LONG-TERM RENTAL APPLICATION

Transcription

1 p LONG-TERM RENTAL APPLICATION For approval on APCHA-managed units, W2 s, 1099 s and/or Employment History Report from the Social Security Office may be required. THE FOLLOWING MUST BE SUBMITTED FOR ANYONE 18 YEARS OR OLDER: Each application requires a non-refundable processing fee of $50 payable to the City of Aspen - Cash or Check Only. The processing fee to re-qualify every two years is $35. A valid Colorado driver s license or a Colorado ID card; or a US military card or a military dependent s ID card; or US Coast Guard merchant marine card; or a Native American tribal document; or a Permanent Resident card. Lawful Presence Affidavit (complete for each applicant and is included in this packet). COPIES of most recent paycheck stub(s) or an up-to-date profit and loss statement if self-employed. COPIES of most recent year s completed federal income tax return Form 1040 (including all schedules), with W2 s & 1099 s attached. If you do not have a copy of your tax return, contact the IRS at for a free copy of your tax transcript. You must speak to a live person at the IRS in order to have them fax the transcript. Self-employed applicants may be required to produce additional documentation including a copy of their current City of Aspen business license. TAX EXTENSIONS ARE NOT ACCEPTED. Employment Verification (complete for each employer for each applicant). PROJECT NAME: UNIT # # OF BEDROOMS: PERSONAL INFORMATION: Applicant #1: Current Address: Mailing Address: Home Phone: Work Phone: Applicant #2: Current Address: Mailing Address: Home Phone: Work Phone: HOUSEHOLD INFORMATION: List names of all other household members: Name: Relationship: Date of Birth: Name: Relationship: Date of Birth: Name: Relationship: Date of Birth: DO YOU OR ANYONE IN YOUR HOUSEHOLD INTEND TO HAVE ANY PET/ANIMAL INSIDE THE APARTMENT? Include mammals, amphibians, birds, fish, crustaceans, insects and arachnids. Yes No Type of Pet/Animal: Size/Breed (if applicable): EMERGENCY CONTACT: Name: Relationship: Contact #: Name: Relationship: Contact #: To be completed by Housing Staff: APPROVED BY: DATE: Revised 8/2/2017

2 VEHICLE INFORMATION: Year: Make/Model: License Plate #: Year: Make/Model: License Plate #: DO YOU OR ANYONE IN YOUR HOUSEHOLD OWN ANY PROPERTY? Real estate, rental property, etc. (This includes your personal residence, mobile homes, vacation homes, timeshares or commercial property). If additional space is needed, use the back of this form. Yes No Household member: Property Address: Market Value: RESIDENCE HISTORY: Complete only if residing at current address for less than two years. Property type: Amount Owed: APPLICANT A APPLICANT B Contact: Address: Dates of Residence: EMPLOYMENT HISTORY: Please list ALL employment information for the past two years. Current Employer: Address: Dates of Employment: Previous Employer: Address: Dates of Employment: INCOME: Include all sources of income. Gross Monthly Income: (From Employment) Child Support/Alimony: Social Security Income: Dividends/Interest: Trust Disbursements: Rental Income: Other Income:

3 ASSETS AND LIABILITIES: If combined, list only once. Applicant # 1 Applicant # 2 ASSETS: Name of Entity Balance Name of Entity Balance Bank or Credit Union: $ $ Bank or Credit Union: $ $ Stocks & Bonds: $ $ Real Estate: $ $ Retirement Funds: $ $ Trusts: $ $ Automobiles: $ $ Business: $ $ Other: $ $ TOTAL ASSETS: $ TOTAL ASSETS: $ LIABILITIES: Name of Entity Balance Name of Entity Balance Mortgage Loan: $ $ 2 nd Mortgage Loan: $ $ Automobile(s) Loan: $ $ Student Loans: $ $ Credit Card(s): $ $ Other: $ $ TOTAL LIABILITIES: $ TOTAL LIABILITIES: $ TOTAL NET WORTH (assets minus liabilities) $ I/We understand that to qualify for APCHA Deed Restricted/Employee Housing, I/We must not own any developed residential real estate or mobile home in the Ownership Exclusion Zone. I understand that I/We must re-qualify every two years. I/We understand that if I/We rent or own deed-restricted property and if I/We are found to be out of good standing with that property, I/We will be disqualified from renting/bidding/purchasing the unit within the housing program. I/We understand that if the documentation that I/We have provided is found to be false or non-verifiable, I/We will be disqualified. I/We authorize APCHA to make necessary inquiries to evaluate my/our employment, assets and income. Signature: Signature: Date: Date:

4 Form 4506T-EZ (Rev. August 2014) Department of the Treasury Internal Revenue Service Short Form Request for Individual Tax Return Transcript Request may not be processed if the form is incomplete or illegible. For more information about Form 4506T-EZ, visit OMB No Tip. Use Form 4506T-EZ to order a 1040 series tax return transcript free of charge, or you can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on Get Transcript of Your Tax Records under Tools or call a Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number or individual taxpayer identification number on tax return 2a If a joint return, enter spouse s name shown on tax return. 2b Second social security number or individual taxpayer identification number if joint tax return 3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions) 4 Previous address shown on the last return filed if different from line 3 (see instructions) 5 If the transcript is to be mailed to a third party (such as a mortgage company), enter the third party s name, address, and telephone number. The IRS has no control over what the third party does with the tax information. Third party name Telephone number Aspen Pitkin County Housing Authority (IVES # ) Address (including apt., room, or suite no.), city, state, and ZIP code 210 E Hyman # 202, Aspen, CO Caution. If the tax transcript is being mailed to a third party, ensure that you have filled in line 6 before signing. Sign and date the form once you have filled in this line. Completing this step helps to protect your privacy. Once the IRS discloses your IRS transcript to the third party listed on line 5, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your transcript information, you can specify this limitation in your written agreement with the third party. 6 Year(s) requested. Enter the year(s) of the return transcript you are requesting (for example, 2008 ). Most requests will be processed within 10 business days. Note. If the IRS is unable to locate a return that matches the taxpayer identity information provided above, or if IRS records indicate that the return has not been filed, the IRS will notify you or the third party that it was unable to locate a return, or that a return was not filed, whichever is applicable. Caution. Do not sign this form unless all applicable lines have been completed. Signature of taxpayer(s). I declare that I am the taxpayer whose name is shown on either line 1a or 2a. If the request applies to a joint return, either spouse must sign. Note. For transcripts being sent to a third party, this form must be received within 120 days of the signature date. Phone number of taxpayer on line 1a or 2a Sign Here Signature (see instructions) Spouse s signature Date Date For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No S Form 4506T-EZ (Rev )

5 LAWFUL PRESENCE AFFIDAVIT I, (print name), swear or affirm under penalty or perjury under the laws of the State of Colorado that (check one): I am a United States citizen, OR I am a Permanent Resident of the United States, OR I am lawfully present in the United States pursuant to Federal law. If you are not a US Citizen, you must submit one of the following documents in addition to a Colorado ID: Unexpired foreign passport with I-94 Arrival/Departure Record I-327 Reentry Permit I-551 Resident Alien/permanent Resident Card I-571 Refugee Travel Document I-688 (photo temporary resident card) I-688B (employment authorization document) I-766 (photo employment authorization card) Alien or I-94#: DS #: (go to website (top right # on Certificate of Eligibility form) Expiration Date: I understand that law required this sworn statement because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior ot receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. I certify the information given above is true and complete to the best of my knowledge. Signature: Date: Date of Birth: To be completed by Housing Staff: SAVE VERIFICATION #: DATE:

6 EMPLOYMENT & INCOME VERIFICATION Type of Qualification (check all that apply): Rental Property* Sales Property *If rental property, what is the Project/Apartment Complex Name? Unit # Applicant/Tenant Release Statement: I hereby authorize the release of the following information in order to determine my eligibility for the APCHA program. Print Name: Signature: TO BE COMPLETED BY EMPLOYER: Please complete this form in full and return it to APCHA. Please do not put unknown or varies we need specific information. If an item doesn t apply, put N/A no blanks. Date of Hire: Position: Physical Address of Employment/Office: Base Pay: $ per (check one) Year Month Week Hour Other: Average hours per week: Overtime hours per week: Average No. of Shift Differential Hours per week: Year-to-Date Earnings: $ thru (DD/MM/YY): Overtime pay rate: $ Shift Differential Rate per Hour: Does this employee receive? (check all that apply) Bonuses Tips Commission None Average bonus/tips/commission $ per (check one) Year Month Week Hour Are bonus/commissions Guaranteed? Yes No Date of Next Pay Increase (if known): Amount of Next Pay Increase (if known): $ If employment is seasonal/periodic, please specify layoff periods: Employer Comments: Warning: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful, false statements of misrepresentation to any Department or Agency of the U.S. as to any matter within its jurisdiction. Employer Signature: Date: Name and Title: Company Name: Company Website: Address: Telephone Number: Fax Number: Please deliver to: Aspen/Pitkin County Housing Authority 210 East Hyman Ave., Suite #202 Aspen, CO 81611

7 LAWFUL PRESENCE AFFIDAVIT I, (print name), swear or affirm under penalty or perjury under the laws of the State of Colorado that (check one): I am a United States citizen, OR I am a Permanent Resident of the United States, OR I am lawfully present in the United States pursuant to Federal law. If you are not a US Citizen, you must submit one of the following documents in addition to a Colorado ID: Unexpired foreign passport with I-94 Arrival/Departure Record I-327 Reentry Permit I-551 Resident Alien/permanent Resident Card I-571 Refugee Travel Document I-688 (photo temporary resident card) I-688B (employment authorization document) I-766 (photo employment authorization card) Alien or I-94#: DS #: (go to website (top right # on Certificate of Eligibility form) Expiration Date: I understand that law required this sworn statement because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior ot receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. I certify the information given above is true and complete to the best of my knowledge. Signature: Date: Date of Birth: To be completed by Housing Staff: SAVE VERIFICATION #: DATE:

8 EMPLOYMENT & INCOME VERIFICATION Type of Qualification (check all that apply): Rental Property* Sales Property *If rental property, what is the Project/Apartment Complex Name? Unit # Applicant/Tenant Release Statement: I hereby authorize the release of the following information in order to determine my eligibility for the APCHA program. Print Name: Signature: TO BE COMPLETED BY EMPLOYER: Please complete this form in full and return it to APCHA. Please do not put unknown or varies we need specific information. If an item doesn t apply, put N/A no blanks. Date of Hire: Position: Physical Address of Employment/Office: Base Pay: $ per (check one) Year Month Week Hour Other: Average hours per week: Overtime hours per week: Average No. of Shift Differential Hours per week: Year-to-Date Earnings: $ thru (DD/MM/YY): Overtime pay rate: $ Shift Differential Rate per Hour: Does this employee receive? (check all that apply) Bonuses Tips Commission None Average bonus/tips/commission $ per (check one) Year Month Week Hour Are bonus/commissions Guaranteed? Yes No Date of Next Pay Increase (if known): Amount of Next Pay Increase (if known): $ If employment is seasonal/periodic, please specify layoff periods: Employer Comments: Warning: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful, false statemetns of misrepresenatation to any Department or Agency of the U.S. as to any matter within its jurisdiction. Employer Signature: Date: Name and Title: Company Name: Company Website: Address: Telephone Number: Fax Number: Please deliver to: Aspen/Pitkin County Housing Authority 210 East Hyman Ave., Suite #202 Aspen, CO 81611