Form 1 of 10

1 Application Checklist
Form 1 | Application Checklist

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

Property Name

Property Name
Preservation Crossing

Date

Date

Name

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.
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2 Tenant Application for Rural Development and/or Tax Credit Properties

Form 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

Project Name
Preservation Crossing

Type Apartment

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

*

Applicant's Name

Telephone Number

*

Telephone Number

Present Address

*

Present Address

Present Address (Line 2)

Present Address (Line 2)

City

*

City

State

*

State

Zip

*

Zip

How Long Have You Been at the Present Address?

*

How Long Have You Been at the Present Address?

Do You?

Do You?
Choose...

*

Nearest relative not living with you

Name

Name

Phone Number

Phone Number

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Present Landlord

Name

Name

Phone Number

Phone Number

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Prior Landlord

Name

Name

Phone Number

Phone Number

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Prior Landlord

Name

Name

Phone Number

Phone Number

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

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?

Are you or co-applicant a full time student?
Choose...

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 receives assistance u n d e r title IV of the Social Security Act (for example,payments under TANF or AFDC).
Choose...

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.

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.
Choose...

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 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.
Choose...

The members of the household are married and file a joint federal tax return (or are eligible to file a joint return).

The members of the household are married and file a joint federal tax return (or are eligible to file a joint return).
Choose...

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.)

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.)
Choose...

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

Name

Relationship

Relationship

Date of Birth

Date of Birth

Marital Status

Marital Status
Choose...

Social Security Number

Social Security Number

Household Member

Name

Name

Relationship

Relationship

Date of Birth

Date of Birth

Marital Status

Marital Status
Choose...

Social Security Number

Social Security Number

Are you or any member of your household a lifetime sex offender?

Are you or any member of your household a lifetime sex offender?
Choose...

Which household member

Which household member

List below all states where all household members have resided. List name and states resided in

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?

Do you have a household member who is or will be absent from the home?
Choose...

Reason for Absence

Reason for Absence
Choose...

Do you have a live-in attendant?

Do you have a live-in attendant?
Choose...

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?

Do you expect any changes of household composition?
Choose...

Baby due on

Baby due on

Adopting a child(ren) on

Adopting a child(ren) on

Obtaining custody of child(ren) on

Obtaining custody of child(ren) on

Obtaining joint custody of a child(ren) on

Obtaining joint custody of a child(ren) on

Receiving a foster 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

Applicant

Co-Applicant

Co-Applicant

Other Adult

Other Adult

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

Date of Employment

Name of Employer

Name of Employer

Address of Employer

Address of Employer

Address of Employer (Line 2)

Address of Employer (Line 2)

City

City

State

State

Zip

Zip

Phone No. of Employer

Phone No. of Employer

Annual Gross Salary

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

Applicant Earnings

Type of Income

Type of Income

Co-Applicant Earnings

Co-Applicant Earnings

Type of Income

Type of Income

Other Adult Member Earnings

Other Adult Member Earnings

Type of Income

Type of Income

Other Adult Member Earnings

Other Adult Member Earnings

Type of Income

Type of Income

Self Employment Income
(Gross income less business expense. Attach latest annual operating statement)

Applicant Net business income

Applicant Net business income

Co-Applicant Net business income

Co-Applicant Net business income

Other Adult member Net business income

Other Adult member Net business income

Other Adult member Net business income

Other Adult member Net business income

Total Income

Applicant

Applicant

Co-Applicant

Co-Applicant

Other Adult member

Other Adult member

Other Adult member

Other Adult member

IV. Deductions

Are there any full-time students 18 years of age or older in the household.

Are there any full-time students 18 years of age or older in the household.
Choose...

Does any household member qualify for an elderly deduction?

Does any household member qualify for an elderly deduction?
Choose...

(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?

Is there a dependent over the age of 18, who is considered handicapped or disabled that may qualify for a handicap/disable deduction?
Choose...

Does the applicant require a special handicapped accessible unit?

Does the applicant require a special handicapped accessible unit?
Choose...

Do you or the co-applicant have any medical expenses that are not paid for by an outside source such as insurance?

Do you or the co-applicant have any medical expenses that are not paid for by an outside source such as insurance?
Choose...

(For elderly/handicapped/disabled households only)

Do you or the co-applicant have disability expenses that are not paid for by an outside source?

Do you or the co-applicant have disability expenses that are not paid for by an outside source?
Choose...

is this service necessary to enable a household member, including the member with the disability to be employed?

is this service necessary to enable a household member, including the member with the disability to be employed?
Choose...

Do you have attendant care expenses?

Do you have attendant care expenses?
Choose...

is this service necessary to enable a household member to be employed?

is this service necessary to enable a household member to be employed?
Choose...

Do you currently pay for childcare services for any children under the age of 13 residing in the household?

Do you currently pay for childcare services for any children under the age of 13 residing in the household?
Choose...

is this service necessary in order for you to be employed or to attend school?

is this service necessary in order for you to be employed or to attend school?
Choose...

what part of the expense is not reimbursed by an outside source?

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

Type of financial statement
Choose...

B. Real Property Owned

Dwelling

Item

Item

Market Value

Market Value

Unpaid Debt

Unpaid Debt

Monthly Payment

Monthly Payment

Name of Creditor

Name of Creditor

Account Number

Account Number

Address of Creditor

Address of Creditor

Address of Creditor (Line 2)

Address of Creditor (Line 2)

City

City

State

State

Zip

Zip

Other Real Estate

Item

Item

Market Value

Market Value

Unpaid Debt

Unpaid Debt

Monthly Payment

Monthly Payment

Name of Creditor

Name of Creditor

Account Number

Account Number

Address of Creditor

Address of Creditor

Address of Creditor (Line 2)

Address of Creditor (Line 2)

City

City

State

State

Zip

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

Family Member

Bank Name

Bank Name

Account Number

Account Number

Current Balance

Current Balance

D.
List the average checking / savings account balances for the past six(6) months as follows:

Family Member

Family Member

Average 6-Month Balance

Average 6-Month Balance

E.
Last current value of all stocks, bonds, trusts, pension contributions or other assets:

Family Member

Family Member

Type of Asset

Type of Asset

Value

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

Family Member Received

Type of Asset(s)

Type of Asset(s)

Fair Market Value

Fair Market Value

Total Value

Total Value

G.

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

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

VIII. Credit References

Name

Name

Telephone Number

Telephone Number

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

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

*

Signature of Applicant

Date

*

Date

Signature of Co-tenant or persons 18 years and older

Signature of Co-tenant or persons 18 years and older

Date

Date

Signature of persons 18 years and older

Signature of persons 18 years and older

Date

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

Name

Sex

Sex
Choose...

Race

Race

National Origin

National Origin

Children

Name

Name

Sex

Sex
Choose...

Race

Race

National Origin

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.

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3 Request for Credit and/or Criminal History

Form 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

Property
Preservation Crossing

*

Manager

Manager

Report will not be run if any information is missing

Applicant Information - COMPLETE ALL ITEMS

Full Name

*

Full Name
First, Middle, Last

Address

*

Address

Address (Line 2)

Address (Line 2)

City

*

City

State

*

State

Zip

*

Zip

Social Security Number

*

Social Security Number

Date of Birth

*

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

Applicant Signature

Date

Date

Co-Applicant Information - COMPLETE ALL ITEMS

Full Name

*

Full Name
First, Middle, Last

Address

*

Address

Address (Line 2)

Address (Line 2)

City

*

City

State

*

State

Zip

*

Zip

Social Security Number

*

Social Security Number

Date of Birth

*

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

Co-Applicant Signature

Date

Date

Please make money order made payable to INTEREST. Remember the cost is $20 per person.

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4 Tenant Release and Consent Form
Form 4 | Tenant Release and Consent Form

Please click here to download a printable version of the Intervest - Tenant Release and Consent Form and fill out manually
Tenant Release and Consent Form

Apartment Complex

Apartment Complex
Preservation Crossing
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

Applicant / Resident

(Print Name)

(Print Name)

Date

Date

Co-Applicant/Resident

Co-Applicant/Resident

(Print Name)

(Print Name)

Date

Date

Adult Household Member

Adult Household Member

(Print Name)

(Print Name)

Date

Date

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5 Under $5000 Asset Certification

Form 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 Value Enter 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 Rate For 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 Income Enter the annual Income of the Asset by multiplying the FMV by the Interest Rate.
Total To 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.

Within the past two (2) years, I/we have sold or given away assets (including cash, real estate, etc.) for more than $1,000 below their fair market value (FMV).

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

I/we have not sold or given away assets (including cash, real estate, etc.) for less than fair market value during the past two (2) years.

3.

I/we do not have any assets at this time.

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

Form 6 | NonEmployment Affidavit

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

Non-Employment Affidavit
To be completed by any adult household member, including emancipated minors, who claim non-employment status and/or income.

Tenant / Applicant

Tenant / Applicant

Unit No

Unit No

Development Name

Development Name

DIRECTIONS: Please select all that applies

1. I am not currently employed in any capacity and do not anticipate the change in my status.

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

I do not plan to look for employment due to

2. I am not currently employed in any capacity; however, I anticipate becoming employed in the next 12 months.

Choose...

Choose...
Choose...

Employer

Employer

Start Date

Start Date

Position

Position

Anticipate earning

Anticipate earning

Pay frequency

Pay frequency

My anticipated income is supported by (check all that applies):
Written confirmation from my new employer
Previous tax return
Previous job pay stub / salary history
Three current employment advertisements showing average compensation for a similar position
Other

Please detail

Please detail

3. I attest that the following is true regarding benefits related to my unemployment: (Please check one)

Iam currently receiving unemployment benefits. (Attach printout from MDES of unemployment benefits.)
I am currently receiving other benefits related to my non-employment status (i.e. disability).
I am not currently receiving but do anticipate receiving unemployment benefits or other benefits.
I am not currently receiving and do not anticipate receiving unemployment benefits or other benefits.

Identify source

Identify source

Amount

Amount

If benefits related to your unemployment slatus (disability, pension, etc.) other than unemployment is anticipated,

Identify source

Identify source

Amount

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

Tenant/Applicant Signature

Date

Date

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7 Child Support Affidavit

Form 7 | Child Support Affidavit

Please click here to download a printable version of the Intervest - Child Support Affidavit and fill out manually

Child Support Affidavit

Head of Household Name

Head of Household Name

Unit Number

Unit Number

Child(ren)'s Name(s)

Child(ren)'s Name(s)

Non-Custodial Parent (NCP)

Non-Custodial Parent (NCP)

I certify that the following is true regarding my current child support situation:

current child support situation

current child support situation
Choose...

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

I am currently receiving payments
Choose...

Last payment received was on

Last payment received was on

How are/were the payments being received?

How are/were the payments being received?
Choose...

Please explain

Please explain

Monthly Amount of Award

Monthly Amount of Award

Date of Court Order

Date of Court Order

County & State of Order

County & State of Order

I

I
Choose...

I receive
monetary contributions
third-party benefits related to NCP's relationship to the child (e.g. SSI payments, etc.)
non-cash contributions (i.e. gasoline, diapers, baby formula, medicine, etc) in lieu of child support

Amount

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

Frequency

Frequency

I am not pursing legal action because (must check at least one):
Financial reasons
Responsible party's location is unknown
Incarceration/Protective Custody
Responsible party is deceased
Other

Are survivor benefits (e.g. SSI, etc) being received?

Are survivor benefits (e.g. SSI, etc) being received?
Choose...

Please explain

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

Signature of Applicant/Resident

Date

Date

Leave this empty
8 Interagency Referral Form

Form 8 | Interagency Referral Form

Please click here to download a printable version of the Intervest - Interagency Referral Form and fill out manually

Interagency Referral Form

General Information

Complex Manager

Complex Manager

Phone

Phone

Complex Name

Complex Name

Fax

Fax

Address

Address

Address (Line 2)

Address (Line 2)

City

City

State

State

Zip

Zip

Email

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

Applicant Signature

Print Applicant Name

Print Applicant Name

Social Security Number

Social Security Number

Date

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

Leasing Representative

Date

Date

Leave this empty
9 Student Status Certification
Form 9 | Student Status Certification

Please click here to download a printable version of the Intervest - Student Status Certification and fill out manually
Student Status Certification
This annual Student Self Certification is in connection with the undersigned's application/occupancy in the following apartment:

Household Name

Household Name

Unit No.

Unit No.

Development Name

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)

A. Household contains at least one occupant who is not a student and has not been/will not be a student for five months or more out ofthe current and/or upcoming calendar year (months need not be consecutive).

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

B. Household contains all students, but is qualified because the following occupant(s) is/are a part-time student(s) who have not been/will not be a fulltime student for five months or more of the current and/or upcoming calendar year.

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

Please list occupants who are part-time students

C. Household contains all students who were, are, or will be FULL-TIME for five months or more out of the current and/or upcoming calendar year (months need not be consecutive).

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?

1. Is any member married and entitled to file a joint tax return?
Choose...

(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?

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?
Choose...

(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)?

3. Is at least one student receiving Temporary Assistance to Needy Families (TANF)?
Choose...

(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?

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?
Choose...

(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?

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?
Choose...

(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

Signature of Applicant/Tenant

Printed Name of Applicant/Tenant

Printed Name of Applicant/Tenant

Date

Date
Please upload applicable documentation(s)

Drag and drop a file here or click
Please upload applicable documentation(s)
Leave this empty
10 Lease Addendum for LIHTC Properties
Form 10 | Lease Addendum for LIHTC Properties

Please click here to download a printable version of the Intervest - Lease Addendum for LIHTC Properties and fill out manually
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:
A single parent with children, none of which are declared as dependents on another Person's tax return.
Married and filing a joint federal tax return.
Receiving AFDC payments on behalf ofminor children.
Enrolled in a job-training program receiving assistance under the Job Training Partnership Act or funded by a state or local government agency.
A former participant in the Foster Care Program.

Tenant certifies that the following information is complete and correct. List all membersof the household:
Name

Name

Social Security Number

Social Security Number

Birth Date

Birth Date

Full-time Student?

Full-time Student?
Choose...

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

Tenant

Date

Date

Leave this empty

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

Fair Market Value	Enter 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 Rate	For 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 Income	Enter the annual Income of the Asset by multiplying the FMV by the Interest Rate.
Total	To acquire the Total Fair Market Value and Annual Income, add amounts for lines "a" through "t" for each respective column

Preservation Crossing

846 North Main St.Hattiesburg, MS 39401

preservationcrossing@outlook.com

(601) 573-5254

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

Form 1 | Application Checklist

Application Checklist

Property Name

Date

Name

Form 2 | Tenant Application for Rural Development and/or Tax Credit Properties

TENANT APPLICATION

Rural Development and/or Tax Credit Properties

Project Name

Type Apartment

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

Are you or co-applicant a full time student?

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

Name

Relationship

Date of Birth

Marital Status

Social Security Number

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?

846 North Main St.
Hattiesburg, MS 39401