CARABETTA

Dea1· Applicant:

Ca1·abetta Management Company would first like to thank you for

considering leasing an apa1·tment in one of our many cormnunities.
We would like to ask how did you hear about us?

[ ] Newspaper [ ] Referral [ ] Sign

[ ] Social Media [ ] Apts. com

If you chose Social Meclia, please indicate which one. (i.e, Facebook,
lnstag1·am etc.)

If you a1·e in need of housing assistance, we determine your eligibility

for occupancy based on many factors including ve1·ification of yom·
income and expenses, in addition to performing credit and background
checks.

Please review the enclosed Rental Application, and p1'ovide us with the
information requested as completely as possible. If there are any
questions that you feel do not apply to you or your household, please
mark "N/A". Any pe1·son 18 years of age AND/OR older must sign the
application.
We would like to advise you that in order to keep a clean, safe and
family friendly community, Ca1·abetta Management Company does not
allow the use of illegal drugs, sale or trafficking on any Ca1·ahetta
p1·operties. Here at Carahetta, we actively promote a drug-free
environment and lifestyle, and we will wodi with Local and State
Authorities to enfo1·ce the law.

1
Carabetta Management Company would like to thank you again for
you1· interest in leasing with us. If the1·e a1·e any questions that you
may have regarding the requfrements of the application, please feel free
to contact our office at 203-237 -7400.

Sincerely,

CARABETTA MANAGEMENT COMP ANY

"Apartments You Will Gladly Call Home"

CARABETTA MANAGEMENT co. does not discriminate on the basis of disability status in the admission or access to, or
treatment or employment in, its federally assisted programs and activities. The person named below has been designated to
coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban
Development's regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988). Sandra Lopez, 504 Coordinator,
Carabetta Management, 200 Pratt Street, Meriden, CT 06450. Tel. 203.639.5124, TTY: 1.800.545.1833

2
 New Applicants for All Properties
The following paperwork is required with
Eve1y Application
f • • •,, • •
i 1 • 1t t• • ' � I •, - ' -. • ' •

· F.or �-II !ouse]tol4Jiie�be_rs:. :_ __ :.

• I •, �.' '"•

Birth Certificate(s) COPIES ONLY

AND/OR
Unexpired Green Card(s)/INS paperwork/Unexpired Passport(s)
COPIES ONLY
Current Photo Identification COPIES ONLY
Social Security Card(s) COPIES ONLY
* EXEMPTION-lnforrnation f om applicants who were age 62 or older as of January 31, 2010, and who do not have a SSN,
r

if lhey were receiving HUD rental assistunce at another location on .January 31, 20 I 0. *

Fo·� alrm�·n1pei·s..vyho_ h_�i� iQc9!ii�:,�o·mii1g)n.tq .th-:e)!Qiis'.e_l�old:.

Employment Verification/Self E111ployment form
. .- ·., · ·4,TO 6 ;E>A);ST@.S·a�e,-r¢quire4 t9 b�.· �!ib(Jiitt.e d
',
•• -• t 0:-.•,• ••,•�- �.• '''"'\,' ,-. -;-• ,--,, -;•••----:.• .,-;-:;--• .. • ' • •.--,• .. -�••, : •••-, -.•, ) l
:, -;••

AND I OR,
Unen1ployment Verification/ Workman's Co1npensation
AND/OR
Welfare Verification form
AND/OR
TPQY of your Current Social Security Benefit
AND/OR

Pension Verification/ Annuity Verification

AND I OR*

Child Support Verification/ Alimony Verification

(IF you ARE NOT REC�IVIN9 CHILD SUP:f9�T,_SUBMIT DOCUMENTATION
J
.... ·.. ·:. ··.. -�-. �GARDING Y )JJR ATT_EMPT TO .PlJBSUE PAY¥ENT) .
 Nuevos Aplicantes Para rfodas las Propiedades

Los Siguientes Documentos Son Requeridos Con Toda Aplicacion

Para todos los miembros de la familia:

Certificado de Nacimiento(s) (COPIAS SOLAMENTE)
ADEMAS/O
Tarjeta de Residencia/INS/Pasaportes que no te expirado
(COPIAS SOLAlvfENTE)
ADEMAS/O
ldentificacion con Foto (s) (COPIAS SOLAMENTE)
ADEMAS/O
Tarjeta de Seguro Social(es) - (COPIAS SOLAMENTE)
* EXENC!6N-i11fonm1ci611 de los solicitantes que fueron mayores de 62 aiios a partir de! 31 de enero de 20 I 0, y que
no tiene LIil SSN, si estaban recibiendo ayuda de alquiler de HUD en otro lugar el 31 de enero de 20 I 0.

Recibos de sueldo de 4 a 6 cheques:

Yerificacion de Empleo/Documentos de negocio propio

ADEMAS/O
Verificacion de Desempleo/Compensacion de Trabajo
ADEMAS/O
Verificacion de Beneficios de Servicios Sociales
ADEMAS/O
Verificacion de Beneficios de Seguro Social TPQY
ADEMAS/O
Pension Y/0 Annuity
ADEMAS/O

Verificacion'de Menores yo Verification' de divorcio

(SI USTED NO RECIBE MANUTENCION DE NINOS, SOMETA DOCUMENTACION
DEL EST ADO INDICANDO LA RAZON)
Updated 04/05/2017* subject to change
Return to:
CARABETT A MANAGEMENT CO
P.O. BOX C-1011 EQU�L HOUSING
OPPORTUNITY
MERIDEN, CT 06450
203.237.7400
Southford
Complex: ______________________
Kai Vilela
Applicant:_ Applicant: ______________
__________
(Name) (Name)
12730 central ave se
(Address) (Address)
Albuquerque nm 87123
(City/State/zip code) (City/State/zip code)
5059109631
(Telephone) (Telephone)
042943350
(Social Security Number)* (Social Security Number)*
*SENIOR EXEMPTION yes_ *SENIOR EXEMPTION yes_

*Infonnation from applicants who were age 62 or older as of January 31, 2010, and who do not have a
SSN, if they were receiving HUD rental assistance at another location on January 31, 2010.

List all household members who will be living in the unit together with the information listed
below:
Name Relationship Date of Birth Social Security Number

Adam Vilela spouse 11/15/84 373066026

SOURCE OF INCOME FOR ALL MEMBERS: (IF EMPLOYED COMPLETE NEXT

SECTION):
Employed
All Source(s) of Income: ----------------------------

EMPLOYMENT IDSTORY:
Head of Household: Spouse/Co-Head:
Name of Employer: _________
Hartford hospital Name of Employer: ____________
Street: Street:
City/ST: New britain City/ST: ______________
Position: ER pct Position: ________________
How Long: Starting 1/27 How Long:_______________
Annual Income: Annual Income: _____________

LANDLORD HISTORY:
Current: Prior:
Name: ------------ Name:
Street: ------------ Street:
City/ST: ----------- City/ST:_____ _ _ _ _ _ _ _ _
Length of Occupancy:_______ Length of Occupancy: __________
Rent: $ ----------- Rent: $---------------
(Annual/Monthly) (Annual/Monthly)
Federally Subsidized [ ] yes [ ] no Federally Subsidized [ ] yes [ ] no
Updated 04/05/2017* subject to change

PERSONAL IDSTORY:

Applicant: Applicant:
Date of Birth: Date of Birth:
Driver License#: _________ Driver License#: ____________

*(Optional)*Sex: [ ] male [ ] female *(Optional)*Sex:[ ] male [ ] female

*Race:[ ] Caucasian [ ] Hispanic *Race:[ ] Caucasian [ ] Hispanic
[ ] Black [ ] Alaskan Native [ ] Black [ ] Alaskan Native
[ ] Ame1ican Indian [ ] Asian [ ] American Indian [ ] Asian

Familial Status (Optional): Familial Status (Optional):

[ ] married [ ] single [ ] married [ ] single

[ ] widowed [ ] divorced [ ] widowed [ ] divorced

A) Do you wish to be considered for a handicap accessible unit? [ ] yes [ ] no

B) Do you have reason to believe that you may be entitled to a $400 disability/handicap adjustment
to your income? [ ] yes [ ] no

C) Will you require "reasonable accommodation" as defined in the Fair Housing Act Amendment to
a unit that is not desi gned as a handicap accessible unit? [ ] yes [ ] no

D) Will you require "reasonable accommodation" as defined in the Fair Housing Act Amendment in
any common areas? [ ] yes [ ] no

E) Do y ou require a "live-in aide"? [ ] yes [ ] no

Note: Live-in aides are not considered part of the lease. However, all live-in aides must disclose and
provide proof their Social Security Number and must authorize Management to run back ground criminal
checks including national sex offender registry.

The infonnation solicited under the Personal History section of the Application is requested by the Owner
and/or its Agent (Carabetta Management Co.) in order to assure the Federal Government that Federal laws
prohibiting discrimination against resident applicants on the basis of race, color, national origin, religion,
sex, familial status, age and disability are complied with. You are not required to furnish this
infonnation, but you are encouraged to do so. This info1mation will not be used in evaluating your
application or to discriminate against you in any way.

BANK REFERENCES:
Name of Bank: __________ Name of Bank: _____________
Street: ------------ Street:._______________
City/ST: ----------- City/ST: _____________
Telephone: ___________ Telephone: _______________
Account#: ___________ Account#: _______________
Type of Acct:__________ Type of Acct:_______ _ _ _ __
Updated 04/05/2017* subject to change

VEIDCLES:
Model: Model: ______________
Year: Year:
Color: Color:
License#: ----------- License#: _______________

A) Have you ever lived at the apartment complex before? [ ] yes [ ] no

B) Have you ever lived at an apartment complex managed by Carabetta Management Co.
before? [ ] yes [ ] no

C) Will a credit or prior landlord investigations reveal any infonnation that you think might
be negative? [ ] yes [ ] no

D) Source of Credit:

Name: Name: ________________

Street: ____________ Street: ________________
City/ST: __________ City/ST: _____________
Telephone: ___________ Telephone: ______________
Purpose: Purpose: _______________
Date Opened/Closed: _______ Date Opened/Closed: ___________

E) Have you ever been a party to an eviction proceeding? [ ] yes [ ] no

F) Do you have any pets? [ ] yes [ ] no If yes, what type?
G) Management may conduct a home visit as a part of its application process. [ ] yes [ ] no

H) Contact in Case of Emergency: (SECTION 8 ONLY PLEASE COMPLETE HUD form 92006)

Name: Name:
Street: ------------ Street:
City/ST: ---------- City/ST: _____________
Telephone: ___________ Telephone: ____________
Relationship: ___________ Personal Physician: ___________

I) References:

Relative Not Living With You: Relative Not Living With You:
Name: Name:
Street: ------------ Street:
City/ST: __________ City/ST: ______________
Telephone:___________ Telephone:_______________

J) How did you learn about us? [ ] newspaper [ ] referral [ ] drive by [ ] s1gn

K) Are you or any members of your household subject to a national life time Sex Offender
Registration Program in any State: [ ] yes [ ] no If yes, who__________

L) List of States you have lived/resided in:__________________

Updated 04/05/2017* subject to change

M) Are you or any members of your household seeking VAWA protection? [ ] yes [ ] no

If yes, please provide documentation or complete a CERTIFICATION OF DOMESTIC VIOLENCE,

DATING VIOLENCE, SEXUAL ASSAULT OR STALKING, AND ALTERNATIVE
DOCUMENTATION (HUD-5382). You cannot be denied admission or denied assistance because you
are or have been a victim of domestic violence, dating violence, sexual assault, or stalking.

By si gn ing below, you certify that the apartment you may occupy will be your pennanent residence and
that you will not maintain a separate, subsidized rental unit in another location.

By si gning below, you agree that the apartment cannot be occupied until the Lease is signed and one
month's security plus the first month's rent is paid by check or money 01·der; CASH IS NOT
ACCEPTED. If, after being approved for occupancy, you elect not to occupy the apartment, you agree
to forfeit your deposit.

Upon completion of this application, we/I understand we/I have seven (7) working days to return any and
all income and expense verification documentation as may be requested by Management to confinn
our/my eligibility for occupancy. We/I also agree to provide copies of birth certificates and social
security cards* (senior exemption) for all individuals who will be residing in the unit as a household
member.

It is understood that in order to determine eligibility for residency in subsidized communities, certain
information must be verified on appropriate forms provided by Management prior to occupancy.
Incomplete applications cannot be considered. These procedures are followed by every applicant,
regardless of rent structure or subsidy, and the additional infonnation is used for detennining rent
amounts; it is not basis for granting or denying tenancy.

We/I hereby certify that only those persons listed in this application will occupy the premises. Further,
we/I agree that if any other infonnation herein contained is false, Management may, at its option and
without notice, cancel any lease made on the basis of infonnation provided as part of this application.

We/I hereby certify that we/I am 18 years of age or older. We/I hereby apply for an apartment at the
above-mentioned location with our/my si gnature(s) below. We/I hereby authorize and request all credit
reporting agencies, employers, credit, and personal references to release all pertinent information about
us/me.

APPLICANT'S SIGNATURE: _____________ DATE: _______

PRINT NAME:

CO-APPLICANT'S SIGNATURE:--------------DATE: --------

PRINT NAME:

ADDITIONAL INFORMATION MAY BE REQUESTED AT A LATER DATE TO COMPLETE

THE PROCESSING OF THIS APPLICATION.

WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful
false statements or misrepresentations to any Department or Agency of the United States as to any
matter within its jurisdiction.
 APPLICANT STATEMENT OF AUTHORIZATION

As a condition of residency, I / We authorize Carabetta Management Company or any

investigative service to investigate my background to determine suitability for residency. I/We
understand that inclusion of any false or misleading information on my application may be
grounds for the denial of my application.

I/We have reviewed this form, fully understanding the intent of this authorization and give my
full consent for the disclosure of all my records (whether personal or otherwise) from current
and/or previous employment, educational institutions, credit and financial institutions,
Department of Motor Vehicles, criminal law and law enforcement agencies, military records
(which could include a copy of my DD-214 Separation Form) as well as National Sex Offender
Registry.

I fully understand the information provided by the agent is accurate only as to what was provided
to them, and therefore do not hold the agent, Carabetta Management Company liable in anyway.

A photocopy of this release will be valid as an original, even though said photocopy does not
contain an original writing of my signature.

EVERYONE EIGHTEEN YEARS AND OVER MUST SIGN

Applicant Signature Co- Applicant Signature

Date of Birth Date of Birth

Social Security Number Social Security Number

Date Date

(The inclusion of your birth date is voluntary, but could assist in verifying records obtained)

Please indicate below if you have been employed or educated under another name, and
the dates this name was used, i.e. maiden name, nickname, alias, etc.
 0MB Control# 2502-0581
Exp. (11/30/2015)
Optional and Supplemental Contact Information for HUD-Assisted Housing Applicants

SUPPLEMENT TO APPLICATION FOR FEDERALLY ASSISTED HOUSING

This form is to be provided to each applicant for federally assisted housing

Instructions: Optional Contact Person or Organization: You have the right by law to include as part of your application for housing,
the name, address, telephone number, and other relevant information of a family member, friend, or social, health, advocacy, or other
organization. This contact information is for the purpose of identifying a person or organization that may be able to help in resolving any
issues that may arise during your tenancy or to assist in providing any special care or services you may require. You may update,
remove, or change the information you provide on this form at any time. You are not required to provide this contact information,
but if you choose to do so, please include the relevant information on this form.

D Check this box if you choose not to provide the contact information.

Applicant Name:
Mailing Address:

Telephone No: Cell Phone No:

Name of Additional Contact Person or Organization:

Address:

Telephone No: Cell Phone No:

E-Mail Address (if applicable):

Relationship to Applicant:
Reason for Contact: (Check all that apply)
□ Emergency □ Assist with Recertification Process
□ unable to contact you □ Change in lease terms
□ Termination of rental assistance □ Change in house rules
□ Eviction f om unit r
□ Other:
□ Late payment of rent
Commitment of Housing Authority or Owner: If you are approved for housing, this information will be kept as part of your tenant file. If issues
arise during your tenancy or if you require any services or special care, we may contact the person or organization you listed to assist in resolving the
issues or in providing any services or special care to you.

Confidentiality Statement: The information provided on this form is confidential and will not be disclosed to anyone except as permitted by the
applicant or applicable law.

Legal Notification: Section 644 of the Housing and Community Development Act of I 992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be ofTered the option of providing information regarding an additional contact person or
organization. By accepting the applicant's application, the housing provider agrees to comply with the non-discrimination and equal opportunity
requirements of 24 CFR section 5.105, including the prohibitions on discrimination in admission to or participation in federally assisted housing
programs on the basis of race, color, religion, national origin, sex, disability, and familial status under the Fair Housing Act, and the prohibition on
age discrimination under the Age Discrimination Act of 1975.

I Date
Signature of Applicant
The infonnation collection rcquiremcms contained in this fonn were submitted lo the OAicc ofManagcment and Budget (0MB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). ·n,e
public reponing burden is estimated nt 15 minutes per response, including the time for reviewing instmctions. searching existing dma sources, gathering and maintaining the data needed� and completing
and reviewing the collection of infonnation. Section 644 ofthe Housing and Community Development Act of 1992 (42 U.S.C. 13604) imposed on HUD the obligation to require housing providers
participating in HUD's assisted housing programs to provide any individual or family applying for occupancy in I-IUD-assisted housing with the option to include in the application for occupancy the nnmc,
address, telephone number, and other rclcvmu infommtion of a family member, friend. or person nssociated with a social, health. ndvocncy, or similar organization. The objective of providing such
infonnation is to facilitate contact by the l10tL'iing provider with the person or organiza1ion identified by the 1enan1 to assist in providing any delivery of services or special cnrc to the tenant and assist with
resolving n11y tenancy issues arising during the tenancy of such tenant. 1l1is supplemental application information is to be main1ained by the housing provider and maintained as confidential infommtion.
Providing the infonnation is b.tsic 10 the operations of the HUD Assisted-Housing Program and is voluntary. It supports statu1ory requirements nnd program nnd management controls that prevent fraud,
waste and mismanagement. In accordance with 1.he Paperwork Reduction Act. an agency may not conduct or sponsor, and a person is not required to respond to, a collection ofinfonnation, unless the
collection displays a currently valid 0MB control nwnber.
Privacy Statement: Public Law I 02-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the infonnation (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.

Fonn HUD- 92006 (05/09)

 CARABE1TA MANAGEMENT COMPANY
200 PRA1T STREET
MERIDEN, CT 06450
HELLO! Providing us with the following brief information will greatly assist our Leasing
Staff in helping you find the perfect unit.

Today's Date: _________ What prompts you to look for an apa11ment?

Narne(s'-'-: __________

Address:__________ Size Bedroom you are looking for: _______

City/State:__________ Date you need to move by: __________

Phone: Home ( )

Work( )
Affordable rent range for you: $ _____

How did you hear about us?

(Name of Complex, if applicable)

___ Resident Referral What is the most important feature in your new
apa11rnent?
___ Newspaper
Size: _____ Closet Space: _____
___ Sign in front of building.
View: _____ Other: _______
___ Other ? Please explain

FOR STAFF USE ONLY

Application Given: _____________

Apartment Shown:_____________

Staff person taking this information: _________ Date: ___________

 1\I•P I..YIN(, I.,() ll II IJI)
Ilf)IJSIN(,
1lSSIS'I11lNf�I�?
'J1UINI{ AHOUT 'J1UIS...
IS l."llAUD 1\TOll'J111 l'11?

Do You Realize ...

If you commit fraud to obtain assisted housing from HUD, you could be:

• Evicted from your apartment or house.

• Required to repay all overpaid rental assistance you received.
• Fined up to $10,000.
• Imprisoned for up to five years.
• Prohibited from receiving future assistance.
• Subject to State and local government penalties.

Do You Know ...

You are committing fraud if you sign a form knowing that you provided false or misleading
information.

The information you provide on housing assistance application and recertification forms
will be checked. The local housing agency, HUD, or the Office of Inspector General will
check the income and asset information you provide with other Federal, State, or local
governments and with private agencies. Certifying false information is fraud.

So Be Careful!

When you fill out your application and yearly recertification for assisted housing from
HUD make sure your answers to the questions are accurate and honest. You must include:

All sources of income and changes in income you or any members of your household
receive, such as wages, welfare payments, social security and veterans' benefits,
pensions, retirement, etc.

Any money you receive on behalf of your children, such as child support, AFDC
payments, social security for children, etc.

form HUD-1141
(12/2005)
 Any increase in income, such as wages from a new job or an expected pay raise or
bonus.

All assets, such as bank accounts, savings bonds, certificates of deposit, stocks, real
estate, etc., that are owned by you or any member of your household.

All income from assets, such as interest from savings and checking accounts, stock
dividends, etc.

Any business or asset (your home) that you sold in the last two years at less than full
value.

The names of everyone, adults or children, relatives and non-relatives, who are living
with you and make up your household.

(Important Notice for Hurricane Katrina and Hurricane Rita Evacuees: HUD's
reporting requirements may be temporarily waived or suspended because of your
circumstances. Contact the local housing agency before you complete the housing
assistance application.)

Ask Questions

If you don't understand something on the application or recertification forms, always ask
questions. It's better to be safe than sorry.

Watch Out for Housing Assistance Scams!

• Don't pay money to have someone fill out housing assistance application and
recertification forms for you.
• Don't pay money to move up on a waiting list.
• Don't pay for anything that is not covered by your lease.
• Get a receipt for any money you pay.
• Get a written explanation if you are required to pay for anything other than rent
(maintenance or utility charges).

Report Fraud

If you know of anyone who provided false information on a HUD housing assistance
application or recertification or if anyone tells you to provide false information, report that
person to the HUD Office of Inspector General Hotline. You can call the Hotline toll-free
Monday through Friday, from 10:00 a.m. to 4:30 p.m., Eastern Time, at 1-800-347-3735.
You can fax information to (202) 708-4829 or e-mail it to Hotline@hudoig.gov. You can
write the Hotline at:

HUD OIG Hotline, GFI

451 i h Street, SW
Washington, DC 20410

form HUD-1141
(12/2005)