Pre-Application Form (LIHTC)

Cameron Senior Patio Homes is an affordable senior independent living community intended and operated for occupancy by persons ages 55 and older. It is subject to income and other regulatory restrictions. All interested persons who are in need of affordable housing are encouraged to apply.

All information must be entered in all blanks for pre-application to be complete. Incomplete preapplications will be returned and will not be added to the waiting list. Only one pre-application per household will be accepted; additional applications will be denied

Head of Household Contact Information
Mailing Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Email
Alternate Contact Name
First Last
Alternate Contact Phone
Please Select From the Following
- Single
- Married
- Divorced
- Widowed
- Never Married
Household Members
Full Legal Name
Relationship
Date of Birth
MM slash DD slash YYYY
Full Time Student
Full Legal Name
Relationship
Date of Birth
MM slash DD slash YYYY
Full Time Student
Full Legal Name
Relationship
Date of Birth
MM slash DD slash YYYY
Full Time Student
Full Legal Name
Relationship
Date of Birth
MM slash DD slash YYYY
Full Time Student
All Household Income Sources & Assets
Include income for all personals to occupy the residence. Types of income include wages, social security, pensions, alimony, self-employment, unemployment, VA benefits, etc.
Income Source
Gross Monthly
Income Source
Gross Monthly
Income Source
Gross Monthly
Include assets for all personals to occupy the residence. Types of assets include checking account, savings account, IRA, CD, bonds, stocks, money market account, trust funds, life insurance policy, etc
Account Holder
Type of Asset Account
Current Value
Interest Rate and/or Income
Account Holder
Type of Asset Account
Current Value
Interest Rate and/or Income
Account Holder
Type of Asset Account
Current Value
Interest Rate and/or Income
Account Holder
Type of Asset Account
Current Value
Interest Rate and/or Income
Questionnaire
When are you available to move in to Cameron Senior Patio Homes?
Does anyone in the household require barrier free, hearing or visually impaired accommodations?
If yes, what is requested?
Do you have any rental assistance (i.e. tenant/housing voucher, etc)?
Does anyone in the household require a live-in aid?
Within the past 2 years, has anyone in the household sold or given away assets for more than $1,000 below fair market value (including cash, real estate, etc)?
If yes, please explain:
Has anyone in the household ever been evicted?
I/We hereby certify that the answers and information provided in this pre-application are true, correct, and accurate to the best of my/our knowledge. I/We understand that any misrepresentation or false information given will result in my/our application being cancelled or denied. I/We understand that at the time of my/our eligibility interview and full application submission, I/We will be required to provide verification of the information I/We have provided on this pre-application
I/We hereby certify that the answers and information provided in this pre-application are true, correct, and accurate to the best of my/our knowledge. I/We understand that any misrepresentation or false information given will result in my/our application being cancelled or denied. I/We understand that at the time of my/our eligibility interview and full application submission, I/We will be required to provide verification of the information I/We have provided on this pre-application
- Agree
Applicant Signature
Date
Co-Applicant Signature
Date

Pre-Application Form (LIHTC)

Head of Household Contact Information

Household Members

All Household Income Sources & Assets

Questionnaire