Hud Application For Housing Template Page 5
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9Assets – include checking and savings accounts, equity in real property, stocks, bonds, and other forms of
capital investment. Do not include automobiles or furniture. If you have no assets, write “none” in the space.
Checking Account – Name of Bank
Savings account – Name of Bank
Address:
Address:
Account Number:
Account Number:
Cash Value /Balance:
Cash Value /Balance:
$
$
Other Account – Name of Bank
Other Account – Name of Bank
Address:
Address:
Account Number:
Account Number:
Cash Value /Balance:
Cash Value /Balance:
$
$
401K/403B/IRA
Other Account – Name of Bank
Address:
Address:
Account Number:
Account Number:
Cash Value /Balance:
Cash Value /Balance:
$
$
Stocks and Bonds Value:
Savings Bond Value:
$
$
Do you own Real Estate or Real Property? If yes, where? What is the current value?
Yes
No
Have you ever owned Real Estate or Real Property? If yes, when? Where? When Sold? How Much?
Yes
No
Have you or any adult member of your household disposed of any assets within the last 2 years for less than fair market
value? Yes
No
If yes, what was disposed and for how much?
__________________________________________________________________________________________________________
Part V. Program Information
1.Do you require a unit with accessible features for persons with disabilities? Yes
No
If yes, what features:
____ Mobility Impairment
_____ Visual Impairment
_____ Hearing Impairment
______ Other
2. Do you require a reasonable accommodation due to a disability that requires changes to our rules, policies, procedure or physical
modification(s) to the dwelling unit or common areas? Yes
No
If yes, please describe your needs:
__________________________________________________________________________________________________________
3. Do you currently hold a Section 8 voucher? Yes
No
If so from what county?
__________________________________________________________________________________________________________
Page 4 of 5
v. 04/2015
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