Online Application Form

Please fill in all of the information below then click the 'Submit' button on the bottom.
Any questions please Click Here

If you would prefer to print out an application and deliver it to us, Click Here

NOTE: Before filling out one of the forms, you will need to view the USDA Rural Rental Housing information form. Click Here to view it.

You Must fill in all information that applies to you.

Town Preference:

List all persons who will occupy the apartment
Last Name: First Name: M.I. Date of Birth: Age:
1.
2.
3.
4.

Present Address:
How Long: Home Phone Number:
Landlord's Name:Phone Number:
Landlord's Address:

List all sources of income to the household:
Applicant's Income Source(s):
Estimated Annual Income: $
Co-Applicant's Income Source(s):
Estimated Annual Income: $

Income from assets: $
(Please complete asset statement further down below)
Total Gross Income: $
Deductions-Child Care Expenses: $/year. Medical Expenses After Insurance: $/year
Have you ever been convicted of a felony or any drug charges?
Yes
No
If so, explain below:

Are you a smoker?
Yes
No

I/We certify this apartment will be my/our permanent residence.
I/We do not maintain a seperate subsidized rental unit in a different location.
I/We posess capacity to enter into a legal contract.
I/We certify that the above information is true and complete to the best of my/our knowledge.
I/We authorize inquireies to be made to verify the statements above.


Date: Electronic Signature (Your name):
Date: Electronic Signature (Your name):

If you are less then 62 years old, are you eligible for occupancy based on your status as an individual with handicaps or disabilities?
Yes
No
Do you wish to have priority for an apartment with special design features for persons with diabilities (if available at this complex)?
Yes
No
Do you wish to claim a $400.00 deduction from your income based on a disabling condition?
Yes
No

The information regarding race, national origin, and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service that the Federal laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin, religion, sex, familial status, age and disability are comlied with. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity, and sex of individual applicants on the basis of visual observation or surname.
Ethnicity: Race: Gender:
Hispanic or Latino White Male
Not Hispanic or Latino Black or African American Female
Am. Indian/Alaska Native
Asian
Native Hawaiian or Other Pac. Islander

IF THIS SECTION IS NOT COMPLETED-THE APPLICATION WILL NOT BE REVIEWED
Current Landlord:
Name:
Address: City:
Home Phone: Work Phone:

Previous Landlord:
Name:
Address: City:
Home Phone: Work Phone:

Personal Non-Related References:
Name:
Address: City:
Home Phone: Work Phone:

Name:
Address: City:
Home Phone: Work Phone:

Assets Statement

Assets
A.
Net Case Value
B.
Annual Income
1. Real Estate Owned:

Description-house, farm, # of acres, etc.
  A. Gross value minus selling cost
  B. Actual verified income
$ $
2. Contract Held or other notes receivable:
  A. Unpaid Balance
  B. Interest portion of payments
$ $
3. Bonds:
  A. Actual cash value today
  B. Interest earned each year
$ $
4. Stocks:
  A. Cash Value
  B. Actual verified income including dividends
$ $
5. IRA's and other retirement accounts
  A. Current balance
  B. Interest earned each year
$ $
6. Money Market Accounts & CD's
  A. Current Balance
  B. Actual interest earnings
$
$
$
$
7. Cash on hand
  A. Amount currently on hand
  B. Value
$ $
8. Checking account
  A. Current balance
  B. Interest earnings
$
$
$
$
9. Savings account
  A. Current balance
  B. Interest earnings
$ $
10. Cash value life insurance
  A. Current balance
  B. Actual verified income including dividends
$ $
11. Revocable trusts
  A. Current balance/value
  B. Actual verified income
$ $
12. Business assets where tenant is NOT
actively engaged in business:
  A. Gross value minus debts or expenses
selling costs
  B. Actual verified income
$ $
13. Business or houshold assets disposed of in the past two (2) years:
  A. Market value minus sales price expenses
$
14. All other: $ $

I/We certify that all assets, income producing or otherwise, except for necessary items of personal property such as furniture and automobiles, are listed above. I/We understand that this informaiton is necessary for computing our income.

Tenant's Electronic Signature
(Your name)
Co-Tenant's Electronic Signature
(co-tenant name)
Date

*Assets are valued at "NET Cash Value" to impute income. Therefore, you are allowed to deduct selling expenses, etc., even if you do not plan to sell in order to arrive at a cash basis.


I/we understand that KarTay Apartment Management must verify all information prior to housing and thtat its staff may contact any agencies, offices, groups, or organizations to obtain any information or materials which it deems necessary to complete my/our application.

Electronic signature of applicant(s):
Date:
Email Address: