Author: Lisa Riley

SOLDOTNA AREA SENIOR CITIZENS, INC.
197 West Park Avenue
Soldotna, AK 99669
(907) 262-2322

SOLDOTNA SENIOR INDEPENDENT HOUSING RENTAL APPLICATION
In compliance with the Federal definition of “Housing for Older Persons” Sec. 807, [42 U.S.C. 3607] Implemented at 24 CFR 100.300-308, the Soldotna Senior Independent Hosing is intended for, and solely occupied by, persons 62 years of age or older.
I certify that I am age 62 years of age or over and making application to reside at Soldotna Senor Independent Housing at 144 N. Fireweed in Soldotna, AK, which will be my primary residence.
Incomplete or falsified information will result in the rejection of this application for housing. You must update the information if it changes and at renewal of lease. If this application is approved, tenant(s) must make the security deposit, rental payment and sign the lease before the tenancy begins.
Soldotna Area Senior Citizens, Inc., Senior Independent Housing (Landlord) complies with all Federal and State laws regarding discrimination and does not discriminate based upon age, sex, race, marital status, religion, financial status, national origin or other prohibited classifications.
Note: No pets are allowed. No smoking inside or within 20 feet of housing unit.
Unit has six 2-bedroom units and two 1-bedroom units.
Rental rates are based on market value: $825 for 1 bedroom (784 sq.ft.), $950 for 2-bedroom (973 sq.ft.). Resident pays for electricity, phone and cable.
Security deposit is $825 for 1-bedroom and $950 for 2-bedroom.
Refrigerator, stove, dishwasher, clothes washer and dryer are installed.
Applicant Information (1st person to reside in housing unit):
Name:_______________________________________________________________________
Social Security Number:___________________ Date of Birth:_______________ Sex:________
Current Address _____________________________City_______________ State___ Zip______
Telephone #______________________ Emergency # ______________ _____U.S. Citizen Y or N
Cell #___________________ Fax #____________ Email Address________________________

Person to notify in case of emergency: ______________________________ Phone # ________________________
Have you been convicted of a felony? N or Y If yes, when? _____________________________________________
(Also, if you answered yes, you may be asked to provide details)
Co-applicant Information (2nd person to reside in housing unit):
Name:_______________________________________________________________________
Social Security Number:___________________ Date of Birth:_______________ Sex:________
Current Address _____________________________City_______________ State___ Zip______
Telephone #______________________ Emergency # ______________ _____U.S. Citizen Y or N
Cell #___________________ Fax #____________ Email Address________________________
Person to notify in case of emergency: ______________________________ Phone # ________________________
Have you been convicted of a felony? N or Y If yes, when? _____________________________________________
(Also, if you answered yes, you may be asked to provide details)
Co-applicant Information (3rd person to reside in housing unit):
Name:_______________________________________________________________________
Social Security Number:___________________ Date of Birth:_______________ Sex:________
Current Address _____________________________City_______________ State___ Zip______
Telephone #______________________ Emergency # ______________ _____U.S. Citizen Y or N
Cell #___________________ Fax #____________ Email Address________________________
Person to notify in case of emergency: ______________________________ Phone # ________________________
Have you been convicted of a felony? N or Y If yes, when? _____________________________________________
(Also, if you answered yes, you may be asked to provide details)
Annual household adjusted income (include PFD and any housing support):
Minimum household income is based on monthly rent rate and $600 for 1st person and $300 per additional person:
1 bedroom unit 1 person $1350 2 persons $1650
2 bedroom unit 1 person $1475 2 persons $1775 3 persons $2075
Source ____________________________________________ Amount ________________
Source ____________________________________________ Amount ________________
Source ____________________________________________ Amount ________________
Source ____________________________________________ Amount ________________

Source ____________________________________________ Amount ________________
Source ____________________________________________ Amount ________________
Total ___________________
Number of bedrooms requested: 1 ____ 2 _____
Does applicant(s) own a vehicle (limit of 2 vehicles per unit)? Yes___ No____
Year ________ Make __________ Model __________________ License # ________________
State __________________ Expiration Date _______________ Insurance ___________________
Year ________ Make __________ Model __________________ License # _________________
State __________________ Expiration Date _______________ Insurance ___________________
Personal References:
Name _________________________________________ Phone # _________________________
Name _________________________________________ Phone # _________________________
Do you: Own your own home _____________ Rent ______________
Disclosure of Landlord for past 3 years:
Current Landlord _______________________________ Address ____________________________
Phone # ___________________________
Prior Landlord _______________________________ Address ______________________________
Phone # ___________________________
Credit References (credit cards, businesses or utility companies):
Name ________________________________________ Address _____________________________
Account Number _______________________________ Phone ______________________________
Name ________________________________________ Address _____________________________
Account Number _______________________________ Phone ______________________________
Name ________________________________________ Address _____________________________
Account Number _______________________________ Phone ______________________________

CONSENT FORM FOR CREDIT, CRIMINAL AND RENTAL HISTORY
Required for all applications

Consent to Credit Check Date________________
The undersigned applicant(s) authorizes Soldotna Area Senior Citizens, Inc., (SASC) or their agent to order and review applicant(s) credit history and investigate the accuracy of the infor mation applicant(s) provided in applicant(s) rental application to obtain housing from SASC. The undersigned applicant(s) further authorize all banks, employers, creditors, references and any and all other persons to provide SASC any and all information concerning my credit history.
Printed Name Signature