Address City State Zip Address City State Zip. Employment Date Salary Position Employment Date Salary Position

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1 $30.00 Non-Refundable Application Fee Required For Each Adult Applicant MONEY ORDERS ONLY PLEASE (757) FAX: (757) TDD: (757) Chesapeake Redevelopment & Housing Authority Rental Application Application Date: Work Phone: Size Unit Needed: Home Phone: Date Needed: Cell Phone: Date & Time Stamp Name Name Address City State Zip Address City State Zip Former Address City State Zip Former Address City State Zip Employer Employer Employment Date Salary Position Employment Date Salary Position Other Source of Income: Amount $ Other Source of Income: Amount $ All sources and amounts of income must be listed and will be verified by CRHA. List all persons who will occupy unit. Include social security numbers and date of birth for each family member. Relationship To Social Security # D.O.B. Head of Household Head of Household Spouse/Co-Applicant Emergency Contact Person: Personal References: Rental Reference: Name Address Name Address Current Landlord Apartment Name Telephone # Telephone # Telephone # Have you or anyone on this application ever been convicted of any crime other than traffic violations? Yes No WARNING: Section 1001 of Title 18 U.S. Code makes it a criminal offense to make willful false statements or representations to any department or agency of the U.S. as to any matter within it's jurisdiction. I hereby authorize the agency of these premises, or his agent or Representative to verify any statement made herein and to obtain a credit report from any credit reporting agency and to interview third parties, such as business associates and financial sources. Signature Signature Notes: Date requesting Credit/Criminal Report: Felony Conviction: No: Yes: If yes, type and date: Approved Not Approved Reason Not Approved Rev: 08/10

2 Geneva Square Rental Information Click on Housing and use the link at the top of the page Thank you for your interest in our community. Please read all information carefully and feel free to contact the Rental Office if you have any additional questions as you complete your application. There is a $30.00 nonrefundable application fee per adult. A social security card and picture ID is required for each adult listed on the application. Credit and criminal/sex offender reports will be checked through Trak-1 Technologies, P.O. Box Houston TX Telephone number Credit report may not contain any unpaid judgment, rental judgments (paid or unpaid within the last twelve months and bad debt balances. Total of all collection accounts may not exceed $1, with the exception of medical. Bankruptcy of any kind must have been discharged for at least six months. We will also verify your income and obtain a landlord reference. You will be notified if your income meets our requirements and your application is approved. A reservation deposit (security deposit) will be required in order to hold the unit for you. In some instances, it can take from 3 6 weeks from the time we notify you until your move in date. We have 2, 3 & 4 bedroom townhouse apartments. We do accept Housing Choice Vouchers, please call for more details. BEDROOMS SQ. FT RENT SECURITY DEPOSIT MINIMUM INCOME $ $ $26, ,019 $ $ $29, ,279 $ $ $32, We also have maximum income limits based on family size as follows: $38, $43, $49, $54, $58, $63, $67, $72, The units are total electric and equipped with a refrigerator, range, dishwasher, and full size washer/dryer (stackable). Resident pays for water and electricity. Each unit has a partially enclosed patio. We also have computer access in our Community Resource Center. Sorry, no pets or open flamed cooking devices allowed. Employment: Must have been gainfully employed at current job (full and/or part time) for a minimum of six months. Employment will be verified with pay stubs and/or directly with employer. SECURITY DEPOSIT AGREEMENT By signing this agreement, I understand that my application has been approved and that CRHA requires a reservation deposit in order to reserve a unit for me. CRHA hereby accepts a reservation deposit in the form of certified check or money order in the amount of $. I understand that, by signing this agreement, a unit has been reserved for me and will be taken off the list of available units. I further agree that the entire reservation deposit will be applied to my Security Deposit when I move in. If I fail to sign a lease and take occupancy on the date agreed upon, I understand that my reservation deposit will be applied to damages as specified in the Virginia Landlord/Tenant Act. A reservation deposit of $ has been paid and will hold off the market until the anticipated move-in date of. I understand that this date can not be guaranteed, but every effort will be made to make the unit available on the date agreed upon. I understand that the monthly rent will be payable in advance and without demand. I further agree that the entire reservation deposit will be applied to my Security Deposit when I move in. If I fail to sign a lease and take occupancy on the date specified above after my application is accepted, I understand that my deposit will be applied to damages as specified in the Virginia Landlord/Tenant Act. Dominion Virginia Power should be contacted as soon as your lease is signed in order to have service placed in your name and to insure uninterrupted service. You may call Dominion Virginia Power at Signature of Applicant Telephone # Date Signature of Applicant Telephone # Date Revised 08/10

3 CHESAPEAKE REDEVELOPMENT AND HOUSING AUTHORITY 1468 South Military Hwy Chesapeake, Virginia (757) (757) Agreement, Authorization, and Consent for Release of Information FOR OFFICE USE ONLY: Prepared by : Date Processed by: Date Property Name I,, hereby give consent and authorize Chesapeake Redevelopment & Housing Authority to obtain a copy of my Criminal History/Sex Offender report. If upon receiving my Criminal/Sex Offender report, the Chesapeake Redevelopment & Housing Authority finds that I have been charged with a felony within the past five (5) years and/or I have a history of criminal activity and/or subject to a lifetime sex offender registration requirement under a State sex offender registration program, I will be declared ineligible for housing. If I am housed at that time, my lease will be terminated from the Conventional Housing Program. I have read the above statement and understand that this issue cannot be grieved. Name Date Address Date of Birth City/State/ZIP SSN Other names used or previously known as Signature 12/04

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5 WHAT YOU WILL NEED.. Thank you for visiting Geneva Square. For us to begin processing your application, we will need the items shown below that apply to you or to anyone who will be living in this apartment: Photo ID for all members who are 18 years of age and older Social Security Card for all members who are 18 years of age and older Birth Certificates for all children Employment/Other Income: All adult household members who are employed must sign a Verification of Employment form giving us permission to verify their gross anticipated earnings for the next 12 months and to verify length of employment. If any household member has other income such as Social Security, SSI, Disability, Worker s Compensation, VA Benefits, Unemployment Compensation, TANF, etc., we must have proof of the gross amount being received over the next 12 months. Six most recent pay stubs; If self employed, need copy of business license and most recent tax return. Separation/Child Support: If your marital status is listed as separated or divorced, you will need to complete Marital Status Form. If you have a court order for spousal support and/or child support, we need a copy of the court order from the courthouse or the office of Child Support Enforcement that is not more than 90 days old and a printout of payments received.. Custody of Children other than your own: If you have custody of a child that is not your own, we must have a copy of a court order granting custody AND a copy of your most recent taxes showing proof that you claim the child or children on your taxes. The court order should state the length of time the child will be in your custody. Credit: If you have filed bankruptcy and it has been discharged for at least six months, please provide a copy of the legal paperwork that shows all creditors included in the bankruptcy. If you have recently paid a collection, judgement, or bad debt that was on your credit report, you must provide receipts as proof of payment. These items must be submitted along with the application. Credit reports that contain judgements, collection accounts (except for medical collections), and/or bad debt listings that do not have verification of payments will not be approved. Applicant must then wait six months before re-applying. Please take the time to read additional information contained on the back of the Application. Thank you for your cooperation in getting these very important documents to our community office as soon as possible so that we may begin processing your application. We look forward to having you as a resident of Geneva Square!

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