Wilson Villa Wait List Application

Wilson Villa
Completed Applications to be sent to Management Agent;
Sage Management Corporation of Western New York
916 Upper Mountain Road, Lewiston, NY 14092
Phone: 716-298-4966 Fax: 716-298-4489
www.sagemanagementcorp.com
Wilson Villa Building A
240 Autumnview Drive
Wilson NY 14172
12 One Bedroom Apartments
Wilson Villa Building B
240 Autumnview Drive
Wilson NY 14172
12 Two Bedroom Apartments

To Qualify You Must

· Meet Screening Criteria Listed In Tenant Selection Plan. (Found Here)

· Meet the income qualifications listed below.

Income Level	1 Person	2 Persons	3 Persons
Very Low	$21,250	$24,250	$27,300
Low	$35,350	$40,400	$45,450

Priority is given to those applicants with very low income.

Income Levels Updated: April 1 2025

Please check below to acknowledge you have read the above.*

I am acknowledging I have read Things you should know USDA Rural Rental Housing Page 1.

Please check below to acknowledge you have read the above.*

I am acknowledging I have read Things you should know USDA Rural Rental Housing page 2.

Please check below to acknowledge you have read the above.*

I am acknowledging I have read the NY Know Your Rights Justice Involvement.

Please check below to acknowledge you have read the above.*

I am acknowledging I have read the NY Know Your Rights Credit Policy.

Head Of Household
Name*

First NameLast Name
Social Security #*
Date Of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Driver's License /State ID #
State Issued
Race*
Gender*
Ethnicity*
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Please List All Other Household Memebers
If you have more than one person in the household. You must provide all their infomation for the application to be complete. Press the arrow on the right side to drop down the required infomation. If you do not have any other household members, select Next on the bottom of the page. If you do not have the infomation, you can save the application and complete at a later date.

Co-Head
Name

First NameLast Name
Social Security #
Date Of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Race
Gender
Ethnicity
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Household Member #3
Name

First NameLast Name
Social Security #
Date Of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Race
Gender
Ethnicity
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Household Member #4
Name

First NameLast Name
Social Security #
Date Of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Race
Gender
Ethnicity
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.

Household Member #5
Name

First NameLast Name
Social Security #
Date Of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Race
Gender
Ethnicity
The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government, acting through the Rural Housing Service, that the Federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. You are not required to furnish this information but are encouraged to do so.

This information will not be used in evaluation of your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity and sex of individual applicants on the basis of visual observation or surname.
Name:   First Name   Last Name
Date of Birth:   Date Of Birth
Social Security No:   SSN#
Phone:   Area Code   Phone Number
Email:   Email
Address:    Street Address   Address Line 2   City   State   Zip
License Information:     License #   State
Race:
Gender:
Ethnicity:
----------------------------------------------------------------------------------------
Name:   First Name   Last Name
Date of Birth:   Date Of Birth
Social Security No:   SSN#
Phone:   Area Code   Phone Number
Email:   Email
Address:    Street Address   Address Line 2   City   State   Zip
License Information:     License #   State
Race:
Gender:
Ethnicity:
----------------------------------------------------------------------------------------
Name:   First Name   Last Name
Date of Birth:   Date Of Birth
Social Security No:   SSN#
Phone:   Area Code   Phone Number
Email:   Email
Address:    Street Address   Address Line 2   City   State   Zip
License Information:     License #   State
Race:
Gender:
Ethnicity:
----------------------------------------------------------------------------------------
Name:   First Name   Last Name
Date of Birth:   Date Of Birth
Social Security No:   SSN#
Phone:   Area Code   Phone Number
Email:   Email
Address:    Street Address   Address Line 2   City   State   Zip
License Information:     License #   State
Race:
Gender:
Ethnicity:
----------------------------------------------------------------------------------------

Other Household Information
Do you Have a Pet?*

YesNo

If yes, please provide pet information*

	Species	Weight	Color
Animal

If yes, please provide documentation of any required licenses and required shots.

Cancelof
Do you have a vehicle?*

YesNo

If yes, please provide vehicle information.*

	Year	Make	Model	Color	License Plate #	State Issued
Vehicle

RELEASE OF INFORMATION AUTHORIZATION
I do hereby authorize Sage Management and any authorized representative to contact any agencies, offices, groups or organizations to obtain and verify any information or materials which are deemed necessary to complete my application for housing. This could include police/background checks and credit checks.
Head Of Household*
Date*

MonthDayYear
Date
Signature*

Clear
Sage Management Corporation of Western New York & Wilson Villa do not discriminate on the basis of race. color, religion, sex, national origin, age, marital status, disability, handicap, sexual orientation, gender identity, or familial status.
Should be Empty:

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Wilson Villa

Wilson Villa Wait List Application

Special Unit Questionnarie

Head Of Household

Please List All Other Household Memebers

Other Household Information

Income

Assets

Declaration of No Assets

Medical Expenses

Justice Involvement Check

Landlord Reference

CERTIFICATION

RELEASE OF INFORMATION AUTHORIZATION

	Name	Asset Type	Cash Value
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