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Apply for The Village
The Village Apartments, Monmouth. The same questions as the paper application, one part at a time.
Grand Management Services, Inc.
Signature pages
Signature Clause
I/We hereby certify that this apartment will be my/our permanent residence and I/we will not maintain a Separate subsidized rental unit in a different location. I/We agree to the landlord’s representative the authority to investigate and obtain my/our credit rating, current and previous rental history, personal references, criminal background, current/past utility records, income verifications, and any other information necessary to determine my/our eligibility for this housing. My/our signature below certifies that the statements made on this application are true and correct and gives management consent to verify the information provided in this application. I/we understand that if it is determined that I/we have provided false information, I/we may be denied occupancy or may be evicted after occupancy. I/we understand that due to changes in circumstances, additional information may be requested at a later date to complete the processing of this application.
Authorization for Release of Information
Consent. I authorize and direct any federal, state, or local agency, or any organization, business, or individual to release to Grand Management Services any information or materials needed to complete and verify my application for participation, and/or to maintain my continued assistance under one of the following programs: 1. USDA Rural Housing Services RRH, RCH, LH programs Section 515 Assistance Programs 2. Section 221 (d)(3) BMIR 3. Rent Supplement 4. Section 8 Housing Assistance 5. All Section 8 Housing Assistance Payment Programs Rent Assistance Payments (RAP) 6. Section 236 7. Oregon Housing and Community Services programs 8. LIHTC programs
I give my consent for the releases also for the minor children in my care, who live with me. I understand and agree that this authorization or the information obtained with its use may be given to and used by the Oregon Housing and Community Services (OHCS) agency or the U.S. Department of Housing and Urban Development (HUD) or USDA Rural Development in administering and enforcing program rules and policies.
Information covered. I understand that, depending on program policies and requirements, previous or current information regarding me or my household may be needed. Verifications and inquires that may be released, include but are not limited to: 1. Identity 2. Employment 3. Credit History 4. Social Security #’s 5. Medical Expenses 6. Income sources 7. Criminal background 8. Utility Consumption data 9. Child Care Expenses 10. Income Amounts 11. Residences and Rental Activity 12. Assets
Groups or individuals that may be asked. The groups or individuals that may be asked to release the above information (depending on program requirements) include but are not limited to: 1. Previous Landlords 2. Welfare Agencies 3. Medical Providers 4. Retirement Systems 5. Post Offices 6. State Unemployment Agencies 7. Support and Alimony Providers 8. Child Care Providers 9. Banks & Other Financial Institutions 10. Credit Providers and Credit Bureaus 11. Schools and Colleges 12. Utility Companies 13. Past & Present Employers 14. Veteran’s Administration 15. Public Housing Agencies 16. Social Security Admin
Computer matching notice and consent. I understand and agree that OHCS or HUD or RD or a Public Housing Authority (PHA) may conduct computer matching programs to verify the information supplied for my certification or recertification. If a computer match is done, I understand that I have a right to notification of any adverse information found and a chance to disprove incorrect information. OHCS or HUD or the PHA may in the course of its duties exchange such automated information with other Federal, State, or local agencies, including but not limited to: State Employment Security Agencies; Department of Defense; Office of Personnel Management; the U.S. Postal Service; the Social Security Agency; and State welfare and food stamp agencies.
Conditions. I agree that a photocopy of this authorization may be used for the purposes stated above. The original of this authorization is on file with the management office and will stay in effect for a year and one month from the date signed. I understand I have a right to review my file and correct any information that I can prove is incorrect.
Supplement to Application for Federally Assisted Housing (Form HUD-92006 (05/09))
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the issues or in providing any services or special care to you.
Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the applicant or applicable law.
Bring or mail these pages to Grand Management Services, Inc., 375 Park Ave, Suite 1, Coos Bay, OR 97420. Questions: 541-269-5561, TTY 711.