SCRPC 2025 Apartment Application

Schoharie County Rural Preservation Corp

Apartment Application
Dear Applicant:

Thank you for your interest in becoming a resident of Parsonage Pines Apartments of Schoharie or Spring Meadow Apartments of Sharon Springs. Applications may be submitted in person or by mail to Schoharie County Housing Development Fund, Inc., P O Box 168, 597 East Main Street, Cobleskill, NY 12043.

INSTRUCTIONS: Please read carefully. An incomplete application will not be processed.

• You will receive a confirmation after your application is received. You will be contacted when a vacancy becomes available. Please note it is not our policy to disclose to applicants their specific positions on the waiting list.

• If your household is over-income, or otherwise unqualified, your application will be denied. You will receive written instructions on the informal review process.

• It is the applicant's responsibility to notify management of address or telephone number changes. If we are unable to contact you, your application will be removed from the waiting list.

All applicants are subject to the following Resident Selection Criteria:

The head-of-household must be disabled or at least 62 years old or older, and meet the income guidelines.

Landlord/Personal Character Reference: Management will verify residency through references provided and with current and prior landlords. We are specifically looking at payment history, incidents of damage and/or housekeeping issues, lease violations and eviction proceedings. If a negative landlord reference is received, applicant will not be accepted.

Criminal & Sex Offender Screening: An applicant convicted of producing methamphetamine in their home will be denied admission.

An applicant legally required to be a lifetime registrant on the state sex offender registry will be denied admission.

Eligibility for an applicant with a criminal history will be determined by the following:

• Only crimes for which the applicant had been convicted and recent pending arrests may be considered

• Only offenses that involved physical danger or violence to persons or property or that adversely affected the health, safety and welfare of other people may be considered.

• Convictions that have been excused by pardon, overturned on appeal or otherwise vacated may not be considered.

Admission to the program shall not be denied on the basis that the applicant is or has been a victim of domestic violence, dating violence, or stalking, if the applicant otherwise qualifies for assistance or admission.

If you require assistance in completing this application, please contact our office.
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TENANT APPLICATION

PLEASE PROVIDE ALL INFORMATION REQUESTED AND RETURN TO

Schoharie County Rural Preservation Corporation

597 East Main Street PO Box 168 Cobleskill, NY 12043
Indicate Property(s) you are Applying For Apartment:*
Name, Head of Household*
Email*
example@example.com
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Friend or Relative's Telephone *
Please enter a valid phone number.
Type a question
Are you and all members of your household a citizen or national of the U.S.
Type YES or NO
If No, are you and all members of your household non-citizens with eligible immigration status?

STARTING WITH THE HEAD OF YOUR HOUSEHOLD, LIST THE FOLLOWING INFORMATION FOR EVERYONE LIVING IN YOUR HOUSING UNIT USING THEIR LEGAL NAMES.
1. Last Name, First Name, Middle*
Smith, John T.
1. DOB*
1. Social Security #*
1. Household Member*
2. Last Name, First Name, Middle
2. DOB
2. Social Security #
2. Household Member
3. Last Name, First Name, Middle
3. DOB
3. Social Security #
3. Household Member
4. Last Name, First Name, Middle
4. DOB
4. Social Security #
4. Household Member
5. Last Name, First Name, M.
5. DOB
5. Social Security Number
5. Household Member
6. Last Name, First Name, Middle
6. DOB
6. Social Security Number
6. Household Member
7. Last Name, First Name, Initial
7. DOB
7. Social Security Number
7. Household Member

INCOME INFORMATION

List all household income information for all family members 18 or older, including income received on behalf of household members under the age of 18. Add any new income sources in the spaces provided below. Income is any of the following types listed below. Should you have income that is not listed, please provide any and all information.

Wages/Salaries - Worker's Compensation - Unemployment Benefits - Alimony Payments - Periodic Gifts - Self Employment - Social Security Benefits - Retirement Payments - Child Support - Food Stamps - Welfare Benefits - SSI - Disability Benefits Military Pay - Financial Aid Assistance

Income Information *

Rows	Household Member (Name)	Income Type	Monthly Income $	Source Address	Address
1
2
3
4
5
6
7
8
9
10

Did you file a Federal Income Tax Return last year? *
Does anyone living outside your household pay any of your bills?*
Do you or any household member own or have an interest in any real estate, boat, and/or mobile home?
Have you sold any real estate in the last 2 years?*
State Yes or No and if Yes state the address.
Do you own any stocks or bonds*
State Yes or No and and if yes, state the names of the stocks.
Do you own a car?*
State Yes or No and if Yes state the Make Model and Age.

ASSET INFORMATION

List household assets held by any family member, irrespective of age, in the space provided below. An asset is any one of the following types, without limitation:

401(k) or 403(b) - Pensions - Stocks - Money Market Account - Checking Account Bonds - Mutual Funds - Savings Account - Inheritances - Life Insurance Policies Individual Retirement Accounts (IRA) - Trust Funds - Real Property (land) - Certificate of Deposit

Asset Information*

Rows	Type of Acct	Account No.	Current Balance	Account Status Open/Closed	Source Name and Address
Account Holder #1
Account Holder #2
Account Holder #3
Account Holder #4
Account Holder #5

Additional Information about Assets if Necessary
Has any member of the family given away or disposed of assets valued at more than $1,000 for less than fair market value during the past two years? *
Add details if Yes (Above) to disposed of
Applicants/tenants must also disclose any assets disposed of for less than fair market value in the two years preceding the effective date of the certification or recertification.
Did you have any assets in the last two years not listed above? *
If yes, did you dispose of any assets for less than market value? (This means that the assets were either given away or sold at less than the allotted market value.)*
(This means that the assets were either given away or sold at less than the allotted market value.) If YES, What where the Assets, Market Value, Amount Received and date disposed of. Answer YES/NO
Any assets listed as disposed of for less than fair market value in the two years preceding the effective date of the certification recertification will be counted as assets. If the difference between the value and the amount disposed of is $1.00 or less, this would not be counted.

PLEASE ANSWER THE FOLLOWING QUESTIONS:
1. Are you 62 years or older? *
1a. If no, are you applying due to disability?*
2. Do any household members require a fully accessible unit due to disability? *
2a. Check any that apply*

MobilityHearingVisual
3. Do any household members require a unit with special features or modifications due to disability? *
3a. If you answered yes, please explain the special features below:
4. Does anyone in the household receive any regular contributions or gifts from non-household members? YES/NO*
5. Are you or any member of your household a current illegal user of a controlled substance or has a previous conviction. Yes/No If Yes explain below.*
6. Have you or anyone in your household ever been convicted of the illegal manufacture or distribution of a controlled substance? Yes/No If Yes, explain below.*
7. Have you or any member of your household been convicted of a Felony? YES/NO.If yes, please state the conviction charge, year of conviction, and Town/City/State of conviction: *
8. Are you legally required to be a lifetime registrant on the state sex offender registry? *
If you answered yes to questions 6 & 7, have you or anyone in your household successfully completed a controlled substance abuse recovery program or currently enrolled in such a program? If yes, provide documentation with the application. *

MEDICAL EXPENSES (Attach an additional sheet if necessary)

LIST ANY OF THE FOLLOWING EXPENSES PAID DURING THE PAST 12 MONTHS NOT COVERED BY INSURANCE, MEDICARE, OR MEDICAID:*

Rows	Type of Insurance	Premium Amt.	Name of Company	Address of Company
Household Member
Household Member
Household Member
Household Member
Household Member

Prescriptions*

Rows	Prescription Name	Prescription Amount	Name of Pharmacy	Address of Pharmacy
Household Member
Household Member
Household Member
Household Member

REFERENCES

Please provide two references below: Can be current landlord, family friend, employer, etc. (no relatives).*

Rows	Name	City State and Zip	Connection to applicant
References
References

I hereby make this application for an apartment and certify that the information contained in this application is correct. I have disclosed all income received and assets owned. I authorize you to contact any reference that I have listed. I also certify that the unit applied for will be my permanent residence and I will not maintain a separate subsidized rental unit in a different location.
Applicant Signature*

Clear
Co-Applicant Signature

Clear
Date of signature (Applicant)*

MonthDayYear
Date
Date of signature (Co-Applicant)

MonthDayYear
Date

"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 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, ethnicity, and sex of individual applicants on the basis of visual observation or surname".
Minority Code:

American Indian/Alaskan NativeAsianBlack or African AmericanWhiteNative Hawaiian or Pacific IslanderOther
Ethnicity Code:

Hispanic/LatinoNon-Hispanic/Latino
"This is an Equal Opportunity Program. Discrimination is prohibited by federal laws. Complaints of discrimination may be filed with the USDA, Director, Office of Civil Rights, Rm. 326-W, Whitten Building, 14th and Independence Ave., SW, Washington, DC 20250-9410, or call (202) 720-5946 (voice and TDD),"
AUTHORIZATION FOR RELEASE OF INFORMATION

CONSENT

I authorize and direct any federal, State, or local agency, organization, business, or individual to release to and verify my application for housing/or other grant/loan program assistance through Schoharie County Rural Preservation Corporation (SCRPC). I understand and agree that this authorization or the information obtained with its use may be given to and used by Schoharie County Rural Preservation Corporation in administering and enforcing program rules and policies.

INFORMATION COVERED

I understand that, depending on program policies and requirements, previous or current information regarding my household or me may be needed. Verifications and inquiries that may be requested include but are not limited to:

Employment, Income and Assets

Credit and Criminal Activity

Residences and Rental Activity

GROUP OR INDIVIDUAL THAT MAY BE ASKED

The groups or individuals that may be asked to release the above information (depending on program requirements) includes; but not limited to:

Previous Landlords (including Public Housing Agencies)

Support and Alimony Providers

Past and Present Employers

Medical and Childcare Providers

Welfare Agencies

Veterans Administration

Courts and Post Offices

Retirement Systems

State Unemployment Agencies

Banks and other Financial institutions

Schools and Colleges

Utility Companies

Social Security Administration

Credit Providers and Credit Bureaus

Law Enforcement Agencies

CONDITIONS

I agree that a photocopy of this authorization may be used for the purposes stated above. The original of this authorization is on file with the SCRPC and will stay in effect for a year and one month from the date signed, I understand I have a right to review my file and correct any information that I can prove is incorrect.

Signatures
Head of Household Signature*

Clear
Head of Household Signature Date*

MonthDayYear
Date
1. Family Member Signature (over 18)

Clear
1. Date Signed

MonthDayYear
Date
2. Family Member Signature (over 18)

Clear
2. Date Signed

MonthDayYear
Date
3. Family Member Signature (over 18)

Clear
3. Date Signed

MonthDayYear
Date
4. Family Member Signature (over 18)

Clear
4. Date Signed

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Schoharie County Rural Preservation Corp