• NORTHWEST MINNESOTA MULTI-COUNTY HRA
    205 Garfield Ave | PO Box 128 | Mentor, MN 56736
    Phone: 218-637-2431 | Fax: 218-637-2433

     

    APPLICATION FOR HOUSING AND REDEVELOPMENT AUTHORITY  DEVELOPMENT

    Complete this application if you are interested in one or more of the following units listed below that are owned by the HRA. Check the boxes next to the properties you are interested in. 
    NOTE: These units are not income based; however, Section 8 Vouchers are accepted.

  • Select the properties you would like to apply for:*
  • Fosston Homes - Select your bedroom option*
  • Cottage Apartments - Select your bedroom option*
  • McIntosh Homes - Select your bedroom option*
  • River Road Apartments - Select your bedroom option*

  • HEAD OF HOUSEHOLD

  • Do you have a middle name?*
  • Sex:*
  • Married:*
  • Do you receive mail at this address?*
  • Do you have a phone number we can reach you at?*
  • Format: (000) 000-0000.
  • Do you have an email address we can reach you at?*
  • Would you like a contact person in case we are unable to reach you?*

  • FAMILY COMPOSITION

  • Do you have additional family members to add to the application that will live in the household?*

  • Family Member #1 Information

  • Does this family member have a middle name?*
  • Sex:*
  • Married:*

  • Family Member #2 Information

  • Does this family member have a middle name?*
  • Sex:*
  • Married:*

  • Family Member #3 Information

  • Does this family member have a middle name?*
  • Sex:*
  • Married:*

  • Family Member #4 Information

  • Does this family member have a middle name?*
  • Sex:*
  • Married:*

  • INCOME FOR ALL HOUSEHOLD MEMBERS

    List ALL wages from employment, unemployment, Social Security, SSI, MSA, GA, MFIP,VA, Child Support, Pensions, Self-Employment, and any other monies received.

  • Sources of income include, but are not limited to:

    • Employment (including wages, salaries, overtime, tips, bonuses, commissions)
    • Public Assistance
      • Minnesota Family Investment Program (MFIP) / Cash Assistance (CA)
      • Minnesota Supplemental Aid (MSA)
      • Diversionary Work Program (DWP)
      • General Assistance (GA)
      • Housing Grant (HG)
    • Child Support
    • Social Security (including for minor children)
    • Supplemental Social Security/SSI (including income for minor children)
    • RSDI
    • Veteran's Composition
    • Self-Employment Income OR Cash received for Odd Jobs
    • Unemployment OR Severance Pay
    • Alimony OR Spousal Maintenance
    • Regular payments from Pension (PERA, Railroad, etc.)
    • Regular payments from Annuities, Life Inheritance, Insurance Settlement, Lottery Winning, etc.
    • Regular Monetary Assistance from Others (rent, utilities, insurance, phone, gas, tobacco, etc.)
    • Any other monies received on a regular basis
  • Does anyone in your household have any of the income listed above?*
  • Frequency of this income*
  • Is there another source of income that you need to add?*
  • Frequency of this income*
  • Frequency of this income*

  • BACKGROUND INFORMATION

  • Do you expect changes in the number of persons in your household?*
  • Does anyone in the household require a reasonable accommodation?*
  • Have you ever received rental assistance from another agency?*
  • Have you ever been given a move-out notice by a landlord?*
  • Is anyone in the household a registered sex offender?*
  • Has any household member been involved in ANY illegal activity in the last 5 years?*

  • APPLICANTS STATEMENT

  • 1. This application is taken and subject to the approval of the owner.

    2. Before approval to occupy the unit, I authorize the owners to:

    a. Complete a credit check on the applicant and any adult household members 18 years and older.

    b. Complete a criminal background check on the applicant and any adult household members 18 years and older.

    c. Complete reference checks on the applicant and any adult household memebrs 18 years and older

    3. I/We certify that the information given to the Northwest Minnesota Multi-County HRA in this application is accurate and complete to the best of my/our knowledge and belief. If I/We falsify information on my/our application, it will be denied.

    4. I/We understand the lease is made on the strength of this application and may be terminated at any time, at the owner's option, if any information herein is false.

     

  • Date*
     / /
  • All adult household members 18 years and older must sign the application. Do you have additional adult members that need to sign?*
  • Date*
     / /
  • Date*
     / /
  • Submission Date
     / /
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