THE STUDIOS AT HOTEL BERRY

Application Instructions

Dear Applicant, Thank you for your interest in applying for housing at The Studios at Hotel Berry. Please complete the attached application and return to us at either of the following addresses:

The Shasta Hotel 1017 10th Street Sacramento, CA 95814

Sacramento Housing and Redevelopment Agency 801 12th Street Sacramento, CA 95814

Applications will be reviewed for income eligibility. Applications that do not meet the minimum income or exceed the maximum income qualifications will not be processed. Each person may only submit one application. Applications may be mailed or hand delivered. Applicants must meet the following eligibility criteria: Monthly income must be a minimum of two times the monthly rent. (Minimum income requirements do not apply to Section 8 Voucher Holders. Income and Rents subject to change.) The maximum occupancy is one (1) person. All Applicants are subject to the Resident Selection Policy including credit and criminal background checks and third party income and asset verification to determine the occupants combined annual income in accordance with the Housing Tax Credit Program. Thank you again for your interest in The Studios at Hotel Berry and we look forward to receiving your application.

Number of Units 10 Studio Units (MHSA Restricted) 1 Studio Unit 11 Studio Units 70 Studio Units 12 Studio Units

% of Area Median Income 20% 30% 35% 40% 45%

Maximum Income $10,660 $15,990 $18,655 $21,320 $23,985

Rents as of 01/01/2012 $249 $399 $466 $533 $599

For more information, please call 916 448 7510. Sincerely,

THE JOHN STEWART COMPANY

TDD Telephone device for the deaf only California Relay Service (711)

DO NOT DUPLICATE

ONE APPLICATION PER HOUSEHOLD ONLY The Studios at Hotel Berry

729 L Street, Sacramento, CA 95814 APPLICATION FOR ADMISSION
The Studios at Hotel Berry will comply with the provisions of any federal, state or local law prohibiting discrimination in housing on the basis of race, color, creed, ancestry, national origin, sex, sexual orientation, familial status, source of income, age, disability, AIDS, or AIDS relation condition. TDD Telephone device for the deaf only - California Relay Service (711). Please fill in all blanks. Incomplete applications will not be processed. APPLICANT NAME: DATE OF BIRTH: SOCIAL SECURITY #:

CURRENT ADDRESS: CITY, STATE, ZIP CODE: HOME PHONE #: CELL PHONE #: FAX #: E-MAIL: ________________________________ WORK #: OTHER#:

APT. #:

OTHER WORK #:

INDICATE TWO PEOPLE WHO GENERALLY KNOW HOW TO CONTACT YOU: 1. NAME: ______________________________________ 2. NAME: ____________________________________ ADDRESS: ___________________________________ ADDRESS: ___________________________________ PHONE #:____________________________________ PHONE #:____________________________________

DO YOU OWN A CAR? _______ PORTIONS OF THIS COMMUNITY ARE NON-SMOKING Smoking is prohibited in the common area on floor one (1) and the studio units on floors two (2), three (3) and four (4). Smoking is allowed inside the studio units on floors five (5) and (6), but prohibited in common areas and hallways on these floors. Are you a smoker? YES _______ NO ________ CURRENT HOUSING STATUS How many people live in your home now?

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Have you had your residency/tenancy terminated for fraud, non-payment of rent or failure to comply with lease provisions? ____ YES ____ NO. If YES, please explain

Have you been convicted of a felony? ____ YES ____ NO. If YES, please list the disposition behind each incident:

Do you have any family members or friends who currently work at this property? YES. _____ If YES, name of employee: ___________________________________________ NO. _____ Do you have a section 8 voucher or certificate? Yes No Expiration Date:

Please list at least two (2) years of rental history below.

1. CURRENT LANDLORD: PHONE #: FAX #: WHAT IS YOUR CURRENT RENT? ____________ LANDLORD'S ADDRESS: ___________________________________________________________ DATE OF MOVE-IN: YOUR ADDRESS/APT. #: 2. PREVIOUS LANDLORD: PHONE #: RENT AMOUNT: $__________________ LANDLORD'S ADDRESS: DATE OF MOVE-IN: YOUR ADDRESS/APT. #: INCOME INFORMATION Do you now receive or expect to receive income from any of the following sources? For each YES answer, provide the details in the chart below: Income
I am self-employed. (List nature of self employment) YES YES NO NO I have a job and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer 1)____________________________________________________________________ 2)____________________________________________________________________ I receive cash contributions of gifts including rent or utility payments, on an ongoing basis from persons not living with me. $_________________ $_________________

FAX #:

DATE OF MOVE-OUT:

Monthly Gross Income

(use net income from business) $_________________

YES

NO

$_________________

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I receive unemployment benefits. YES YES YES NO I receive Veterans Administration, GI Bill, or National Guard/Military benefits/income. NO I receive periodic social security payments. NO I receive unearned income from Trust Fund disbursements, etc. YES YES NO I receive Supplemental Security Income (SSI). NO I receive disability or death benefits other than Social Security. YES NO I receive Public Assistance Income YES YES YES NO I receive alimony/spousal support payments NO I receive periodic payments from trusts, annuities, inheritance, retirement funds, NO pensions, insurance policies, or lottery winnings. If yes, list sources 1)__________________________________________________________________ 2)__________________________________________________________________ I receive income from real or personal property. YES YES NO I receive student financial aid (public or private, not including student loans). NO 1)____________________________________________________________________ 2)____________________________________________________________________ $__________________ $__________________ (use net earned income) $__________________ $__________________ $_________________ $_________________ $_________________ $_________________

$_________________

$_________________

$_________________

$_________________ $_________________

TOTAL HOUSEHOLD MONTHLY INCOME TOTAL ANNUAL INCOME (TOTAL MONTHLY INCOME x 12)
Asset Information Interest Rate
I have a checking account(s). YES NO If yes, list bank(s) 1)________________________________________________ 2)________________________________________________ 3)________________________________________________ _______% _______% _______%

$__________________ $__________________

Cash Value

$____________ $____________ $____________

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I have a savings account(s) YES NO If yes, list bank(s) 1)_________________________________________________ 2)_________________________________________________ I have a revocable trust(s) YES NO If yes, list bank(s) 1)_______________________________ I own real estate. YES NO If yes, provide description: _____________________________________________ I own stocks, bonds, or Treasury Bills YES NO If yes, list sources/bank names 1)_______________________________ 2)_______________________________ 3)_______________________________ I have Certificates of Deposit (CD) or Money Market Account(s). YES NO If yes, list sources/bank names 1)________________________________________________ 2)________________________________________________ 3)________________________________________________ I have an IRA/Lump Sum Pension/Keogh Account/401K. YES NO If yes, list bank(s) 1)_________________________________________________ 2)_________________________________________________ I have a whole life insurance policy. YES YES YES NO NO NO I have disposed of assets (i.e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed: 1)_________________________________________ 2)_________________________________________ I have income from assets or sources other than those listed YES NO above. If yes, list type below: 1)_________________________________________ 2)_________________________________________ _______% _______% $_____________ $_____________ $_____________ $_____________ If yes, how many policies __________ I have cash on hand. $_____________ $_____________ _______% _______% $____________ $____________ _______% _______% _______% $____________ $____________ $____________ ______% ______% ______% $____________ $____________ $____________ $____________ _______% $_____________ _______% _______% $_____________ $_____________

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Student Status Yes No

Are you a full-time students ( Examples: College/University, trade school, etc.)? Do you anticipate becoming a full-time student household in the next 12 months?

PLEASE CONSIDER COMPLETING THIS OPTIONAL SECTION: Do you require special unit design features for mobility impairment? Do you require special unit design features for visual impairment? Do you require special unit design features for hearing impairment? Yes_____ Yes_____ Yes_____ No______ No______ No______

APPLICANT CERTIFICATIONS 1. 2. 3. 4. 5. I certify that if selected to move into this project, the unit I occupy will be my primary residence. I certify that the statements made in this application are true and complete to the best of my knowledge and belief. I understand that false statements or information are punishable under federal law and cause for immediate denial of housing. I understand we must provide written notification of any changes to the information on this form, especially income, address and telephone number. I understand that the above information is being collected to determine my/our eligibility for an apartment. I authorize the owner to verify all information provided on this application and to contact previous or current landlords, employers, or other sources for credit and verification information which may be released by appropriate federal, state, local agencies, or private persons to the owner/management. I agree to allow management to perform a consumer credit check and criminal background check including sex offender registry. (I may request copies of these documents.) This will be required prior to an application being processed. Housing is subject to availability. Rents are subject to change.

6.

7. 8.

NAME (PLEASE PRINT): SIGNATURE: DATE:

*How did you hear about our apartment community? ____Newspaper ____Flyer

____Word of mouth

____Other (please state) _____________________________________________________ Thank you.

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