Trinity Tower Housing Application Form
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8TRINITY TOWER OF BUFFALO, INC.
33 LINWOOD AVENUE
BUFFALO, NEW YORK 14209
(716) 882 -4348
Please Print
APPL ICANT
Name:
Social Security #
Address:
Apt.
Cit y:
State:
Zip:
Phone
Are you 62 years of age or older?
CURRENT LANDLORD
Phone:
Address:
Cit y:
State:
Zip:
From:
to
Present Monthly Rent or Mortgage Payment:
Approximate cost of all Utilities paid (per month):
FORMER LANDLORD
Phone:
Address:
Cit y:
State:
Zip:
From:
to
Monthly Rent :
Approximate cost of all Utilities paid (per month):
Yes
No
DO YOU HAVE A SE CTION 8 VOUCHER OR CERTIFICATE?
Do you own a pet?
If so, what?
(Dog, Cat, Bird, etc.)
Date desired to move in?
FAMILY OR HOUSE HOLD COMPOSITION
List all persons in your Household who will be living with you.
Full Name
Relationship
Social Security Number
62 yr or over?
1.
2.
IN C OM E : L I S T A L L I NC OME SO UR CE S. T H IS I NC L U DE S B U T I S NO T L IMI T E D T O F UL L OR P AR T
TI ME E MP LO YME N T , SOC IA L SE C UR I TY , P E N SI O N, S SI , DI SA BI LI T Y, AR ME D FOR CE S R E SE R V E S ,
U NE MP LOY ME N T CO MP E N SA T IO N, E TC .
S O UR C E O F I N CO M E
GR OS S HO US E HOL D
ME M BE R
(I NC L U DE NA ME A N D AD DR E S S)
IN C OM E/ YE AR
(I F M OR E S P A C E IS NE ED ED , US E A DD IT IO NAL S H EE TS O F P AP E R)
(OV E R)
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