Wait List Application HUD

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
Lewiston Villa
930 Upper Mountain Road
Lewiston NY 14092
24 One Bedroom Apartments
Lewiston Meadows
922 Upper Mountain Road
Lewiston NY 14092
24 One Bedroom Apartments

To Qualify You Must

· Be 62 years of age or older

· Meet the income qualifications listed below.

· Meet Screening Criteria Listed In Tenant Selection Plan (available upon request or found on our website)

Income Level	1 Person	2 Persons	3 Persons
Extremely Low	$32,500	$37,150	$41,800

Priority is given to those applicants with Extremely Low income.

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

I am acknowledging I have read NY Know Your Rights Justice Involvement Policy

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

I am acknowledging I have read 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

Please complete all Request Information, place N/A for anything that does not apply.
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:
----------------------------------------------------------------------------------------

If yes, please provide pet information. If you don't have a pet, put N/A*

	Species	Name	Color
Vehicle

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

	Information
Applicant Name
Mailing address
Address line#2
Telephone No.
Name of Additional Contact Person or Organization
Address
Address#2
Telegraph No
Email Adress
Relationship to Applicant

How did you hear about us?*

Online SearchDepartment of Social ServicesReferral by friend or familyPaper AdvertisementCity or TownshipOther

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 & Lewiston Villa & Lewiston Meadows 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.
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Wait List Application