Malden Housing Application 2024

MHA Pre-Application
Dear Applicant, We are happy that you are interested in renting a unit at Malden Housing Authority. Please read all carefully before completing application.

The following items must be provided once your application has been approved:

1. Birth certificates & Social Security cards of all household members.

2. Photo ID of anyone 18 or older.

3. Income verification from all sources on ALL family members in household.

4. Divorce decree stating child support amounts or provide case number.
You will be asked to sign a release to validate information in the following areas:

1. Employment, self-employment, or any other source of income.

2. Bank statements and tax forms.

3. Current and previous landlords.

4. Criminal history on all applicants age 15 years and older.

5. Character references.

6. Child care expenses.

7. Medical expenses: pharmacy co-pays, or health insurance.

NOTE:

Submission of this application does not obligate you to the Malden Housing Authority in any way. This application must be submitted with all information required in order for you to be placed on the waiting list. All blanks must be filled in. If any information doesn't apply to you, write "N/A". You are placed on the waiting list upon satisfactory completion of validation and reviews by the date and time the completed application and required documents are received.

Application rejection will occur if application is found to be fraudulent in any way.

WE ARE A NO SMOKING FACILITY. NO SMOKING IS ALLOWED IN THE UNITS.
At the time of a unit offer, you must provide the following:

1. Security Deposits are as follows: Elderly/Disabled $100.00. All others $150.00. Pet Deposit $200.00. Pet Policies are available at our office. ALL deposits must be paid in full! NO EXCEPTIONS!

2. An estimated date of unit availability will be provided by the office. Within three (3) days of the date of unit availability, you will need to provide: proof of utilities through Board of Public Works (electric/water/sewer) 573- 276-2238; their deposit is $185.00. Liberty Utilities Gas Co 855-872- 3242, their deposit is determined at the time you call them. These must be in the head of household's name. We recommend that you verify with Board of Public Works and Liberty Utilities Gas that you do not owe a past bill and if you do, pay it as soon as possible to avoid delays in moving in.

3. Rent amount (will be pro-rated at move-in date).

Please make sure that your mailing address and phone number are current with our office. We will update our wait list and send offers by mail and if you do not reply as requested your name will be dropped from the wait list.

4. Application rejection will occur if application is found to be fraudulent in any way.

5. We are a no smoking facility. NO SMOKING ALLOWED INSIDE THE UNITS.
Once you are approved, you will receive a notice of eligilibility from our office.

Please fill out the name and information requested below of each person who will reside in the unit. Please provide First Name, Last Name, and MIDDLE INITIAL.

Rows	Name (First, MI, Last)	Relationship	Birth Date	Sex	SSN	Disabled	Student	US Citizen
1.
2.
3.
4.
5.
6.

Does anyone above request a handicapped accessible unit?
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Has anyone listed above been evicted?
Has anyone listed above ever been convicted of a crime? If yes, list year and crime:
Do you have any pets? Please request pet policy for restrictions on pets allowed.
List any maiden or previous married last names.
References

List names, complete addresses, and phone numbers of 2 people, NOT related to you, who can attest to your character.
Name of Reference (NOT related to you)
Email of Reference
example@example.com
Phone of Reference
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Second Reference (NOT related to you)
Phone of Second Reference
Format: (000) 000-0000.
Email of Second Reference
example@example.com
Address of Reference

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List names, complete addresses, and phone numbers of 2 people, related to you, who can attest to your character.
Name
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Income

For each person who will occupy the home, fill in GROSS amount of income.
Employment Income (provide proof of all income)
Head of Household's Employer

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer's Email
example@example.com
Start Date

MonthDayYear
Date
Hourly Wage
Average hours worked per week
Other Adult's Employer

First NameLast Name
Address of Employer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Employer
Please enter a valid phone number.Format: (000) 000-0000.
Email of Employer
example@example.com
Start Date

MonthDayYear
Date
Hourly Wage
Average hours worked per week

Non Employment Income

Rows	Head of Household	Other Adult
Child Support
Child Support Case #
Alimony
SS/SSI
Pension
Unemployment
School Grants/Loans
Other

Please list any assets (real estate, checking/savings accounts, stocks/bonds/CDS) and the value and account numbers of each.
Expenses
Monthly Child care expenses.
Medical Expenses not paid by Insurance
Previous Residence
Landlord Name

First NameLast Name
Date Move In

MonthDayYear
Date
Date Move Out

MonthDayYear
Date
YOUR Address at time of Residency

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landlord's CURRENT Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Landlord's Email
example@example.com
Landlord Name

First NameLast Name
Date Move In

MonthDayYear
Date
Date Move Out

MonthDayYear
Date
Address at time of Residency

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landlord Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landlord's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Landlord's Email
example@example.com
Please check if you have ever lived in any of the following. Select all that apply.

Other
Please list PHA name or Section 8 landlord if you checked any boxes above.
Everything that I have stated in this application is true and correct to the best of my
knowledge. I understand that false statements are grounds for denial or termination of
assistance. I understand that the Housing Authority will only retain this application and all
copied support documentation as required by HUD. You are authorized to obtain information
from present and former landlords and employers to ask questions about their experience
with me. You are further authorized in the future to share information about my tenancy
with prospective landlords.
I understand that this is not a contract and does not bind either party. The above information
is full, true, and complete to the best of my knowledge. I have no objections to the above
statements being verified.
Signature of Head of Household
Signature of Other Adult
Statistical Information
The information regarding races, national origin, and sex designation solicited on thisapplication is requested in order to assure the Federal Government that Federal Lawsprohibiting discrimination against tenant applicants on the basis of race, color, nationalorigin, religion, sex, familial status, age, and disability are complied with. You are notrequired to furnish this information, but you are encouraged to do so. This information willnot be used in evaluating 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/nationalorigin and sex of an individual on the basis of visual observation or surname.
Statistical Information
The information regarding races, national origin, and sex designation solicited on this application is requested in order to assure the Federal Government that Federal Laws prohibiting discrimination against tenant applicants 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 you are encouraged to do so. This information will not be used in evaluating 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/national origin and sex of an individual on the basis of visual observation or surname.

BLANKET AUTHORIZATION for RELEASE OF INFORMATION

I hereby authorize and direct any Federal, State, or local agency, organization, business, or individual to furnish information concerning myself, and/or my household to Malden Housing Authority and/or a duly authorized representative of Malden Housing Authority. This information will be used to determine occupancy eligibility and the rent amount of federally subsidized housing.
I am aware that this form may be used to collect sensitive information, which is protected by the Privacy Act. This information will not be disclosed or released outside of Malden Housing Authority except to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators and prosecutors.
The groups or individuals that may be asked to release information include but are not limited to:
• Law Enforcement Agencies/Criminal History
• Credit Providers & Credit Bureau
• Previous Landlords (including Public Housing Agencies)
• Past and Present Employers
• State Unemployment Agencies
• Medical Professionals & Facilities
• Child Care Providers
• Retirement & Investment Services
• Banks and other Financial Institutions
• Courts and Post Offices
• Schools and Colleges
• Child Support & Alimony Providers
• Welfare Agencies
• Social Security Administration
• Veterans Administration
• Utility Companies

I agree that a photographic or FAX copy of this authorization may be deemed to be the equivalent of the original and may be used as a duplicate original. The original of this authorization is on file with Malden Housing Authority and will stay in effect for fifteen months from the date signed.
If I or any adult members of my household fail to sign this authorization, I understand that this action may constitute grounds for denial of eligibility or termination of assistance or tenancy, or both. I understand that I have the right to review my file and correct any information that I can prove is incorrect.
Signature
Once pre-application is submitted additional HUD documents must be signed to officially complete.
Should be Empty:

MHA Pre-Application

References

Income

Previous Residence

BLANKET AUTHORIZATION for RELEASE OF INFORMATION