Certificate of Deposit (CD’s)
Other-Property, Homes, Etc
In the spaces provided below, please complete the information requested for either a relative or friend whom we many contact in the event we are unable to reach you:
The following question pertain to yourself and every member of your household who will occupy the unit.
I/We understand the information in this application will be used to determine eligibility for Section 8 housing assistance and that this information will be verified. I/We understand that any false information may make me/us ineligible for a unit. I/We certify that all information given in this application is true, complete and accurate. I/We understand that if any of this information is false, misleading or incomplete, management may decline my/our application or, if move-in has occurred, terminate my/our lease agreement. I/We understand that any action (s) by myself/ourselves or my/our household members, whether verbal or non-verbal, that harass, intimidate, threaten or are perceived by management to harass, intimidate or threaten the health or safety of the management stall or interfere with the management of the property is grounds for management to decline my/our application for housing. I/We authorized management to make any and all inquiries to verify this information, directly or through information exchanged now or later with rental and credit screening services, and to contact previous and current landlords or other sources for credit and verification information which may bereleased to appropriate Federal, state or local agencies. If my/our application is approved, and move-in occurs, I/We certify that only those persons listed in this for whom I/we have, or expect to have, responsibility to provide housing. I/We agree to notify management in writing regarding any changes in household address, telephone number, income and household composition. My/Our signature (s), as indicated below, acknowledge that I/We have read and completed each section of this rental application, as applicable.
PENALTIES FOR MISUISING THIS CONSENT: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States government, HUD, the PHA and any owner (or any employee of HUD the PHA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willfully requests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information responsible for the unauthorized disclosure or improper use.Penalty provisions for misusing the social security numbers are contained in the Social Security Act at 42 U.S.C 208(f), (g) and (h). Violations of these provisions are cited as violations of 42 U.S.C 408 (f),(g), and (h).