Dear Applicant:

Thank you for applying for tenancy at O a k s a t W e s t m i n s t e r 1 l o c a t e d in Elizabeth, New

Jersey 07208. Please complete this application in accordance with the following application
instructions:

1. PLEASE READ CAREFULLY

Applications will be processed in order of date and time received.

There is a $0 application fee.

Incomplete applications or applications not accompanied by the appropriate documentation

or fees will not be processed and will be returned.

2. COMPLETE ALL AREAS.

If an item does not apply to you, answer “N/A” to that question or mark with a “0” if it is a
dollar amount line or section. Answer all questions; do not leave any questions blank. Do
not cross out or use white out on the application.
a) All sources of earned income must be reported for all household members.
b) All unearned income and assets must be reported for all household members.

3. SIGNATURES
Signatures are required for all adult applicants.
4. PLEASE PROVIDE COPIES OF THE FOLLOWING INFORMATION
a. Valid Driver’s License or other government issued identification for adult household
members age 18 and older;
b. Birth Certificates for all household members;
c. Social Security cards for all household members;
d. Name, address and phone number of current employer; and
e. Income verification:
1. Social Security award letter;
2. Four (4) current consecutive pay stubs; however, eight (8) paystubs will be required
if Landlord is unable to verify income;
3. Bank name, address, and phone number; along with 6 most recent bank statement
for all checking and savings account(s);
4. Most recent Tax Return; along with all W-2’s and 1099’s;
5. Real Estate documents if you owned or sold a home within the past two years;
6. Child Support Award Letter;
7. All asset information; (e.g. Cash held in savings and/or checking accounts, safe
deposit boxes or at home, etc., trusts, equity in real estate or other capital
investments, stocks, bonds, treasury bills, certificate of deposits (CD’s) money
market accounts);
8. Pension benefits award letter; 401K, IRA, Annuities, or any retirement account(s);
9. Life Insurance policies,
10. Welfare/public assistance documents, AFDC Documentation;
11. Workers compensation award letter;
12. Disability award letter and;
13. Unemployment award letter or 4 consecutive unemployment check stubs
PLEASE RETURN APPLICATION TO:
OAKS AT WESTMINSTER
450 IRVINGTON AVENUE
ELIZABETH, NJ 07028

Should you have any questions, please feel free to contact Oaks at Westminster at: (908) 354-
0485.

Thank you,

Oaks at Westminster Staff

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 1 of 6
 APPLICATION FOR HOUSING
Low-Income Housing Property
Please Print Clearly
This is an application for housing at: Community: OAKS AT WESTMINSTER

Please complete this application and mail to: 410 IRVINGTON AVENUE
ELIZABETH, NJ 07028

Applications are placed in order of date and time received. An applicant may be interviewed only after the
receipt of this tenant application.

ALL QUESTIONS MUST BE ANSWERED OR APPLICATION WILL BE CONSIDERED INCOMPLETE AND RETURNED

If a section doesn’t apply, write NA. Do not cross out.

A. GENERAL INFORMATION
Applicant Name(s):

Address:
Street Apt.# State ZIP

Home Phone: Cell Phone:

Email Address:

No. Of BR’s in
current unit: Do you  RENT or  OWN (circle one)

Amount of current monthly rental or mortgage payment: $

If owned, do you receive monthly rental income from property?  Yes  No (circle one)

Circle utilities paid by you:  Heat  Electricity  Gas  Other (specify) __________________

Approximate monthly cost of utilities paid by you (excluding phone and cable TV): $

Do you receive rental assistance? (Example: Section 8 or any other type of voucher)  Yes  No (circle one)

Is any member of the applicant household a Lifetime Sex Offender Registrant:  Yes  No (circle one)

Please list any states where you have previously resided: ____________________________________________________________________________________

How did you hear about us? (Please be specific.)___________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

B. HOUSEHOLD COMPOSITION

List ALL persons who will live in the house. List the head of household first.
Relationship Marital Status Student
Name to head M-married D-divorced Birth Age SS# Y/N
S-single E-estranged Date
L-legal separation
Applicant
Co-Applicant
3.
4.
5.
6.

Will any of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an
educational institution (other than a correspondence school) with regular faculty and students?  Yes  No (circle one)

IF YOU CIRCLED YES, ANSWER THE FOLLOWING QUESTIONS:

Are any full-time student(s) married and filing a joint tax return? (circle one)  Yes  No
Are any student(s) enrolled in a job-training program receiving assistance under the Job Training Partnership Act? (circle one)  Yes  No
Are any full-time student(s) a TANF or a title IV recipient? (circle one)  Yes  No

Are any full-time student(s) a single parent living with his/her minor child who is not a Dependent on another’s tax return?  Yes  No
(circle one)

Do you anticipate any additions to the household in the next twelve months?  Yes  No (circle one)
If yes, explain:

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 2 of 6
 C. INCOME
List ALL sources of income as requested below. If a section doesn’t apply, write NA.
Gross Monthly
Household Member Name Source of Income
Amount
Social Security $
SSI Benefits $
Pension (list source) $
Veteran’s Benefits (list claim #) $
Unemployment Compensation $
Unemployment Compensation $
Title IV/TANF $
Title IV/TANF $
Title IV/TANF $

Full-Time Student Income (18 & Over Only) $

Full-Time Student Income (18 & Over Only) $

Interest Income (source) $

Interest Income (source) $
Other _______________________________________________________ $

Household Member Name Source of Income Monthly Amount

$
Employment amount

Employer:
Position Held
How long employed:

Employment amount $

Employer:
Position Held
How long employed:

Alimony
Are you entitled to receive alimony?  Yes  No
If yes, list the amount you are entitled to receive. $
Do you receive alimony?  Yes  No
If yes list amount you receive. $

Child Support
Are you entitled to receive child support?  Yes  No
If yes list the amount you are entitled to receive. $
Do you receive child support?  Yes  No
If yes, list the amount you receive. $
Other Income $
Other Income $
TOTAL GROSS ANNUAL INCOME (Based on the monthly amounts listed above x 12) $
TOTAL GROSS ANNUAL INCOME FROM PREVIOUS YEAR $
Do you anticipate any changes in this income in the next 12 months?  Yes  No
If yes, explain:

D. ASSETS
If your assets are too numerous to list here, please request an additional form.
If a section doesn’t apply, write NA.
Checking Accounts # Bank Balance $
# Bank Balance $
Savings Accounts # Bank Balance $
# Bank Balance $
Trust Account # Bank Balance $
# Bank Balance $
Certificates of Deposit
# Bank Balance $
Credit Union # Bank Balance $
Savings Bonds # Maturity Date Value $
Life Insurance Policy # Cash Value $

Mutual Funds Name: #Shares: Interest or Dividend $ Value $

Stocks Name: #Shares: Dividend Paid $ Value $
Bonds Name: #Shares: Interest or Dividend $ Value $
Investment Appraised
Property Value $

Real Estate Property: Do you own any property? (circle one)  Yes  No
If yes, Type of property
Location of property
Appraised Market Value $
Mortgage or outstanding loans balance due $
Amount of annual insurance premium $
Amount of most recent tax bill $

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 3 of 6
 Have you sold/disposed of any property in the last 2 years? (circle one)  Yes  No
If yes, Type of property
Market value when sold/disposed $
Amount sold/disposed for $
Date of transaction
Have you disposed of any other assets in the last 2 years (Example: Given away money to relatives, set up
Irrevocable Trust Accounts)?
(circle one)  Yes  No
If yes, describe the asset
Date of disposition
Amount disposed $

Do you have any other assets not listed above (excluding personal property)? (circle one)  Yes  No
If yes, please list:

E. ADDITIONAL INFORM ATION

Have you or any member of your household ever been evicted from any housing? (circle one)  Yes  No
If yes, describe

Have you ever filed for bankruptcy? (circle one)  Yes  No

If yes, describe

Will you take an apartment when one is available? (circle one)  Yes  No
Briefly describe your reasons for applying:

F. REFERENCE INFORMATION
Name:
Address:
Current Landlord
Home Phone:
Bus. Phone:
How Long?
Name:
Address:
Prior Landlord Home Phone:
Bus. Phone:
How Long?
Credit Reference #1:
Address:
Account #: Phone #:
Credit Reference #2:
Address:
Account #: Phone #:

Personal Reference #2:

Address:
Relationship: Phone #:
Personal Reference #3:
Address:
Relationship: Phone #:

G. VEHICLE AND PET INFORMATION (if applicable)

List any cars, trucks, or other vehicles owned. Parking will be provided for only one vehicle.
Type of Vehicle: License Plate #:
Year/Make: Color:
Type of Vehicle: License Plate #:
Year/Make: Color:
Do you own any pets? (circle one)  Yes  No
If yes, describe:

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 4 of 6
 TO COMPLETE THIS APPLICATION FOR TENANCY, PLEASE
CAREFULLY READ ALL TERMS AND COMPLETE THE ATTACHED
PAGES WHICH FORM PART OF THE APPLICATION.
PLEASE READ ALL TERMS CAREFULLY ON THIS FORM AND SIGN BELOW:

Oaks at Westminster complies with all state and federal statutes which prohibit discrimination in the rental of dwellings.
This application is subject to Oaks at Westminster and may without designating cause, be disapproved by them. I
understand that this application creates no obligation for Oaks at Westminster or applicant. This application may be made
part of my lease. I understand that the truth of the information contained herein is essential. If Oaks at Westminster deems
any answer or statement herein to be false, or misleading, any lease granted by virtue of this application maybe canceled
at their option.

AGREEMENT, AUTHORIZATION AND CONSENT FOR RELEASE OF

BACKGROUND INFORMATION

I understand that in conjunction with my application for tenancy, Oaks at Westminster may use the services of an outside
agency to research and verify the information I have provided on my application for housing including my personal
background, work history and qualifications. I therefore authorize Oaks at Westminster, CIS, CIS Management Inc., or Yardi
Resident Screening (or any authorized entity hired for this purpose) to verify any information provided by me in this tenancy
application and any supplemental attachments, including but not limited to: criminal conviction record, current and former
employers, credit reports, and personal references and I agree, authorize and consent to the release and disclosure of any and
all information including but not limited to the above to Oaks at Westminster , CIS, CIS Management Inc., Yardi Resident
Screening and any authorized reporting agency.

I further agree, authorize and consent to Oaks at Westminster, CIS and/or CIS Management Inc. to obtain a consumer report
as well as a criminal and sexual offender report from Yardi Screening Reports (or any other entity hired for this purpose and/or
investigative consumer report, which may contain information about my credit worthiness, credit standing, credit capacity,
and criminal background.

In accordance with the Fair Credit Reporting Act, I will be notified by Oaks at Westminster, CIS and/or CIS Management
Inc. if my tenancy is denied because of information obtained from a consumer reporting agency. I further understand that I
may request a copy of the report from the consumer reporting agency having conducted the background investigations.

By signing this application, I hereby expressly release Oaks at Westminster and any agent, procurer or furnisher of
information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understand
that my application information may be provided to various local, state and/or federal government agencies, including
without limitation, various law enforcement agencies.

SIGNATURE(S)

(Signature of Tenant) Date

(Signature of Co-Tenant) Date

(Signature of Co-Tenant) Date

(Signature of Co-Tenant) Date

____________________________________________________________________________________________
1
For the purpose of this Application for Housing, the term Oaks at Westminster refers to Oaks at Westminster Urban
Renewal, LLC and its successors, assigns, divisions, affiliated or related entities, owners, partners, officers, directors,
management and parent companies, including CIS and CIS Management Inc.

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 5 of 6
 Acknowledgment of Application for Housing Procedure

A completed, signed, dated application along with the required deposit (where applicable) is
required to be considered for housing at Oaks at Westminster. The Application will be time and
date stamped upon receipt. Depending on availability the application will be logged in the waitlist
book and processed or placed on the waiting list to be processed when an appropriate size unit
becomes available. Once an application has been submitted, it cannot be altered or modified to add
or remove members. Applicants that are rejected may respond to the owner in writing or request a
meeting within 14 days to dispute the rejection. If the rejection of the applicant stands after a
meeting or review of a written dispute, the applicant can re-apply after six (6) months and another
application fee will be required, if applicable.

Management will conduct background screening (credit and criminal), including the Lifetime Sex
Offender Registration status on all members of the applicant household age 18 and older. The
application may be denied/rejected based upon information obtained and applicant household will
be notified in writing. If the application has been accepted based upon the background screening,
Management will request documents to verify information in the rental application to ensure that
the household will meet the requirement of the HUD/LIHTC and or other applicable housing
program for which the household is applying including but not limited to verifying all sources of
income and will calculate it in accordance with applicable program guidelines. It may be
determined during this process that the application requires additional information to process,
which must be submitted within 48 hours of being notified. Failure to respond may cause for the
application to be denied. Based upon this review, Management will determine if the file is suitable
to be presented to New Jersey Housing and Mortgage Finance Agency, NJHMFA. In the event
the file is determined not to be suitable the applicant will receive written notification.

Upon review and verification of the application, NJHMFA may still request additional information
that must be presented to Management for submission to NJHMFA within 48 hours. Failure to
provide the documents requested and/or based upon the information submitted, the application for
housing may be rejected and/or denied.

An offer for housing will only be offered after Management has received NJHMFA approval.
Management is not responsible if applicant gives notice or vacates their home prior to Management
receiving NJHMFA approval.

By signing and dating below, I____________________________, acknowledge receipt of the

Application for Housing Procedure.

________________________________________ ________________
Signature Date

________________________________________ ________________
Signature of Co-Tenant Date

________________________________________ ________________
Signature of Co-Tenant Date

________________________________________ ________________
Signature of Co-Tenant Date

Rental Application - Oaks at Westminster, Elizabeth, NJ 07028

Page 6 of 6
 MULTIPLE DWELLING REPORTING RULE TENANT/APPLICANT INQUIRY

The New Jersey Law Against Discrimination, N.J.S.A. 10:5-1 to –49, makes it unlawful to discriminate
in the sale or rental of housing based on a person’s race, creed, color, national origin, ancestry, nationality,
affectional or sexual orientation, disability, gender, marital status, familial status (whether you have a
child, a parent-child relationship with a minor, or you are pregnant), lawful source of income or rental
subsidy used for rental payments.

The New Jersey Division on Civil Rights is the State agency that is authorized to enforce the Law
Against Discrimination. Under the Division’s Multiple Dwelling Reporting Rules, N.J.A.C. 13:10-1.1
to -2.6, the Division requires landlords to collect and record information about applicants for apartment
rentals and tenants in apartment complexes throughout New Jersey. The Multiple Dwelling Reporting
Rule requires landlords to provide a summary of this information to the Division and to retain the
information on this form. The information is used to prevent and eliminate discrimination in housing.
Your cooperation in filling out this form will assist the Division in enforcing the Law Against
Discrimination.

Please note that, although landlords must record certain information about the race and ethnicity of
applicants and tenants, it is unlawful to record or ask applicants or tenants about other characteristics such
as religion, gender, marital status or affectional or sexual orientation.

If you feel you have been denied housing or treated differently for one of the reasons listed above, you
may contact the Division on Civil Rights at (609) 984-3138 for referral to a local Division office for
additional information or assistance.
Visit the Division on Civil Rights Web site at: www.NJCivilRights.org

• •
Tenants/applicants: Fold & tear along dotted line and retain top portion for your records

MULTIPLE DWELLING REPORTING RULE TENANT/APPLICANT INQUIRY

If the tenant/applicant chooses not to complete this form, the landlord or the landlord’s
representative is required to conduct a visual observation of the tenant or applicant and then
complete this form as accurately as possible.

This form is not intended to be a part of the rental application process and must be kept separate
and apart from rental records.

Tenant Applicant Name:________________________________________________________

Address:___________________________________________________________________________
City:____________________ State:_____ Zip code:________ Phone Number:___________________

Race/Ethnicity: Please check all that apply to leaseholders (tenants) or applicants.

Black or African American: a person having origins in any of the original peoples of Africa
Hispanic or Latino: a person of Cuban, Mexican, Puerto Rican, South or Central American or
other Spanish origin or culture, or a person having a Spanish surname
Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian subcontinent, including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam
American Indian or Alaska Native: a person having origins in any of the original peoples of
North or South America
Native Hawaiian or Other Pacific Islander: a person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific Islands
White or Caucasian: a person having origins in any of the original peoples of Europe, the Middle
East, or North Africa

Date:_____________ Completed by: Tenant Applicant Landlord

If you have any questions regarding this inquiry please contact the Division on
Civil Rights, Multiple Dwelling Unit at 609-984-3138 between the hours of 9:00
to 5:00 Monday through Friday, or e-mail the MDRR unit at
DCRMDRR@njcivilrights.org
DCR/HIU/MDRR/LS2005
 OMB Control # 2502-0581
Exp. (02/28/2019)
Supplemental and Optional 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.

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 from unit 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 1992 (Public Law 102-550, approved October 28, 1992)
requires each applicant for federally assisted housing to be offered 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.

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

Signature of Applicant Date

The information collection requirements contained in this form were submitted to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520). The
public reporting burden is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Section 644 of the 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 HUD-assisted housing with the option to include in the application for occupancy the name,
address, telephone number, and other relevant information of a family member, friend, or person associated with a social, health, advocacy, or similar organization. The objective of providing such
information is to facilitate contact by the housing provider with the person or organization identified by the tenant to assist in providing any delivery of services or special care to the tenant and assist with
resolving any tenancy issues arising during the tenancy of such tenant. This supplemental application information is to be maintained by the housing provider and maintained as confidential information.
Providing the information is basic to the operations of the HUD Assisted-Housing Program and is voluntary. It supports statutory requirements and program and management controls that prevent fraud,
waste and mismanagement. In accordance with the Paperwork Reduction Act, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information, unless the
collection displays a currently valid OMB control number.

Privacy Statement: Public Law 102-550, authorizes the Department of Housing and Urban Development (HUD) to collect all the information (except the Social Security Number (SSN)) which will be
used by HUD to protect disbursement data from fraudulent actions.
Form HUD- 92006 (05/09)