Hud Application For Housing Template Page 3
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96. Is there a live-in aide who will be residing with you in the unit? Yes
No
If yes, please provide name.
__________________________________________________________________________________________________________
7. How did you hear about this housing opportunity?
8. Do you have any animals? Yes
No
If yes, please list:
_________________________________________________________________________________________________________
9. Do you own a car? Yes
No
If yes, please list:
________________________________________________________________________________________
10. Are you an U.S. military veteran? Yes
No
Which Branch? Air Force
Army
Coast Guard
Marines
Navy
Part III. Housing References – Please list current and previous landlords for the last five years.
Address of Present Residence:
Present Landlord Name:
Landlord Telephone:
Fax:
(
)
(
)
Present Landlord Mailing Address:
City, State:
Zip Code:
Monthly rent:
# of bedrooms:
Is your rent subsidized?
Rent
Own
$
1 2 3 4 5
YES
NO
How long have you lived at this address?
Reason for wanting to move?
________Years ________Months
Is there anyone living with you now that will not be moving with you to this property? YES
NO
If yes, who? And why?
If you have lived at your current address less than five years, what was your previous address?
Previous Address:
Name of previous Landlord:
Landlord Telephone:
Fax:
(
)
(
)
Previous Landlord Mailing Address:
City, State:
Zip Code:
Monthly rent:
How long have you lived at this address?
Reason for moving?
$
________Years ________Months
If you lived in the above two housing situations for less that 5 years, where did you live?
Previous Address:
Name of previous Landlord:
Landlord Telephone:
Fax:
(
)
(
)
Previous Landlord Mailing Address:
City, State:
Zip Code:
Monthly rent:
How long have you lived at this address?
Reason for moving?
$
_______Years ________Months
List all states in which you and all adult household numbers have lived since the age of 18:
______________________________________________________________________
Page 2 of 5
v. 04/2015
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