Property: the Hitchner Management Agent



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Property:

the Hitchner

Management Agent:

530 Exeter Avenue

NDC Real Estate Management, Inc.

West Pittston, PA 18643

321 Spruce Street, 3rd Floor

Phone: C/O 570.344.5999

Scranton, PA 18503

Fax: C/O 570.344.7097

570.344.5999

Phone Number



800.654.5984

TT Number



570.344.7097

Fax Number



EQUAL HOUSING

OPPORTUNITY



RESIDENCY APPLICATION

For LIHTC/HOME/Rural Development/Section 8 Properties



























Date Received:




Time Received:




AM/PM

Applicant #:













*** Management Use Only ***




You must provide all information requested on this application. Information you provide will be used strictly to determine your eligibility for housing in this Community. All information you provide will be handled confidentially. Incomplete applications will not be accepted. The Resident Selection Plan and Screening Criteria which provides specific detail regarding application processing as well as additional guidance regarding waiting list preferences, if any, is posted in the rental office. Copies are available upon request.







HEAD OF HOUSEHOLD INFORMATION




(Use Legal Name)










Last Name:




First:




Middle:




























Present Telephone #:




Alternate Telephone #:






















Current Address:





















Birth Date:




Sex:




Marital Status:










(Single, Married, Divorced, Separated, Widowed)

Social Security #: ______________________________________






(List below the legal names of all persons in addition to yourself who will reside in the apartment with you)






















Legal Name (First, MI, Last)

Sex

Birth Date

Relationship to you

Social Security #























































































































































































































































We are required to report the Race and Ethnic Originof every applicant household member. Please assist us in supplying accurate information by answering the following questions. This question is optional and your response will have NO bearing on your eligibility and shall not be used to discriminate against you in any way. If you choose not to furnish it, the owner is required to note the Race and Ethnic Origin of the Head of Household by visual observation or surname. Please circle or check all that apply.


HOUSEHOLD MBR# 1

RACE ETHNIC ORIGIN

First Name: ____________________

White




Black or African

American




Hispanic or Latino




Middle Initial: __________

American Indian or

Alaska Native





Native Hawaiian or

Other Pacific

Islander






Last Name: ____________________

Asian




Do Not Wish to Answer







Relationship to Head

of Household: __________________












HOUSEHOLD MBR# 2

RACE ETHNIC ORIGIN

First Name: ____________________

White




Black or African

American




Hispanic or Latino




Middle Initial: __________

American Indian or

Alaska Native





Native Hawaiian or

Other Pacific

Islander






Last Name: ____________________

Asian




Do Not Wish to Answer







Relationship to Head

of Household: __________________












HOUSEHOLD MBR# 3

RACE ETHNIC ORIGIN

First Name: ____________________

White




Black or African

American




Hispanic or Latino




Middle Initial: __________

American Indian or

Alaska Native





Native Hawaiian or

Other Pacific

Islander






Last Name: ____________________

Asian




Do Not Wish to Answer







Relationship to Head

of Household: __________________












HOUSEHOLD MBR# 4

RACE ETHNIC ORIGIN

First Name: ____________________

White




Black or African

American




Hispanic or Latino




Middle Initial: __________

American Indian or

Alaska Native





Native Hawaiian or

Other Pacific

Islander






Last Name: ____________________

Asian




Do Not Wish to Answer







Relationship to Head

of Household: __________________












HOUSEHOLD MBR# 5

RACE ETHNIC ORIGIN

First Name: ____________________

White




Black or African

American




Hispanic or Latino




Middle Initial: __________

American Indian or

Alaska Native





Native Hawaiian or

Other Pacific

Islander






Last Name: ____________________

Asian




Do Not Wish to Answer







Relation to Head

of Household: __________________









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