Park Grove Baldwin Commons Apts Lottery

Baldwin Commons Apts Lottery

785 Merrick Rd. Baldwin, NY 11510 516-757-3772 TDD 800-662-1220 BaldwinCommons@ParkGroveLLC.com www.parkgrovellc.com/baldwin-commons
Initial occupancy for these apartments will be held by lottery.

The lottery will be held April 22th, 2025 at 12 noon and will be livestreamed at: https://bit.ly/4guUqRB

Please have your application postmarked by April 8, 2025 to be eligible for the lottery.
Concatenated Name + SSN + DOB + Lottery Name
Office Only - HWs Staff Code
Applicant leave this field BLANK.
Submission Date and Time (must match the date/time stamp on the application)*

YearMonthDay
Date
Hour MinutesAM/PM Option
App entered by HWs staff

Yes
SSN Substring
DOB Substring
Head of Household (HoH) First Name*
HoH Full and Complete Middle Name
HoH Last Name(s)*
Re-Enter HoH Full Name, including your COMPLETE MIDDLE NAME*

First NameCOMPLETE Middle NameALL Last Names
HoH Phone Number*
HoH Email address
CURRENT ADDRESS - include Apt Number in Address Line 1*

Address Line 1

Street Address Line 2

CityState

Five-Digit Zip Code
How long have you resided here?*
Name of your PRESENT Landlord
Phone Number of your PRESENT Landlord
Address of your PRESENT Landlord

Address Line 1, including apartment number and care/of name if applicable

Street Address Line 2

CityState

Five-Digit Zip Code
PREVIOUS Address*

Street Address

Street Address Line 2

CityState

Five-Digit Zip Code
How long did you reside there?*
Name of your PREVIOUS Landlord
Phone Number of your PREVIOUS Landlord
Address of your PREVIOUS Landlord

Street Address including any apartment number or "care/of" name

Street Address Line 2

CityState

Five-Digit Zip Code
Number of adults (18 and over) who will move with you - include yourself!*
The number must be "1" or higher
STOP! You entered "0" for the Number of Adults in your household. But you have to include yourself as the Head of Household, so you answer CANNOT BE "0". Scroll back up the page and change your answer or you won't be able to submit this application.
Number of children (17 and under) who will move with you (enter "0" if none).*
Enter "0" if no children
Total Household Size - ALL Adults and Children including YOURSELF*
List ALL persons who will live in the apartment, Head of Household first
HoH - Full Name (copied from above)*

First NameMiddle NameLast Name
HoH - Relationship
HoH - Date of Birth*

MonthDayYear
mm-dd-yyyy
Today's Date (Used to Calculate Age)*

MonthDayYear
Date
Based on your birthdate, your age is
Does the HoH have a SSN or ITIN?*

YesNo
HoH - SSN or ITIN*
SECOND Household Member - Full Name*

First NameMiddle NameLast Name
SECOND Household Member - Relationship*
SECOND Household Member - Date of Birth*

MonthDayYear
Date
Based on birthdate, SECOND Household Member age is*
Does SECOND Household Member have a SSN or ITIN?*

YesNo
SECOND Household Member - SSN or ITIN*
THIRD Household Member - Full Name*

First NameMiddle NameLast Name
THIRD Household Member - Relationship*
THIRD Household Member - Date of Birth*

MonthDayYear
Date
Based on birthdate, THIRD Household Member age is*
Does THIRD Household Member have a SSN or ITIN?*

YesNo
THIRD Household Member - SSN or ITIN*
FOURTH Household Member - Full Name*

First NameMiddle NameLast Name
FOURTH Household Member - Relationship*
FOURTH Household Member - Date of Birth*

MonthDayYear
Date
Based on birthdate, FOURTH Household Member age is*
Does FOURTH Household Member have a SSN or ITIN?*

YesNo
FOURTH Household Member - SSN or ITIN*
FIFTH Household Member - Full Name*

First NameMiddle NameLast Name
FIFTH Household Member - Relationship*
FIFTH Household Member - Date of Birth*

MonthDayYear
Date
Based on birthdate, FIFTH Household Member age is*
Does FIFTH Household Member have a SSN or ITIN?*

YesNo
FIFTH Household Member - SSN or ITIN*
SIXTH Household Member - Full Name*

First NameMiddle NameLast Name
SIXTH Household Member - Relationship*
SIXTH Household Member - Date of Birth*

MonthDayYear
Date
Based on birthdate, SIXTH Household Member age is*
Does SIXTH Household Member have a SSN or ITIN?*

YesNo
SIXTH Household Member - SSN or ITIN*
Does anyone live with you now who is not listed above?*

YesNo
Explain if you answered Yes

INCOME INFORMATION

	HEAD of HOUSEHOLD - GROSS MONTHLY AMOUNT DON'T INCLUDE PENNIES!	CO-HEAD - GROSS MONTHLY AMOUNT - DON'T INCLUDE PENNIES!
Wages (1)
Wages (2)
Unemployment
Social Security
Public Assistance
Pensions/Annuities
Disability/SSI
Child Support/Alimony
Other

Total YEARLY income for this Household. Round to the nearest dollar.*
Please STOP and LOOK AGAIN at the Total YEARLY income for this Household you just entered.

If you really make that much income, you probably won't be eligible for this Lottery.

If you made a mistake, please CORRECT your income immediately.

Type like this: 54000

Not like this: 54000.34

ASSET INFORMATION

	HEAD of HOUSEHOLD - TOTAL VALUE	CO-HEAD - TOTAL VALUE
Savings Account
Checking Account(s)
Certificates of Deposits (CDs)
Stocks & Bonds
Real Property
Cash (safe deposit box, etc)
Any Other Asset 1
Any Other Asset 2
Any Other Asset 3

Would any household member benefit from the special features of an accessible apartment? Check all that apply:

Wheelchair AccessibleHearing ImpairedVision Impaired
Important Documents

(Clicking each link will open the document in a new window)

· HCR Notice of Occupancy Rights Under the Violence Against Women Act

· HCR New Anti-Discrimination Guidance Affecting People with Criminal Histories

· Right to Reasonable Accommodations (available upon request from Riley Brook office):

716-344-9636 TDD 800-421-1220 RileyBrook@parkgroveLLC.com
Check both boxes! "I am aware of my right to the following, and acknowledge receipt of, electronic or paper copies of the above listed documents." (available in the links above)*

HCR Notice of Occupancy Rights Under the Violence Against Women ActHCR New Anti-Discrimination Guidance Affecting People with Criminal Histories
Check Reasonable Accommodation Box*

I am aware of my right to request a reasonable accommodation or modification as an individual with disabilities under the Americans with Disabilities Act, and I acknowledge receipt of an electronic or paper copy (available in the links above).
We do not require an application fee to apply.

I consent to allow the Landlord/Owners through its agents and employees to obtain and verify my information, and criminal history, and investigate consumer reports, employment, income, and landlord references, for major lease violations only, including determining whether or not to lease me an apartment.

I understand that should I lease an apartment, the landlord shall have a continuing right to review those items. I also affirm that all the information in this application is true and accurate. I understand that I am only allowed one application for my household. I understand that if any such information proves false, it will be deemed an event of default under any such lease and the Landlord/Owners may cancel and annul any lease given in reliance upon such information as allowed by law.

EQUAL HOUSING OPPORTUNITY
ACCESSIBLE
SMOKE-FREE
Signature of Head of Household (the person who completed this application)*

Clear
Signature of co-head or any HH member 18 and older.

Clear
Applicants, press the Submit button above now!

If you see the following error message, click the words "See Errors". This will jump you to any questions that still need an answer.

Once you push the Submit Button, you won't be able to change any of your answers - so it is a good idea to click the tabs at the top of this application, and review all your answers before you press Submit.
Staff Remarks
AMI Category*

30% AMI ELI50% AMI VLI60% AMI80% AMI Low120% AMI Mid
Rent Categories*

30% AMI Fixed Rent50% AMI Fixed Rent60% AMI Fixed Rent
Desired Bedroom Size - We will select this for you*

1BRBoth 1BR and 2BR2BRBoth 2BR and 3BR3BR
Check if you need one of these types of Accessibility

Wheelchair AccessibleHearing ImpairedVision Impaired
Possible Waitlist Assignments

1BR 30% AMI1BR 30% AMI M and V1BR 50% Fixed Rent Minimum Income1BR 50% Fixed Rent Minimum Income M H V1BR 60% Fixed Rent2BR 50% Fixed Rent Minimum Income2BR 50% Fixed Rent Minimum Income M H V2BR 60% Fixed Rent2BR 60% Fixed Rent M H V3BR 50% Fixed Rent Minimum Income3BR 50% Fixed Rent Minimum Income M H V3BR 60% Fixed Rent Minimum Income3BR 60% Fixed Rent Minimum Income M H V
Status

Accepted into LotteryAccepted into Lottery but may be IneligibleApplication was incomplete or illegible
Latest Outcome

Accepted into LotteryApplicant did not complete parts of application - must re-applyApplication contained Illegible or Conflicting ResponsesApplicant requested Reasonable Accommodation - extra BR medicalDuplicate App to treat as UpdateNo units appear to match your household size
Additional Notes

We don't have the size of unit you requested.We don't have the type of unit you requested.You failed to Date or Sign the application (or both).You did not provide required information on the additional HH members.You did not provide your household's TOTAL, ANNUAL Income.
History and Notes
Should be Empty: