Nyc Housing Development Corporation Application For Apartment Page 7
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8E. Current Landlord
Landlord Name
Landlord Address
Landlord Phone #
(If you live in public housing project, enter “NYCHA.” If you
live in a city-owned/In Rem building enter “HPD.”)
What is the total rent on the apartment where
monthly
you currently live or are temporarily staying?
How much do you contribute to the total rent
of the apartment? If nothing, write “0.”
monthly
F. Source of Information
How did you hear about this development? Please check all that apply:
City “affordable housing hotline”
Newspaper
Local organization or church
Friend
Sign posted on property
Community Board
Elected Representative
Other:
G. Ethnic Identification
This information is optional and will not affect the processing of the application. Please check the group(s) that best
identifies the household:
White (non-Hispanic origin)
Black
Hispanic origin
Asian or Pacific Islander
American Indian/Native Alaskan
Other:
H. Signature (Required)
I (WE) DECLARE THAT STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND
COMPLETE TO THE BEST OF MY (OUR) KNOWLEDGE. I (We) have not withheld, falsified, or otherwise
misrepresented any information. I (We) fully understand that any and all information I (we) provide during this
application process is subject to review by The New York City Department of Investigation (DOI), a fully
empowered law enforcement agency which investigates potential fraud in City-sponsored programs.
I (we)
understand that consequences for providing false or knowingly incomplete information in an attempt to qualify for
this program may include the disqualification of my (our) application, the termination of my (our) lease (if discovery
is made after the fact), and referral to the appropriate authorities for potential criminal prosecution.
I (WE) DECLARE THAT NEITHER I (WE), NOR ANY MEMBER OF MY (OUR) IMMEDIATE FAMILY, ARE
EMPLOYED BY THE BUILDING OWNER OR ITS PRINCIPALS.
Signature:
Date:
Signature:
Date:
Plover Apartments Application Page 7 of 8
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