, please respond with "None" or "N/A". Do not leave blank:
    Family Member Received
    Type of Asset(s)
    Fair Market Value
    Total Value

    G.

    Do you or any other household members have any assets that are held jointly with another person?

    VIII. Credit References

    Name
    Telephone Number
    Address
    Address (Line 2)
    City
    State
    Zip
    DISCLOSURE NOTICE: If permitted by State law, Rural Development and/or HUD is required to fully implement and utilize income matching of tenants. This means that Rural Development can receive wage and benefit information from the State Department of Labor (SDOL) and share this information with the owner and management agent of this complex to compare with information provided on your Tenant Certification.

    IX. Application Certification

    I/We certify that the unit applied for wil be the household's permanent residency and that I/We do/will not maintain a separate central unit in a different location. I/We certify that the statements made in this application are true and complete to the best of my/our knowledge and belief.
    Signature of Applicant
    *
    Date
    *
    Signature of Co-tenant or persons 18 years and older
    Date
    Signature of persons 18 years and older
    Date

    X.

    The information regarding race, national origin and sex designation solicited on this application is requested in order to assure the Federal Government, acting through its Agency that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age, and handicap 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.
    Tenant
    Name
    Sex
    Race
    National Origin
    Children
    Name
    Sex
    Race
    National Origin
    If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascc.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office ofAdjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.
  • 3 Request for Credit and/or Criminal History
    Please click here to download a printable version of the Intervest - Request for Credit and/or Criminal History and fill out manually

    Request for Credit and/or Criminal History


    Cost - $20.00 per person for all Rural Development Properties.
    Property
    *
    Manager

    Report will not be run if any information is missing


    Applicant Information - COMPLETE ALL ITEMS

    Full Name
    *
    First, Middle, Last
    Address
    *
    Address (Line 2)
    City
    *
    State
    *
    Zip
    *
    Social Security Number
    *
    Date of Birth
    *
    I authorize INTEREST to acquire, at their discretion, any and al of my credit / criminal history information, including that of a confidential or privileged nature. This includes work records, financial and credit status records, police records, and other information requested.
    Applicant Signature
    Date

    Co-Applicant Information - COMPLETE ALL ITEMS

    Full Name
    *
    First, Middle, Last
    Address
    *
    Address (Line 2)
    City
    *
    State
    *
    Zip
    *
    Social Security Number
    *
    Date of Birth
    *
    I authorize INTEREST to acquire, at their discretion, any and al of my credit / criminal history information, including that of a confidential or privileged nature. This includes work records, financial and credit status records, police records, and other information requested.
    Co-Applicant Signature
    Date
    Please make money order made payable to INTEREST. Remember the cost is $20 per person.
  • 4 Tenant Release and Consent Form
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    Tenant Release and Consent Form

    Apartment Complex
    To Whom It May Concern:

    I/we, the undersigned, authorize you to furnish to the management of the above mentioned apartment complex any and all information, including that of a confidential or privileged nature, you may have concerning me/us. This may include but is not limited to personal identity, employment, income, and assets; medical or child care, credit status records, police records, and any other financial information that is pertinent to my/our eligibility for and continued participation as a Qualified tenant in a Rural Development, HUD and/or Tax Credit property.

    Example of Groups or Individuals that may be asked for information:
    • Past and Present Employers 
    • Previous Landlords (including Public Housing Agencies) 
    • Support and Alimony Providers 
    • Utility Providers
    • Welfare Agencies
    • State Unemployment Agencies 
    • Social Security Administration 
    • Medical and Child Care Providers
    • Veterans Administration
    • Retirement Systems
    • Banks and other Financial Institutions 
    • Law Enforcement Agencies
    CONDITIONS

    I/We agree that a photocopy ofthis authorization may be used for the purposes stated above. The original ofthis authorization is on file and will stay in effect for one year and one month from the date signed. I/We understand I/We have a right to review this file and correct any information that is incorrect.
    SIGNATURES
    Applicant / Resident
    (Print Name)
    Date
    Co-Applicant/Resident
    (Print Name)
    Date
    Adult Household Member
    (Print Name)
    Date
  • 5 Under $5000 Asset Certification
    Please click here to download a printable version of the Intervest - Under $5000 Asset Certification and fill out manually

    Under $5000 Asset Certification

    For households whose combined net assets do not exceed $5,000. Complete only one form per household; include assets of children.

    Instructions for Completing

    Only one form should be completed for each household certifying to a total asset cash value of $5000 or less.

    Household Name Enter the name of the Head of Household
    Unit Number Enter the unit number
    Development Name Enter the name of the development
    Effective Date Enter the effective date of the certification

    QUESTION #1

    For lines "a" through "t", please enter the fair market value (A), interest rate (B) and annual income of each applicable asset.

    Fair Market ValueEnter the fair market value of the respective asset. For cash assets, the fair market value is the current value ofthe asset. However, for checking accounts, the FMV is the last six months average. If an asset does not apply, please enter N/A.
    Interest RateFor interest bearing accounts (such as a savings account, stocks, IRA accounts, etc), please list the current interest rate for the asset. Ifthe asset does not bear interest, please list $0.
    Annual IncomeEnter the annual Income of the Asset by multiplying the FMV by the Interest Rate.
    TotalTo acquire the Total Fair Market Value and Annual Income, add amounts for lines "a" through "t" for each respective column

    QUESTION #2

    For question #2, only one of the checkboxes should be marked. If the household has sold/given away assets for more than $1000 below FMV within the last two years prior to the certification, the first check box should be marked. The total value of the disposed assets should be noted.

    If the household has not sold/given away assets for less than fair market value in the last two years, the second check box should be marked.

    QUESTION #3

    If the household listed $0 or N/A for all assets in Question #1, the household should mark this checkbox.

    HOUSEHOLD CERTIFICATION AND SIGNATURES

    Each household member age 18 or older must sign and date the Under $5000 Asset Certification.

    Household Name
    Unit No.
    Development Name
    Effective Date
    Complete all that apply for 1 through 3:

    1. My/our assets include

    PLEASE NOTE: Certain funds (e.g.Retirement, Pension, Trust) may or may notbe (fully) accessible ot you. Include only those amounts that are
    A. Savings Account
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    B. Cash on Hand
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    C. Certificates of Deposit
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    D. Stocks
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    E. IRA Accounts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    F. Keogh Accounts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    G. Equity in real estate
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    H. Lump Sum Receipts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    I. Life Insurance Policies (excluding Term)
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    I. Life Insurance Policies (excluding Term)
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    J. Other Retirement/Pension Funds not named above
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    K. Personal property held as an investment*

    * Personal property held as an investment may include, but si not limited to, gem or coin collections, art, antique cars, etc. Do not include necessary personal propertysuch as, but not necessarily limited to, household furniture,daily-use autos, clothing, assets of an active business, or special equipment for use by the disabled.
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    L. Money in an online account/app such as PayPal, Venmo, Square Cash, etc.
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    M. Pay Card (e.g. Direct Express debit card, pay card, etc.)
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    N. Other (list):
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    Please list asset(s)
    O. Checking Account
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    P. Safety Deposit Box
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    Q. Money market funds
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    R. Bonds
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    S. 401K Accounts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    S. 401K Accounts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    T. Trust Funds
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    T. Trust Funds
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    U. Land Contracts
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income
    V. Capital investments
    (A) Fair Market Value
    (B) Interest Rate
    (A * B) Annual Income

    TOTAL 

    Add [(a) through (t)]
    Fair Market Value
    Annual Income

    2. 

    Those amounts* are included above and are equal to a total of
    Total
    (*the difference between FMV and the amount received, for each asset on which this occurred); or

    3. 

    Under penalty of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement.
    Applicant/Tenant
    Date
  • 6 NonEmployment Affidavit
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    Non-Employment Affidavit

    To be completed by any adult household member, including emancipated minors, who claim non-employment status and/or income.
    Tenant / Applicant
    Unit No
    Development Name
    DIRECTIONS: Please select all that applies

    I am not seeking employment.
    I have not recently applied for employment.
    I have not been offered employment.
    I am not under any affirmative obligation to obtain employment.
    I do not plan to look for employment due to

    Choose...
    Employer
    Start Date
    Position
    Anticipate earning
    Pay frequency

    Please detail

    Identify source
    Amount
    If benefits related to your unemployment slatus (disability, pension, etc.) other than unemployment is anticipated,
    Identify source
    Amount
    Under penalty of perjury, I certify that the information presented in this affidavit is true and accurate to the best of my knowledge. I further understand that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of my lease agreement.

    WARNING: Section 1001 of Title 18 U.S. Code makes it a criminal offense to willfully falsify a material fact or make a false statement in any matter within the jurisdictionof a federal agency.
    Tenant/Applicant Signature
    Date
  • 7 Child Support Affidavit
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    Child Support Affidavit

    Head of Household Name
    Unit Number
    Child(ren)'s Name(s)
    Non-Custodial Parent (NCP)
    I certify that the following is true regarding my current child support situation:
    current child support situation
    Provide supporting documentation such as a court order, child support agreement, print out from DHS (which shows at least 12 months of history), etc.
    I am currently receiving payments
    Last payment received was on
    How are/were the payments being received?
    Please explain
    Monthly Amount of Award
    Date of Court Order
    County & State of Order
    I

    Amount
    Provide signed statement from non-custodial parent, check copies, etc.
    Frequency

    Are survivor benefits (e.g. SSI, etc) being received?
    Please explain
    I understand that I must notify the owner or management agent of any changes in the status of any child support payments as soon as possible.

    Under penalty of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement.
    Signature of Applicant/Resident
    Date
  • 8 Interagency Referral Form
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    Interagency Referral Form


    General Information

    Complex Manager
    Phone
    Complex Name
    Fax
    Address
    Address (Line 2)
    City
    State
    Zip
    Email

    Federal regulations require that in order for a family to receive housing assistance through the U.S. Department of Housing &Urban Development (HUD), wemust verify the familyincome, expenses and other information related to eligibility. The information you provide will be used only for the purpose of to determine the eligibility status and rent forhousinga tt h eapartmentcomplexlistedabove.

    Recipient's Consent

    I understand that the Agencym a y contact other organizations to obtain proof or documentation of information needed to determine my eligibility for program services. Verifications and inquiries that may be requested include, but are limited to personal identity; employment, income, and assets; medical or child care/other state allowances.

    This form must be signed by the household head and all other household members whose income, assets or other circumstances require verification. As long as the partnership retains the form with original signatures in its files, a photocopy of the authorization may be provided for the purpose stated above fortwelve months from the date signed.

    I hereby authorize MDHS to release the information requested regarding my income or lack of income from Child Support or Economic Assistance.
    Applicant Signature
    Print Applicant Name
    Social Security Number
    Date
    You do not have to sign this form if either requesting organization or the organization supplying the information is left blank.
    The above reference individual has made application for residency at our community. This individual states that helshe may be receiving payments from your agency. This community operates under the IRS section 42 program. For the applicant to be eligible to apply for housing, this form must be completed by an authorized associate at your agency. All information will be held in strict confidence.
    Leasing Representative
    Date
  • 9 Student Status Certification
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    Student Status Certification

    This annual Student Self Certification is in connection with the undersigned's application/occupancy in the following apartment:
    Household Name
    Unit No.
    Development Name
    Check A, B, or C, as applicable (note that students include those attending public or private elementary schools, middle or junior high schools, senior high schools, colleges, universities, technical, trade or mechanical schools, but does not include those attending on-the-job training courses)

    If this item is checked, no further information is needed (Do not answer questions 1-5). Sign and date below.

    Verification of part-time student status is required for at least one occupant. If this item is checked, no further information is needed (Do not answer questions 1-5). Sign and date below.
    Please list occupants who are part-time students

    If this item is checked, questions 1-5 below must be completed
    1. Is any member married and entitled to file a joint tax return?
    (attach marriage certificateor tax return)
    2. Is at least one student a single parent with child(ren) and this parent is not a dependent of someone else, and the child(ren) is/are not dependent(s) of someone other than a parent?
    (attach student's most recent tax return and, ifapplicable, or other parent's most recent tax return)
    3. Is at least one student receiving Temporary Assistance to Needy Families (TANF)?
    (provide release of information for verification purposes)
    4. Does at least one student participate in a program receiving assistance under the Workforce Innovation and Opportunity Act or under other similar federal, state, or local laws?
    (attach verification of participation)
    5. Does the household consist of at least one student who has ever been under the care and placement responsibility of the state agency responsible for administering foster care?
    (provide verification of participation)
    Full-time student households satisfy one of the above conditions are considered eligible. If C is checked and questions 1-5 are marked NO or verification does not support the exception indicated, the household is considered ineligible.

    Under penalties of perjury, I/we certify that the information presented in this Annual Student Certification is true and accurate to the best of my/our knowledge and belief. I/we agree tonotify management immediately of any changes in this household's student status. The under signed further understands that providing false representations herein constitutes an act of fraud. False, misleading, or incomplete information may result in the termination of the lease agreement. All household members age 18 or older must sign and date.
    Signature of Applicant/Tenant
    Printed Name of Applicant/Tenant
    Date
    Please upload applicable documentation(s)
  • 10 Lease Addendum for LIHTC Properties
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    Lease Addendum for LIHTC Properties

    Tenant Eligibility: Landlord does not discriminate on the basis of race, religion, gender, national origin, handicap, or familial status.

    This property has received an allocation of LowIncome Housing Tax Credits (LIHTC) under section 42 of the Internal Revenue Code. The Landlord is responsible for compliance with the code. In order to accomplish this, Tenant agrees to immediately notify the Landlord of all changes in household composition and all changes in household student status. Further, Tenant agrees to complete annually or at any other such time requested by Landlord the Recertification Ouestionnaire disclosing current household composition, household student status and all household income and assets. Tenant agrees to cooperate fully during the recertification process signing all third party verifications and providing all requested names and addresses. Tenant agrees to respond promptly to recertification notices to ensure a timely completion of the process. Tenant understands that failure to comply within thirty (30) days of the initial recertification notice is considered material non-compliance with this lease and therefore grounds for termination of the lease and eviction.

    Tenant understands and certifies that the household meets the following student criteria: If the occupant or if all the occupants of a unit are full-time students, the unit will not be considered a qualifying tax credit unit unless one o f the full-time students is:
    1. A single parent with children, none of which are declared as dependents on another Person's tax return.
    2. Married and filing a joint federal tax return.
    3. Receiving AFDC payments on behalf ofminor children.
    4. Enrolled in a job-training program receiving assistance under the Job Training Partnership Act or funded by a state or local government agency.
    5. A former participant in the Foster Care Program.

    Tenant certifies that the following information is complete and correct. List all membersof the household:
    Name
    Social Security Number
    Birth Date
    Full-time Student?
    For any persons to be added to the lease, they must fill out an application and meet the Landlord's "Tenant Selection Criteria". Any occupant deemed permanent by the Landlord that does not comply with this procedure or vacate promptly when determined ineligible or jeopardizes the household tax credit compliance is the responsibility of the Tenant and grounds for termination of the lease.

    Tenant understands and agrees that the Landlord will verify in writing through a third party when necessary, the information provided on the application and recertification questionnaire in order to ensure IRC section 42 compliance. Failure of the Tenant to provide satisfactory, complete and accurate information will be considered material non-compliance with the lease. Misrepresentation of any information required to determine tenant eligibility will entitle Landlord to terminate this lease and pursue eviction.

    The Tenant is permitted to have a guest(s) visit their household. However, the Landlord reserves the right to request a recorded declaration ofdomicile or proofo f domicile if it is suspected that the guest is an unauthorized household occupant. Such suspicion many arise whenever an adult person(s) is making reoccurring visits or one continuous visit 7 days and/or nights without prior notification to the Landlord. Should the Tenant or person in
    question not provide the requested information needed to confirm other domicile, or should the facts be sufficient to evidence domicile in the project, then the Landlord mayconsider such person(s) an unauthorized occupant and terminate the lease for material non-compliance.

    Tenant understands and agrees to be bound by the above stipulations. Further, the Tenant agrees to take no action to jeopardize the Landlord's tax credit compliance. Should it be determined that Tenant's continued occupancy, for whatever reason, jeopardizes the Landlord's tax credit compliance, the Tenant agrees t o voluntarily after receipt of written notification from the Landlord, relocate to another dwelling and relinquish tenancy in their current unit. The Landlord will allow the Tenant sixty (60) days to accomplish thisprocess
    Tenant
    Date
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Equal Housing Opportunity
This institution is an equal opportunity provider.
Handicap Accessible
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