River Terrace Apartments (Keokuk) Application
Head of House (First, Middle, Last)
Present Address
Email Address
Phone Number
Ethnicity/Race
Do you own this home?
Do you pay lot rent?
Gender
Male
Female
Are you a student?
Yes
No
If you are a student:
Full time (12 credit hours or more)
Part time (less than 12 credit hours)
Do you have a pet?
Yes
No
If you have a pet, what type and how many?
FULL NAME OF OTHER ADULT TO LIVE IN THE HOUSEHOLD:
If not a U.S. Citizen, what Nationality?
Have you or any household member lived in any other state than Iowa?
No
Yes
If "yes," please list which states
RENTAL EXPERIENCE OF HOME OWNERSHIP
1) PRESENT LANDLORD (Name of Complex)
Phone or Fax
Landlord's Address
Date of Occupancy: From (M/Y) to (M/Y)
Date Lease Expires
2) Your 2nd previous address
PREVIOUS 2nd LANDLORD (Name of Complex)
2nd Landlord's Address
2nd Date of Occupancy: From (M/Y) to (M/Y)
2nd Date Lease Expires
3) Your 3rd previous address
PREVIOUS 3rd LANDLORD (Name of Complex)
3rd Landlord's Address
3rd Date of Occupancy: From (M/Y) to (M/Y)
INCOME INFORMATION
A. Income from employment for head of household (Gross earnings, commissions, fees, tips, estimated overtime income from self-employment)
$ Week/Month/Year
Employer (Company name)
Employer Address
Co-Applicant/Spouse/Other Employed Household Member
$ Week/Month/Year
Employer (Company name)
Employer Address
B. INCOME FROM OTHER SOURCES (Public aid, unemployment, insurance benefits, military, child support, etc.)
Additional Source of income
Who receives it
Source of income
Who receives it
Amount $ Week/Month
C. SOCIAL SECURITY & OTHER PENSION
Gross Monthly Social Security Benefit $
Other Pension Income: Agency
Amount $ /Month
2nd Pension Income: Agency
2nd Amount $ /Month
Have you or any member of your family disposed of any assets for less than fair market value during the previous two (2) years?
Yes
No
If yes, please explain
Are you asking for a Handicap Preference?
Yes
No
Mobility accessible?
Yes
No
Have you or any member of your current household ever been convicted of a crime, placed on probation/parole, is there a current warrant for any member's arrest?
Yes
No
If yes, please explain
Are you or any member of your current household involved in any illegal activities?
Yes
No
If yes, please explain
Do you or any member of your current household use or sell any illegal drugs?
Yes
No
If yes, please explain
Have you or any member of your current household ever been evicted or refused to pay rent or has your application been denied by another landlord?
Yes
No
If yes, please explain
Are you or any member of your household subject to a lifetime sex offender registration requirement in any state?
Yes
No
ASSET INFORMATION
Bank/Credit Union name
Bank Address
Checking account
Yes
No
Current checking account balance
Is your current checking account joint, convenience only, or no?
Savings account
Yes
No
Current savings account balance
Is your current savings account joint, convenience only, or no?
CD's account
Yes
No
Current CD's account balance
Is your current CD's account joint, convenience only, or no?
IRA account
Yes
No
Current IRA's account balance
Is your current IRA's account joint, convenience only, or no?
Other account
Yes
No
Current other account balance
OTHER (Stocks, bonds, rental property, real estate, etc.)
Description of Asset
Source to contact for verification
Address
Estimated value $
Annual Income from Asset $
ALLOWANCE INFORMATION - Elderly/Handicapped Households Only:
Name of Health Insurance Company(s)
Name of life Insurance Company(s)
Name of Physician(s)
Name of Pharmacy(s)
- I understand that no water-filled furniture will be allowed in the apartments.
- I understand that this application is only to obtain preliminary information and does not constitute any agreement between the Owner/Management Agent and myself until a lease is signed.
- I hereby state that no one in my household is a current user of a controlled substance and that no one in my household has ever been convicted of the illegal manufacture or distribution of a controlled substance.
- I hereby authorize the Owner/Management Agent to conduct such credit and past history investigations as may be necessary to qualify me for an apartment and rent subsidy.
Date
Applicant (1)
Applicant (2)
EQUAL HOUSING OPPORTUNITY
We do not discriminate against persons because of race, color, religion, sex of the applicant or tenant, familial status, Creed, handicap, age, national origin, sexual orientation or gender identity. We do not discriminate on the basis of disability status in the admission or access to, or treatment, or employment in federally assisted programs and activities, except as permitted by HUD regulations.
I have read and understand this sheet. Today's Date:
Type Applicant(s) Name to Record as a Signature
Type Applicant(s) Name to Record as a Signature
Please Note: A photo ID and SSN are required and will need to be provided prior to processing the application. DO NOT TYPE YOUR SOCIAL SECURITY NUMBER ON THIS FORM DOCUMENT. The building's office will follow up with you for your social security number and ID information at another point after reviewing your application before approval.
Applicant’s signature on this application authorizes management to check applicant’ references including:
- Credit report
- Criminal report
- Income verification
- Employment and/or student verification
- Landlords or Program participation
- County courthouse records for Small Claims filed and housing judgments Law enforcement with jurisdiction over previous addresses
- Others as deemed pertinent from application
Federal Fair Housing Act Title VIII Section 804 [42 U.S.C.3604] (f) (6) (9), State Iowa Code Chapter 216.20b, Iowa’s anti-discrimination law, and City of Cedar Rapids Municipal Ordinance Chapter 69.16(b)6F do not affect: “Tenancy of an individual that would constitute a direct threat to the health or safety of other individuals or tenancy that would result in substantial physical damage to the property of others.”
Be advised that management will not:
1. Rent to persons who lie on their applications
2. Continue tenancy with persons who management later learns lied
3. Rent to applicants with or whose family includes persons with recent convictions for felonies and
aggravated misdemeanors including illegal drug and alcohol related crimes and sex offenses
4. Continue tenancy with persons who are currently convicted for a felony or aggravated misdemeanor
violations
5. Rent to, or continue to tenancy, with persons who entertain guests with recent convictions for
felonies and aggravated misdemeanors
6. Rent to persons with a history/habit of poor credit
7. Continue tenancy with persons who disregard provisions of the rental agreement
8. Continue tenancy with persons who cause property damage/disturbances
Management considers convictions for felonies and aggravated misdemeanors such as this list unacceptable behavior/activity/involvement for tenants of this property:
- Assault/personal injury/domestic violence
- Prostitution/known sex offenders
- Criminal mischief/vandalism/property damage/arson/trespass
- Drug use/drug abuse/drug trafficking/drug manufacturing
- Child molestation/endangerment/neglect
- Breaking and entering/theft/burglary/robbery/possession stolen property Illegal possession/use/discharge of firearms/gun Stalking/kidnapping/rape/sexual abuse
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