Wheatland Investments Group

The Estates of Lawrence

Low Income Housing Tax Credit Program

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Applicant Information

Date

Bedroom Size (1st choice)

Bedroom Size (2nd choice)

Full Name *

Social Security Number

Date of Birth

Email Address

Current Address

City

State

ZIP

Daytime Phone

Evening Phone

Household Members

List all persons who will live in the unit

Household Members

Questionnaire

Will any event in the last 7 years affect the credit of any household member (collections, judgments, liens, etc.)?

YesNo

If yes, please explain

Do you have a pet?

YesNo

Pet Breed

Pet Weight

Pet Type

Do you expect any additions to the household?

YesNo

If yes, please explain

Do you have full physical custody of any children?

YesNo

If yes, please explain

Has any member of the household filed for bankruptcy in the past 7 years?

YesNo

If yes, please explain

Has any member of the household ever been convicted of a felony?

YesNo

If yes, please explain

Has any member of the household ever been evicted from housing?

YesNo

If yes, please explain

Residence History

List previous addresses (last 3 years)

Previous Addresses

Personal Reference

Name

Relationship

Address

Phone

Years Known

Vehicles

Emergency Contact

Name

Relationship

Phone

Address

Annual Income Information

Income Details

Add a row for each income source checked above

Does any household member have ZERO income?

YesNo

If yes, which household member(s)?

Asset Information

Asset Details

Add a row for each asset category checked above

Student Information

Is any member of the household a full-time student?

YesNo

If yes: does the student file a joint tax return?

YesNo

If yes: is the student receiving AFDC / TANF assistance?

YesNo

If yes: is the student enrolled in a JTPA or similar program?

YesNo

If yes: is the student a single parent?

YesNo

If yes: is the student living with a non-student spouse?

YesNo

If living with a non-student spouse, who?

Live-in Care Attendant

Does any household member require a live-in care attendant?

YesNo

Attendant Name

Attendant Relationship

Housing Assistance

Does any household member currently receive Section 8 assistance?

YesNo

Agency Name

Agency Contact

Has any household member applied for Section 8 in the future?

YesNo

If yes, please explain

Agency Name (future application)

Signatures & Certification

The undersigned certify that all information provided is true and complete. Any misrepresentation may result in denial or termination of tenancy.

Applicant Signature

Sign here

Date

Co-Applicant Signature (if applicable)

Sign here

Date