Gateway Court Blue Cassel Site A Realty, LLC We are now accepting applications for apartments at Gateway Apartments, a rental development locate at 701 Prospect Ave in the New Cassel section of Westbury. Apartments feature, hardwood floors, individually controlled heat and air conditioning, designer kitchens with built in dishwashers and modern appliances, onsite laundry room and parking. Please take the time to make sure every item on the application is completed. Failure to fully complete the application will delay or prevent us from processing it. YOUR APPLICATION MUST BE MAILED BY REGULAR MAIL ONLY Blue Cassel Site A Realty, LLC 90-11 160 th St. Suite 100 Jamaica, NY 11432 Apt. Type Monthly Rent* Family Size Minimum/Maximum Income (Based on Household Size) 1 Bedroom $1190 1 2 3 1 Bedroom $1244 1 2 3 2 Bedroom $1427 2 3 4 2 Bedroom $1700 2 3 4 $35,700-$45,780 $35,700-$52,320 $35,700-$58,860 $37,320-$68,670 $37,320-$78,480 $37,320-$88,290 $42,810-$52,320 $42,810-$58,860 $42,810-$65,400 $51,000-$78,480 $51,000-$88,290 $51,000-$98,100 Page 1 of 9
/Time Received: Log: APPLICATION FOR HOUSING This is an application for housing at: Blue Cassel Site A Realty, LLC Please complete this application and return to the address below. Please Print Clearly: Blue Cassel Site A Realty, LLC 90-11 160 th St. Suite 100 Jamaica, NY 11432 Applications are placed in order of date and time received. An applicant may be interviewed only after the receipt of this tenant application. A. GENERAL INFORMATION Applicant Name(s): Street Apt. # City State Zip Daytime Phone: Email: No. of BR s in current unit: Do you RENT or OWN (check one) Amount of current monthly rental or mortgage payment? Check utilities paid by you: Heat Electric Gas Other (specify) Approximate monthly cost of utilities paid by you (excluding phone and cable TV): $ Bedroom size requested: Studio One Bedroom Two Bedroom Three Bedroom Do you desire an apartment with accessible features? Yes No (check one) If so, what features? Marketing Information: How did you hear about the property? Newspaper Friend Walk By Other (specify) If referred by a friend, who can we thank? If referred by an agency, please state agency name Page 2 of 9
B. HOUSEHOLD COMPOSITION List ALL persons who will live in the apartment. List the head of household first. Name Relationship to head Birth Age SS# Race/Ethnicity** Student Y/N Head Co-T 3. 4. 5. 6. 7. 8. Do you anticipate any additions to the household in the next twelve months? YES NO If yes, explain Are all members of the household U.S. citizens? YES NO **This information is used for statistical purposes only and is optional Are you currently receiving a tenant based section 8 voucher or certificate YES NO Will all of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an educational institution (other than a correspondence school) with regular faculty and students? YES NO IF YES, ANSWER THE FOLLOWING QUESTIONS: Are any full-time student(s) married and filing a joint tax return? YES NO Are any student(s) enrolled in a job-training program receiving YES NO assistance under the Job Training Partnership Act? Are any full-time student(s) a TANF or a title IV recipient? YES NO Are any full-time student(s) a single parent living with his/her minor child who is not a Dependant on another s tax return? YES NO ALL APPLICANTS WILL BE SUBJECT TO A BACKGROUND CHECK TO DETERMINE ELIGIBILITY FOR RESIDENCY. Page 3 of 9
C. INCOME List ALL sources of income as requested below. If a section doesn t apply, cross out or write NA. Household Member Name Source of Income Social Security $ Social Security $ Social Security $ Social Security $ SSI Benefits $ SSI Benefits $ SSI Benefits $ SSI Benefits $ Pension (list source) $ Pension (list source) $ Pension (list source) $ Veteran s Benefits (list claim #) $ Veteran s Benefits (list claim #) $ Unemployment Compensation $ Unemployment Compensation $ Title IV/TANF $ Title IV/TANF $ Title IV/TANF $ Gross Monthly Amount Full-Time Student Income (18 & over only) Full-Time Student Income (18 & over only) $ $ Interest Income (source) $ Interest Income (source) $ Interest Income (source) $ Interest Income (source) $ Page 4 of 9
Employment Amount $ (Monthly Amount) Employer: Position Held: How Long Employed: Employment Amount $ (Monthly Amount) Employer: Position Held: How Long Employed: Employment Amount $ (Monthly Amount) Employer: Position Held: How Long Employed: Employment Amount $ (Monthly Amount) Employer: Position Held: How Long Employed: Alimony Are you entitled to receive Alimony? YES NO If yes, list the amount you are entitled to receive. $ Do you receive Alimony? YES NO If yes, list the amount you receive. $ Child Support Are you entitled to receive Child Support? YES NO If yes, list the amount you are entitled to receive. $ Do you receive Child Support? YES NO If yes, list the amount you receive. $ Other Income: Other income: Other income: Monthly Amount Total Gross Annual Income (based on the monthly amounts listed above X 12) $ Total Gross Annual Income From Previous Year $ Do you anticipate any changes in this income in the next 12 months? YES NO If yes, explain: Page 5 of 9
D. ASSETS If your assets are too numerous to list here, please request an additional form. If a section doesn t apply, cross out or write NA. Checking Account # Bank: Balance $ Checking Account # Bank: Balance $ Checking Account # Bank: Balance $ Savings Account # Bank: Balance $ Savings Account # Bank: Balance $ Savings Account # Bank: Balance $ Trust Account # Bank: Balance $ Certificates # Bank: Balance $ Certificates # Bank: Balance $ Certificates # Bank: Balance $ Certificates # Bank: Balance $ Credit Union # Bank: Balance $ Credit Union # Bank: Balance $ Savings Bond # Maturity : Value $ Savings Bond # Maturity : Value $ Savings Bond # Maturity : Value $ Life Insurance Policy # Cash Value $ Life Insurance Policy # Cash Value $ Mutual Name: # Shares Interest or Dividend Value Funds Mutual Name # Shares Interest or Dividend Value Funds Stocks Name # Shares Interest or Dividend Value Stocks Name # Shares Interest or Dividend Value Stocks Name # Shares Interest or Dividend Value Bonds Name # Shares Interest or Dividend Value Bonds Name # Shares Interest or Dividend Value Investment Property Appraised Value $ Page 6 of 9
Real Estate Property: Do you own any property? YES NO If yes, Type of Property: Location of Property: Appraised Market Value $ Mortgage or outstanding loans balance due $ Amount of annual insurance premium $ Amount of most recent tax bill $ Have you sold/disposed of any property in the last 2 years? YES NO I yes, Type of Property: Market value when sold/disposed: $ Amount sold/disposed for: $ of Transaction: Have you disposed of any other assets in the last 2 years (Example: Given away money to relatives, set up Irrevocable Trust Accounts)? YES NO If yes, describe asset: of disposition: Amount disposed: $ Do you have any other assets not listed above (excluding personal property? If yes, please list: YES NO E. ADDITONAL INFORMATION Are you or any member of your family currently using an illegal substance? Have you or any member of your family ever been convicted of a felony? If yes, describe: Have you or any member of your family ever been evicted from housing? If yes, describe YES YES YES NO NO NO Have you ever filed for bankruptcy? YES NO If yes, describe: Will you take an apartment when one is available? YES NO Briefly describe your reason for applying: Page 7 of 9
Please list every State that each member of the household member has resided in: Head of Household: Member 2: Member 3: Member 4: Member 5: Member 6: Member 7: Member 8: Member 9: Member 10: Is any member of your household subject to a lifetime sex offender registration requirement in any State? YES NO I understand that should it be discovered that a member of my household is subject to a lifetime registration requirement at admission, management will immediately pursue eviction and termination of assistance for the household member YES NO Name Address Home Phone Business Phone How Long? F. REFERENCE INFORMATION CURRENT LANDLORD PRIOR LANDLORD Name Address Home Phone Business Phone How Long? Credit Reference #1: Account #: Phone # Credit Reference #2: Account #: Phone # Credit Reference #3: Account #: Phone # Personal Reference #1: Relationship: Phone # Personal Reference #2: Relationship: Phone # Personal Reference #3: Relationship: Phone # Page 8 of 9
In case of emergency notify: Relationship: Phone # G. VEHICLE INFORMATION (if applicable) List any cars, trucks, or other vehicles owned. Type of Vehicle: License Plate #: Year/Make: Color: Type of Vehicle: License Plate #: Year/Make: Color: H. PET INFORMATION (if applicable) Please be aware that pets are not permitted. Service animals are not considered pets. Do you own any pets? YES NO If yes, describe: CERTIFICATION I/We hereby certify that I/WE DO/WE WILL not maintain a separate s rental unit in another location. I/We further certify that this will be my/our permanent residence. I/We understand I/We must pay a security deposit for this apartment prior to occupancy. I/We understand that my eligibility for housing will be based on applicable income limits and by management s selection criteria. I/We certify that all information in this application is true to the best of my/our knowledge and I/We understand that false statements or information are punishable by law and will lead to cancellation of this application or termination of tenancy after occupancy. All adult applicants, 18 or older, must sign application. SIGNATURE (S): (Signature of Tenant) (Signature of Tenant) (Signature of Tenant) (Signature of Tenant) Page 9 of 9