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Application for Occupancy
John Paul Apartments

Welcome to Assumption Community! We ask that you fill out this application for occupancy, sign and date as


How did you hear about John Paul Apartments?

FAMILY COMPOSITION: Please list all household members who will live in the unit:

Unit Type

Can be obtained by calling the Senior Linkage Link 1.800.333.2433 option one, must complete survey prior to lease signing.

CITIZENSHIP: Are you a US Citizen?

If no, do you have eligible alien status?


If yes, what branch?

INCOME: List all income for household members.  Include full and part-time employment earnings, welfare, SSI, Social Security, pensions, disability compensations, child care earnings, alimony, child support, annuities, income from rental property, earned income tax credits, Armed Forces Reserves income, scholarships and/or grants, net income from operation of business, contributions from family, etc.

Certification of Assets Disposed of for Less Than Fair Market Value

I, or any family member,                                         dispose of one or more assets, worth more than $1,000, for less than fair market value during the 24 months preceding my annual recertification date.

If asset(s) were disposed of for less than fair market value, describe below:


ASSETS: Enter the amount or value of the asset, the current interest or dividend received, and the name and address of the bank or financial institution where the account is located.



Int Rate/Div

Bank/Financial Inst. Name & Address


Do you receive VA or Medicare benefits?

Do you receive Medical Assitance?

Additional medical insurance?

Are you paying off outstanding medical bills?

Prescription drug costs?

Any other reoccurring medical expenses?

Do you have any additional out of pocket expenses for attendant care or special apparatus for a disabled or handicapped household member that is necessary for a household member to be employed?

Please list any information on places you have rented in the past 5 years:


Have you, or any members of your household, ever lived in any financially assisted housing?

Have you, or any members of your household, ever committed fraud in a federally assisted housing program, or been requested to repay money for knowingly misrepresenting information to such housing programs?

Have you, or any members of your household, ever been evicted from a rental dwelling?

Have you, or any members of your household, ever been convicted of a misdemeanor or felony offense?

Are you or any member of your household, currently subject to a lifetime sex offender registration Requirement?

Please list all the states you have lived in:

Do you currently use illegal drugs or abuse alcohol?

Do you now, or have you ever used any aliases?

Are you currently homeless or being forced to move?

Do you consider the condition of your current housing to be Substandard?

REASONABLE ACCOMMODATION REQUEST:  If you are disabled, please request any reasonable accommodations you wish to be made that may help you access or use John Paul Apartment's housing programs or services.


I/We certify that the information given to John Paul Apartments on household composition, income, net family assets, allowable expenses, and background is accurate and complete to the best of my/our knowledge and belief.  I/We understand that false statements or information are punishable under federal law.  I/We also understand that false statements of information are grounds for rejection of the application, termination of housing assistance, and termination of tenancy.

This is a preliminary application and is not binding.  You will be notified as soon as possible about the availability of an apartment.  You will need to attend a personal interview, provide verification of age, citizenship status, income, assets, and medical allowances before eligibility can be determined.

Reference checks are made and John Paul Apartments reserves the right to reject applicants solely on negative references.  Rent is determined annually on a percentage of your anticipated annual income and medical allowances as defined by the HUD Section 9 projects.  Telephone is not included in the rent.  Electricity costs are included in the form of utility allowance.  Meal program and Cable TV costs are separate charges payable with rent each month.

200 8th Ave North

Cold Spring, MN 56320

Release for Credit and Background

I/We authorize John Paul Apartments to use information disclosed on Application for Tenancy, to complete an investigation of all information provided within my application for tenancy.  I have personally filled in or reviewed all information within the application for tenancy.  A complete investigation of the application will include a Credit report, Criminal record search, Rental history report, Identity trace, sex offender search, terrorism search, check-writing history, and personal interviews with the provided references.  The source of information might come from but is not limited to credit bureaus, bank, and other depository institutions: current and former employers, federal and state records including state employment Security Agency records, County or state criminal records as follows, or other sources as required.  It is understood that the photocopy of Fax copy of this form will qualify as authorization.  I/We understand that I have the right to make a written request to have this information provided by this report.

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