Rental Agreement – Greenfield Apartments

1. Property

Greenfield Apartments are 3-bedroom, 1 bath, 2-floor townhouses; bedrooms and bath are on the second level. Some units have a basement and some are on a slab. The washer-dryer hookup for basement units is in the basement and on the first level on slab units. Greenfield is rent-restricted program that is not based on 30% of adjusted gross income.

2. Head-of-Household.

Last Name:

First Name:

Middle Name:

Street Address:

Apartment:

Total Household Monthly Gross Income:

City:

State:

Zip:

Phone:

Email Address:

Do you currently have a Section 8 voucher?

Yes

3. Household.

Please list all persons who will reside in the unit, including yourself.

Name

(Include All Previous Names)

Social Security Number

Date of Birth

Name

(Include All Previous Names)

Social Security Number

Date of Birth

Name

(Include All Previous Names)

Social Security Number

Date of Birth

Name

Social Security Number

Date of Birth

Name

Social Security Number

Date of Birth

4. Background Information.

Have you ever applied for housing with Bangor Housing in the past?

Yes

If Yes, approximately when?

Do you or does any member of your household have a pet?

Yes

Please note that service or assistance animals are not pets.

If Yes, how many and what type?

Have you or any member of your household ever been convicted of a crime?

Yes

If Yes, who where, and when

Are you or any member of your household subject to a registration requirement under any state sex offender registration program?

Yes

If Yes, who and which state(s):

Have you or any member of your household ever been convicted of methamphetamine production?

Yes

If Yes, who and which state(s):

5. Reasonable Accommodation

If you or anyone in your family is a person with a disability, and you require a specific accommodation in order to fully utilize our programs and services, including but not limited to needing an ADA-accessible unit or an assistance animal, please complete a Reasonable Accommodation Request Form. Please note that a reasonable accommodation request is not required to request a first-floor unit.

6. Applicant Certification.

By signing below, I hereby certify the information I have provided in this Pre-Application is true and accurate and I understand and acknowledge that:

Providing false information will result in cancellation or denial of my application and/or termination of my tenancy or housing assistance.
Knowingly providing false information on this Pre-Application is a felony under federal law.
I may be contacted to verify the information contained in this Pre-Application and may need to provide further information or documentation to BHA.
Failure to provide information may result in delays in the processing of my Pre-Application.
Changes occurring after submission of this Pre-Application may affect my qualification for housing.

Further, by signing below, I hereby authorize BHA to:

Perform a criminal background check for all household members who may have an adult criminal adjudication age.
Obtain references from current and/or prior landlords.
Obtain a copy of my consumer credit report for the purpose of verifying information in this Pre-Application or any other information provided by me to BHA.
Conduct searches of any HUD database.
Conduct searches of any federal or state sex offender registry.

Applicant Signature

Date

Co-Applicant Signature

Date

Other Adult Applicant Signature

Date

Warning: Section 1001 of Title 18, United State Code, makes it a criminal offense to make any knowing and willful false statement to any department or agency of the United States as to any matter within its jurisdiction, punishable by a fine not to exceed $250,000.00 and/or imprisonment of not more than 5 years.

Adult Member 1

Current Address

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Previous Addresses

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Signature

Full Name

Date of Birth

SS #

Telephone #

Adult Member 2

Current Address

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Previous Addresses

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Street Address

City

State

Zip

From

Ownership

If Renting – Landlord Name

Landlord Mailing Address

Landlord Phone Number & Fax Number

Signature

Full Name

Date of Birth

SS #

Telephone #

Phone

This field is for validation purposes and should be left unchanged.