ࡱ > r t q { bjbj 8h rfrf 8 n " ^ R T T T T T T $ " 9% r x x H R R R .$ X > 0 % % % L x x % X L : Directions: Print or type all requested information and sign certification. Original application will be time and date stamped upon receipt and entered into NYS Homes and Community Renewals Automated Waiting List (AWL) in chronological order. Applicant will be given a print out of AWL summary with application number. Applicants can monitor waiting list position and update their contact information using the AWLs public access function @ HYPERLINK "https://hcr.ny.gov/mitchell-lama-automated-waiting-list-apps-awl" https://hcr.ny.gov/mitchell-lama-automated-waiting-list-apps-awl Applicant Address: Apartment #:______________ Street Address:_______________________________________ City:________________ State:____________ Zip Code:__________ Phone #:_______________________ Phone #:_______________________ Email Address:______________________________________________________ Head of Household: (Must be completed. Head of household must be 18 years of age or older.) Last NameFirst NameSocial Security No.Age Co-Head of Household: (Complete if applicable. Co-head must be 18 years of age or older.) Last NameFirst NameSocial Security No.Age Other Household Members: (List all other persons who will reside in apartment.) Last NameFirst NameSocial Security No.Age Apartment Size: (Select one or two sizes. Household size must meet applicable occupancy standards.) FORMCHECKBOX Studio (1-2 persons) FORMCHECKBOX 1 Bdrm (1-2 persons) FORMCHECKBOX 2 Bdrm (2-4 persons) FORMCHECKBOX 3 Bdrm (4-6 persons) FORMCHECKBOX 4 Bdrm (5-8 persons) Special Requirements: (Note that special requirements can extend your wait for an apartment.) Gross Household Income: $___________________(Enter total estimated income for all household members, from all sources, for the next 12 months.) Veterans Admission Preference: FORMCHECKBOX If head- or co-head of household is an honorably discharged veteran of the US Armed Services, or such veterans surviving spouse, who served on active duty in time of war and resides in New York State, check box and attach DD-214 to qualify for admission preference. Certification: (Head of household and co-head must sign and date.) The above information is correct to the best of my knowledge. I have no objection to inquiries for the purpose of verifying this information and I agree to furnish all required documentation. Head of Household Signature: ____________________________________________ Date: ___________ Co-Head of Household Signature: _________________________________________ Date: ___________ For Housing Company UseFor HCR UseApplication Date (date original application stamped received): / / AWL #:Approved by:Is this original application? (Check yes/no; if no, attach original application.)Yes ___No ___Bldg #:Apt #:# Bdrms:# Rental Rms:Date: / /Basic Rent:Excess Income:Total Mthly Rent:Comment:Comment:Approved by:Date: / / (ENTER development NAME) Apartment AppliCation (for federal programs) INCLUDEPICTURE "http://www.fhcwm.org/uploads/images/equal%20housing%20logo_small.jpg" \* MERGEFORMATINET HM-79 (Federal Programs, 1/21) L M O Y h t İo]K]9'9 #he: h 6CJ OJ QJ ^J aJ #he: hPUJ 6CJ OJ QJ ^J aJ #he: hz@ 6CJ OJ QJ ^J aJ #he: hi 6CJ OJ QJ ^J aJ #he: hA' 6CJ OJ QJ ^J aJ h. 6CJ OJ QJ ^J aJ h@ 6CJ OJ QJ ^J aJ h@ 6>*CJ OJ QJ ^J aJ &h@ h@ 6>*CJ OJ QJ ^J aJ &heVF h@ 56CJ OJ QJ ^J aJ &h h@ 5>*CJ OJ QJ ^J aJ &hF he: 67CJ OJ QJ ^J aJ Q R g h 7 | } $$If a$gdq $$If a$gd>% d gd. gd. gdr) gd@ gd0 " / ; D \ q ɷۓo]KoK]K]]@9hN; hN; j hN; hN; U#hN; heVF 6CJ OJ QJ ^J aJ #hN; h 6CJ OJ QJ ^J aJ #hN; hz@ 6CJ OJ QJ ^J aJ #he: h0 6CJ OJ QJ ^J aJ #he: h 6CJ OJ QJ ^J aJ #he: hPUJ 6CJ OJ QJ ^J aJ #he: hi 6CJ OJ QJ ^J aJ #he: h; 6CJ OJ QJ ^J aJ #he: hz@ 6CJ OJ QJ ^J aJ #he: hwi 6CJ OJ QJ ^J aJ O P Q R ^ c d f g h t űsbbbbbbbbQbQbbQQbb hN; h>) CJ OJ QJ ^J aJ hN; h. CJ OJ QJ ^J aJ hN; h. 5CJ aJ hN; h 9 5CJ aJ &hN; h 5:CJ OJ QJ ^J aJ #hN; h 5CJ OJ QJ ^J aJ &hN; h 5>*CJ OJ QJ ^J aJ hN; hr) 5CJ aJ &hN; hr) 56CJ OJ QJ ^J aJ hN; hN; 0J j hN; hN; UhN; hN; 5 6 7 ^ { | } ͼtbbP