OPERATING/PROCEDURES
MANUAL
Table of Contents
FAIR HOUSING ............................................................................................................................................................................... 6
MINNESOTA FAIR HOUSING.................................................................................................................................................... 7
FAIR HOUSING STATEMENT ................................................................................................................................................. 8
RENTAL INQUIRIES.................................................................................................................................................................... 11
PROPERTY INFORMATION SHEET ....................................................................................................................................... 12
TELEPHONE ETIQUETTE ........................................................................................................................................................ 13
RENTAL APPLICATIONS ........................................................................................................................................................... 14
INTER-OFFICE MEMO ......................................................................................................................................................... 15
RESIDENT SELECTION CRITERIA....................................................................................................................................... 16
RENTAL APPLICATION ........................................................................................................................................................ 17
ELIGIBILITY QUESTIONNAIRE ........................................................................................................................................... 19
GOVERNMENT DATA PRACTICES ACT .............................................................................................................................. 22
EMERGENCY CONTACT INFORMATION ........................................................................................................................... 24
RENTAL APPLICATIONS ........................................................................................................................................................... 25
WAITING LIST .............................................................................................................................................................................. 26
INQUIRY LIST............................................................................................................................................................................... 27
RRH APPLICATION/WAITING LIST FOR OCCUPANCY ....................................................................................................... 28
NOTICE OF DENIAL OF APPLICATION ................................................................................................................................. 29
WAITING LIST UPDATE LETTER ........................................................................................................................................... 30
WELCOME TO ............................................................................................................... ERROR! BOOKMARK NOT DEFINED.
HOUSE RULES ....................................................................................................................................................................... 33
HOW TO PAY YOUR RENT.................................................................................................................................................... 33
OCCUPANCY ......................................................................................................................................................................... 33
KEYS ....................................................................................................................................................................................... 33
RIGHT OF ENTRY .................................................................................................................................................................. 34
PETS ........................................................................................................................................................................................ 34
PARKING LOTS. CARS AND WALKWAYS ............................................................................................................................ 34
LAUNDRY ROOM ................................................................................................................................................................... 34
LAUNDRY ROOM HOURS ..................................................................................................................................................... 35
TRASH ..................................................................................................................................................................................... 35
REPAIRS AND MAINTENANCE ............................................................................................................................................ 35
CARE OF UNIT ...................................................................................................................................................................... 36
UNIT TRANSFERS .................................................................................................................................................................. 38
PLANNED ABSENCES ........................................................................................................................................................... 38
RECERTIFICATION OF INCOME AND ASSETS .................................................................................................................. 38
MOVING OUT ........................................................................................................................................................................ 39
2
ADDITIONAL REGULATIONS .............................................................................................................................................. 39
CHARCOAL GRILLS .............................................................................................................................................................. 40
FIREARMS / FIREWORKS ..................................................................................................................................................... 40
WELCOME HOME!......................................................................................................................................................................... 40
MOVE-IN CHECKLIST .......................................................................................................................................................... 41
MOVE OUTS .................................................................................................................................................................................. 43
ACKNOWLEDGMENT OF INTENT TO VACATE .................................................................................................................. 45
W ALLS .................................................................................................................................................................................... 45
FLOORS .................................................................................................................................................................................. 45
DOORS AND WOODWORK ................................................................................................................................................... 46
KITCHEN CABINETS AND DRAWERS ................................................................................................................................. 46
REFRIGERATORS .................................................................................................................................................................. 46
RANGE I OVEN I VENT HOOD ............................................................................................................................................. 46
AIR CONDITIONER FILTER AND COVERS ......................................................................................................................... 46
BATHROOM FLOORS AND FIXTURES ................................................................................................................................ 46
WINDOWS .............................................................................................................................................................................. 46
ELECTRICAL FIXTURES ....................................................................................................................................................... 46
HEAT REGISTERS .................................................................................................................................................................. 46
TRASH AND REFUSE ............................................................................................................................................................ 47
STORAGE UNITS (IF APPLICABLE) .................................................................................................................................... 47
GARAGE STALLS ................................................................................................................................................................... 47
CLEANING AND REPLACEMENT CHARGES ..................................................................................................................... 47
CLEANING.............................................................................................................................................................................. 48
REPLACEMENT COST OF COMMON ITEMS ..................................................................................................................... 48
INTENT TO VACATE................................................................................................................................................................... 49
TERMINATION ............................................................................................................................................................................. 50
PERFORMANCE DEPOSIT STATUS REPORT ..................................................................................................................... 53
MISCELLANEOUS ....................................................................................................................................................................... 54
Monthly Paperwork Agenda .................................................................................................................................................... 56
PETTY CASH DISBURSEMENT ................................................................................................................................................ 57
PETTY CASH RECAP ................................................................................................................................................................ 58
INVOICE ................................................................................................................................................................................. 59
PETTY CASH .......................................................................................................................................................................... 60
INDEPENDENT CONTRACTOR INVOICE ........................................................................................................................... 60
SPENDING LIMIT .................................................................................................................................................................. 60
CHARGE ACCOUNTS ............................................................................................................................................................ 60
TOOLS ..................................................................................................................................................................................... 60
DUTIES AND RESPONSIBILITIES OF SITE MANAGERS .................................................................................................... 61
3
Duties ...................................................................................................................................................................................... 61
RESPONSIBILITIES ......................................................................................................................................................................... 61
DAILY ...................................................................................................................................................................................... 61
WEEKLY ................................................................................................................................................................................. 61
MONTHLY .............................................................................................................................................................................. 62
SEMI-ANNUALLY ................................................................................................................................................................... 62
ANNUALLY ............................................................................................................................................................................. 62
COMPENSATION ................................................................................................................................................................... 63
EXTRA DUTIES PERFORMED BY SITE MANAGER............................................................................................................ 63
LEASE VIOLATION ..................................................................................................................................................................... 64
NOTICE OF LEASE VIOLATION ........................................................................................................................................... 65
NOTICE OF HOUSEKEEPING CONDITION ....................................................................................................................... 66
NOTICE OF LEASE VIOLATION ........................................................................................................................................... 68
ANNUAL RECERTIFICATIONS ................................................................................................................................................ 69
Recertification Notice Summary .............................................................................................................................................. 70
MOVE INS ...................................................................................................................................................................................... 71
RESIDENT FILE CHECKLIST ............................................................................................................................................... 72
LANDLORD REFERENCE RELEASE .................................................................................................................................... 73
EMERGENCY CONTACT INFORMATION ........................................................................................................................... 74
RULES AND REGULATIONS ................................................................................................................................................. 75
RACE AND ETHNIC DATA .............................................................................................................................................................. 76
Drug-Free Housing Agreement (Agreement) .......................................................................................................................... 77
PERFORMANCE DEPOSIT RECEIPT AND AGREEMENT ................................................................................................. 78
GOVERNMENT DATA PRACTICES ACT .............................................................................................................................. 82
Section 8, 236 and 202 Programs ........................................................................................................................................... 84
PART A ......................................................................................................................................................................................... 84
PART B ......................................................................................................................................................................................... 84
TENANT CERTIFICATION SUMMARY WORKSHEET ......................................................................................................... 85
TENANT CERTIFICATION SUMMARY WORKSHEET ......................................................................................................... 86
GOVERNMENT DATA PRACTICES ACT .............................................................................................................................. 90
RACE AND ETHNIC DATA .............................................................................................................................................................. 92
CERTIFICATION INTERVIEW CHECKLIST ........................................................................................................................ 93
To Annualize Income ............................................................................................................................................................... 94
VERIFICATIONS .......................................................................................................................................................................... 95
Bank Verification.................................................................................................................................................................................... 96
EMPLOYMENT VERIFICATION ........................................................................................................................................... 97
ALIMONY / CHILD SUPPORT VERIFICATION (Enforcement Agency) .......................................................................................... 98
ALIMONY / CHILD SUPPORT VERIFICATION (Payor) .................................................................................................................. 99
ALIMONY / CHILD SUPPORT SELF CERTIFICATION ................................................................................................................. 100
4
DISABILITY/HANDICAPPED STATUS VERIFICATION .............................................................................................................. 101
EMPLOYMENT VERIFICATION ......................................................................................................................................... 103
DIVESTITURE OF ASSET VERIFICATION ........................................................................................................................ 105
STUDENT FINANCIAL AID VERIFICATION ................................................................................................................................. 107
Live-in Aide Housing Agreement........................................................................................................................................... 108
Military Pay Verification ...................................................................................................................................................................... 109
Public Assistance Verification .............................................................................................................................................................. 110
PHONE VERIFICATION/CLARIFICATION RECORD .................................................................................................................... 111
Real Estate Verification ........................................................................................................................................................................ 112
VERIFICATION OF REGULAR CONTRIBUTIONS ........................................................................................................................ 113
Self-Employment Verification (Existing Business) .............................................................................................................................. 114
Self-Employment Certification (for new business) ............................................................................................................................... 115
SELF-CERTIFICATION OF UNBORN CHILD/ADOPTION/CUSTODY ........................................................................................ 116
Social Security/ SSI Verification .......................................................................................................................................................... 117
STOCKS / BONDS VERIFICATION .................................................................................................................................................. 118
UNEMPLOYMENT COMPENSATION VERIFICATION ................................................................................................................ 119
Documentation of Unit Transfer ........................................................................................................................................................... 120
VETERAN'S BENEFITS VERIFICATION ......................................................................................................................................... 121
CERTIFICATION OF ZERO INCOME ................................................................................................................................ 122
Initial Tenant Payment Transmittal ....................................................................................................................................... 123
RENTAL APPLICATION ...................................................................................................................................................... 124
PROPERTY LISTINGS .............................................................................................................. Error! Bookmark not defined.
CORPORATE OFFICE INFORMATION ................................................................................. Error! Bookmark not defined.
Manager Updates .................................................................................................................................................................. 127
Rents ...................................................................................................................................................................................... 127
Applications........................................................................................................................................................................... 127
Recert Process ....................................................................................................................................................................... 128
Move-In Process .................................................................................................................................................................... 128
INTERIM CERTIFICATIONS: .............................................................................................................................................. 129
ANNUAL CERTIFICATIONS: .............................................................................................................................................. 129
NEW MOVE-INS: .................................................................................................................................................................. 131
Pre-Inspection checklist ........................................................................................................................................................ 133
RENT COLLECTION ................................................................................................................................................................. 134
Things To Remember ............................................................................................................................................................ 136
PAST DUE RENT COLLECTION REPORT ......................................................................................................................... 137
RENT PAYMENT PROCEDURES ........................................................................................................................................ 138
Aged Delinquent Report ........................................................................................................................................................ 139
5
FAIR HOUSING
 PROTECTED CLASSES
 FAIR HOUSING STATEMENT
 CASE STUDIES
6
MINNESOTA FAIR HOUSING
Protected Classes:
1.
Race
2.
Color
3.
Creed
4.
Religion
5.
National Origin
6.
Sex
7.
Marital Status
8.
Sexual or Affectional Orientation
9.
Disability
10. Reliance on Public Assistance
According to Minnesota Law, It Is Illegal to discriminate or treat any of the protected classes differently.
7
PO Box 456, Hopkins, MN 55343
(952) 935-0359
To:
All staff of Cepco Management
FROM:
Curt Carlson
RE:
Fair Housing Statement:
(952) 935-9612 fax
FAIR HOUSING STATEMENT
This organization shall be guided by the Equal Housing Opportunity Statement which is:
We are pledged to the letter and spirit of United States policy for the achievement of equal housing opportunity throughout the nation.
We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing
because of race, color, religion, sex or national origin.
All staff members shall adhere to our policy which is to: Obey all applicable federal, state and local fair housing laws; refrain from
discrimination regarding any application for housing on the basis of race, color, religion, sex, age, marital or familial status, national
origin, and physical or mental handicap (must possess capacity to enter into legal contract); and affirmatively promote fair housing.
Governing laws shall include the provisions of Title of the Civil Rights Act of .1964(42 USC 2000d et seq.), Title VIII of the Civil
Rights Act of 1968 (42 USC 3601 et seq.), and the Fair Housing Amendments of 1988, Executive Order 11246 and the Equal
Opportunity Act of 1974 as they relate to FMHA and the provisions of the Rumford Act and Unruh Act in California law.
All advertising shall conform to Section 804(c) of title VIII of the Civil Rights Act of 1968 (42 USC 3604 (c), as amended, which
makes it unlawful to make, print or publish, or cause to be made, printed, or published any notice, statement, or advertisement, with
respect to the sale or rental of a dwelling, that indicates any preference, limitation, or discrimination.
All advertising shall contain the Equal Housing Opportunity Logotype, statement or slogan. In all space advertising, the Equal
Housing Opportunity Logotype, statement or Slogan shall be of a size which conforms to the standards of Fair Housing Advertising.
Any human models used in photographs, drawings or other graphic techniques shall portrait persons in an equal social setting and
shall indicate that the housing is open to all without regard to race, color, religion, sex, national origin, age, marital/familial status and
physical or mental handicap (must possess capacity to enter into legal contract: and is met for exclusive use of one such group.
8
All signs erected on the project shall contain the Equal Housing Opportunity Logotype in a size which is clearly visible (3 to 5 percent
of sign size).
The Fair Housing Poster and the Equal Housing Opportunity Logotype shall be prominently displayed in the rental office.
A copy of the approved Affirmative Fair Housing Marketing Plan shall be posted in the rental office.
Minority or non-minority shall not be limited to a part of the housing project on the basis of race.
All groups, minority, non-minority, public assistance, working, single, married, elderly, and family should be spread as equitable
throughout the project.
Processing procedures shall be uniform for all persons. There shall not be different procedures utilized on the basis of race.
Staff shall make positive efforts to provide all app1icants with all assistance and information that they may need. Each applicant shall
be given a written of processing procedures, i.e., application review, determination of eligibility, credit check, etc., and the time
required for processing.
The marketing efforts shall be monitored to assure the marketing is attracting the desired mix of applicants, particularly those
identified as least likely to apply. Marketing strategies shall be adjusted as necessary to attract the desired mix of applicants.
An affirmative Fair Housing Marketing Plan has been submitted and approved for your particular project. It is the purpose of this plan
to show how we intend to attract and assist people who may be subject to housing discrimination on the basis of race, color, religion,
sex, age, martial or familial status, national origin or physical or mental handicap (must possess capacity to enter into legal contract)
and assure them that there is housing available for them at our project. It is incumbent on us to make certain that all groups are given
the opportunity to at least have the knowledge that our housing complex exists and that they will not be discriminated against on any
basis. It is the philosophy of this company that we not only comply with the letter of the law and do everything possible to help the
people who have in the past been discriminated against in the area of housing.
The marketing plan for your project may include:
1.
Newspaper advertisements that are attractive, descriptive and contain the Equal Housing Logotype or Slogan. Ads should
also be run in any foreign language newspapers when available.
2.
Newspaper articles that describe the project and its eligibility requirements. Newspapers are often
glad to write news stories on development of this kind as a part of their community relations
program.
9
3.
Radio advertisements can be either paid or free public service announcements. Foreign language
stations should be used when available.
4.
Posters which are attractive and contain descriptive information on the project and the Equal Housing Logotype can be
placed throughout the community in such places as:
Grocery Stores
Social Security Office
Employment Offices
Dept. of Human Services
Food Stamp Office
Churches
Neighborhood Bulletin Boards
5.
Fact sheets can be mailed or delivered to organizations with the ability to distribute them such as:
Churches
Community Organization
Senior Citizen Groups
6.
A large attractive sign will be located in a conspicuous location on the project site and will contain the Equal Housing
Logotype.
7.
A representative of the project (usually the manager) who is thoroughly familiar with the eligibility requirements, application
process, tenant selection criteria, and tenant certification procedures can be scheduled to speak at community gatherings and
meetings.
All personnel must be willing to take the time to explain the housing program and how the different requirements work to benefit the
potential tenant and the success of the project. Once this is understood, reasonable applicants will be willing to provide required
information.
It is required that all members of the on-site staff who will be involved in any marketing, tenant selection or application processing
read and become thoroughly familiar with the Affirmative Fair Housing Marketing Plan for their project.
Management as well as the agency governing your project will carry out periodic surveys to make certain that you are making every
effort to attract people who may not otherwise apply for housing in your project.
REMEMBER: FULLY DOCUMENT ALL OF YOUR OUTREACH ACTIVITIES.
10
RENTAL INQUIRIES
PROPERTY INFORMATION SHEET
TELEPHONE ETIQUETTE
INQUIRY LIST
PROPERTY INFORMATION SHEET
Property Name
Address of Property
Units
# of Units
Basic Rent
Market
Utility
Rent
Allowance
One Bedroom
Two Bedrooms
Three Bedrooms
Utilities Included in Rent
Heat
Water
Trash Removal
Air Conditioning
Income Limits
# of Household Members
Maximum Allowable Income
Maximum Allowable Rent
One
1 BR
Two
2 BR
Three
3 BR
Four
Five
Six
12
TELEPHONE ETIQUETTE
ANSWER THEPHONE WITH A SMILE. THE CALLER CAN HEAR YOUR SMILE.
The purpose of answering this call is to lease an apartment. In order to lease the apartment you need to gain information and give
information.
Lead the conversation. In order to complete the questions on your inquiry list you will need to gain the following information: Name,
Address & Telephone Number, size of unit they would like and month they would like to move in. Do not let the caller lead the
conversation, you will not get the information you need to perform your job.
Example:
SM:
Hello, Thank you for calling ________________ apartments.
My name is _________________ How may I help you?
Caller: How much are your2 Bedroom Apartments?
SM: What month are you interested in moving?
Caller: Not sure how much are they?
SM:
Our community is a Government Financed Property. We are unable to determine the amount of your rent with out completing a
full financial evaluation. Our community has a basic rent of $$$. We also offer rental assistance in which you would pay 30010of your
income. This assistance is assigned to those most in need. Usually a new move in doesn't qualify for rental assistance the first few
months (or years depending on your property). If your income exceeds the guideline for low income you may have to pay a higher rent
based on your income. Let me ask you few questions.
1.
How many people will live in the apartment?
2.
How many Adults / Children.?
3.
How did you hear about us? (used to measure which form of advertising is effective)
4.
And your name, I'm sorry I didn't catch your name.
We do have a three bedroom apartment coming available in May.
A.
Our property has income restrictions. What is your annual income? (If the caller is hesitant to give
income over the phone... rephrase the question. Is your annual below $$$$ (the maximum allowable income
for your property)?
Great it sounds like (Name of Apts.) would be the perfect place for you to live. I have an opening this afternoon at 2:00 to show you the
apartment, will that time work for you? In the event that I need to reach you before 2:00 what number may I call?
Included in your rent is (Name Utilities & Amenities). The security deposit is $$$. We have an application fee of $25 per person
(based on the info they gave you). Please bring along a money order payable to (PROPERTY NAME) so we may begin the application
process. If you would like us to hold the apartment and take it off the market you will need to pay a portion or all of your security
deposit.
13
~
RENTAL APPLICATIONS
RESIDENT SELECTION CRITERIA
RENTAL APPLICATION
PROCESSING INSTRUCTION
14
INTER-OFFICE MEMO
Effective November 1, 2001, Application fees collected from prospective applicants should be issued to the name of the property.
Checks and money orders should be made out to the property; and not Cepco Management Inc.
Each property has to utilized they established Rental Research account code. If you are unsure what that code is, please let your property
manager know. If there are property that do not have a Rental Research code, please have your property manager established one with
Rental Research.
Remember that we only perform instant inquiry checks for prospective applicants when a unit is available, remember that before an
instant inquiry is performed, the site manager should verify at least two-landlord references.
Also remember that HUD properties we cannot charge for application fees. We still perform landlord references and the instant inquiry,
however HUD does not want any applicant to pay for application fees. This monthly expenses just gets posted to account #6290.
* Accounting: The account code for Rural Development properties to post application received is #4125 -Application Fees Received.
The associated account to post the monthly expense is #5375 -Other Administrative Expense.
15
RESIDENT SELECTION CRITERIA
The following requirements must be met in order to become an applicant and to be placed on the waiting list.
1.
A completed Application for Occupancy, must be filled out completely and signed and dated by each adult member of the
household.
2.
A credit check will be run on every adult applicant to help determine payment history and current financial obligations. A written
report from the Credit Reporting Agency must be obtained and reviewed.
3.
Two previous landlords will be contacted in ordered to obtain past payment history and past rental history.
4.
Applicants must be income eligible for the complex as determined by RD, LlHTC, HUD, or MHFA income limits.
5.
Applicants must qualify under occupancy standards as determined by unit size:
1 bedroom: 1-2
2 bedroom: 2-4
3 bedroom: 3-6
6.
All income and expenses must be verifiable in writing.
7.
Households must show evidence of being able to meet household finances.
Applicants will be rejected due to:
1.
A history of unjustified and chronic nonpayment of rent and financial obligations.
Not to exceed:
.
a. two collection accounts.
b. one bankruptcy in the last three years.
c. no history of unlawful detainers.
d. no history of late rent payment.
e. history of poor housekeeping.
2.
A negative household budget after all income and financial obligations have been taken into consideration.
3.
A history of violence and harassment of neighbors.
4.
A history of disturbing the quiet enjoyment of neighbors.
5.
A history of violations of the terms of previous rental agreements such as the destruction of a unit or failure to maintain a unit in a
sanitary condition.
6.
Past convictions or arrests on the sale or possession or use of illegal drugs.
7.
Giving false or misleading information on the Application or Verifications.
8.
Income and/or employment that cannot be verified in writing by a qualified third party.
9.
Lack of credit needed in order to establish payment history of financial obligations.
10. Any convictions, arrests, unsatisfactory police reference and/or checks for criminal activity.
CEPCO MANAGEMENT INC IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER
PO Box 456, Hopkins, MN 55343* Phone 952.935.0359* Fax 952.935.9612
16
________________________________
Property Name
RENTAL APPLICATION
APPLICANT NAME: _____________________________________________________________________________
CURRENT ADDRESS: ____________________________________________APT.NO. ______________________
CITY, STATE, ZIP CODE: _________________________________________________________________________
HOME PHONE #: ____________________________________WORK #: ___________________________________
MARITAL STATUS:
MARRIED ______SINGLE_______PRIOR HOMELESSNESS:
YES _____NO_______
CURRENT LANDLORD: ________________________HOW LONG? ____________PHONE # _________________
LANDLORD'S ADDRESS: _________________________________________________WHAT RENT? ___________
PREVIOUS LANDLORD: ________________________HOW LONG? ____________PHONE # ______________
LANDLORD'S ADDRESS: _________________________________________________WHAT RENT? ___________
PRIOR APPLICANTS ADDRESS: _________________________________________________________________
NEAREST RELATIVE: _______________________PHONE #: ________________RELATION: ______________
ADDRESS: ______________________________________________________________________________________
CURRENT HOUSING STATUS
How many people live in your home now? _________How many bedrooms do you have?___________
_____Yes _____ No
Do you wish to move? What notice do you need to give?______________________________
_____Yes _____ No
Are you being evicted?
_____Yes _____ No
Are you being displaced from your home?
_____Yes _____ No
Do you require a Handicapped Apartment?
_____Yes _____ No
Do you want to claim Handicapped/Disability Status?
_____Yes _____ No
Will there be any changes in household composition within the next 12 months?
HOUSEHOLD COMPOSITION AND CHARACTERISTICS
MEMBER’S FULL NAME
LAST, FIRST, MIDDLE INT.
1.
2.
3.
4.
5.
6.
RELATIONSHIP
DATE OF
BIRTH
AGE
SEX
SOCIAL
SECURITY#
HEAD
STUDENT STATUS:
_____Yes _____ No
Is anyone in the household.18 years or older and a student? ________________________
ELDERLY FAMILIES ONLY:
_____Yes _____No
Do you have medicare? _____ If yes, what is your Medicare premium? _______________________
_____Yes _____No
Do you have any other kind of medical insurance? _________________________________________________
If yes, give policy number and amount? _________________________________________________________
_____Yes _____No
_____Yes _____No
_____Yes _____No
Do you receive medical assistance through the welfare department?__________________________
Do you have any outstanding medical bills on which you are. paying?________________________
Do you expect to have any medical expenses during the next 12 months? _____________________
If yes, amount of medical expenses____________________________________________________
TDD Telephone #(800) 627-3529
17
INCOME INFORMATION
Please answer each of the following questions. For each "yes” answer, provide the details in the chart below. Does any member of your
household now receive or expect to receive income from any of the following sources:
Yes
No
____
_____ Employment, full-time, part-time, or seasonal?
_____ _____ Unemployment Compensation?
_____
_____ Child Support Payments?
_____
_____ Alimony Payments?
_____
_____ Welfare Assistance?
_____
_____ Social Security Benefits?
_____
_____ Pension or Annuity?
_____
_____ Regular cash contributions from individuals not living in the unit?
_____
_____ Income from any other agencies?
_____
_____ Interest from checking and savings accounts. interest and dividends from certificates of deposit, stocks or bonds,
income from rental property?
_____
_____ Income from a dependent?
_____
_____ Did the family receive an earned income tax credit from their federal taxes?
_____
_____ Other Income?
For each Type of income that your household receives from above, give the source of the income and to whom it applies and amount.
FAMILY MEMBER
SOURCE OF INCOME/TYPE OF
INCOME
ANNUAL INCOME
1.
2.
3.
ASSET INFORMATION
Please check each asset that applies to you or a family member. For each one checked provide the details in the chart below.
_____Checking Account
_____Savings Account
_____Stocks
_____Bonds
_____Certificate of Deposit
_____Money Market Funds
_____Property
_____IRA
_____Keough Accounts
_____Pension Funds
_____Personal property held as an investment
FAMILY MEMBER
SOURCE OF ASSET/TYPE OF ASSET
VALUE
1.
2.
3.
Note: You must also include assets disposed of for less than fair market value during the past two years.
EXPENSES
_____Yes _____No
Do you pay for child care which enables you or another family member to work or go to school? If yes,
give name and address of' child care provided, weekly costs, and name of family member enabled to work.
_______________________________________________________________________
HANDICAPPED FAMILIES ONLY:
_____Yes _____No
Do you pay for a care attendant or for any equipment for the handicapped member of the family necessary to
permit that person or someone else in the family to work? If yes, describe expenses _____________
___________________________________________________________________________________
An application fee in the amount of ________ is required by the management for the purpose of checking the applicant's past credit,
criminal and rental history.
Which of the following units are you interested in? 1BR _______ 2BR _______ 3BR _______
I (we) certify this housing is/will be my (our) permanent residence.
I (we) do/will not maintain a separate subsidized rental unit in a different location.
I (we) certify all household and income information is correct.
_____________________________________
_______
_________________________________________
_____________________________________
_______
_________________________________________
(SIGNATURE)
(SIGNATURE)
The following information (a.b.c.) is requested by us in order to assure the Federal Government, acting through its Farmers Home Administration, that Federal Laws prohibiting discrimination against tenant applicants tenant
applicants on the basis of race, national origin, familial status, age, handicap and sex are compiled with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating
your application of to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of individual applicants on the basis of visual observation or surname.
a.
_____White, non-Hispanic
_____Black, non-Hispanic
_____Hispanic
b.
_____Asian or Pacific Islander
_____American Indian or Alaskan Native
c.
_____Sex of Tenant
_____Male
_____Female
18


Initial
Recertification
Property Name
Address
Move-in Date
ELIGIBILITY QUESTIONNAIRE
$___________Rent Amount
Unit #
HOUSEHOLD COMPOSITION
Applicants/residents, complete in your own handwriting. List the Head of Household and all other persons who will be living in the unit.
Give the relationship of each family member to the head. Each household member age 18 years or older must sign and date this application.
A household comprised entirely of students will be required to complete a Student Verification, if not otherwise qualified.
WILL THIS PERSON BE A STUDENT IN
DATE OF
SOCIAL
HOUSEHOLD MEMBER'S NAME
RELATIONSHIP
THE NEXT 12 MONTHS?
BIRTH
SECURITY NUMBER
YES/NO
1
HEAD
2
3
4
5
6
7
8
HOUSEHOLD INCOME INFORMATION
For each household member age ] 8 or older (including family members temporarily absent), list current and anticipated income for the twelve-month period
beginning on the anticipated move-in date or effective date of recertification. All information must be verified.
Include all full time, part time or seasonal income even if completing this application in the off-season.
DO YOU RECEIVE OR EXPECT TO RECEIVE
(check either YES or NO to each item, as applicable, and include gross monthly amount):
YES
NO
Gross Monthly Amount
1. Wages, salaries (include overtime, tips, bonuses, commissions)
$
2. Does any member work for someone who pays them in cash or has self-employment income
$
3. Regular pay for a member of the armed forces
$
4. Public Assistance (MFIP, GA)
$
5. Worker's compensation.
$
6. Unemployment benefits or severance pay.
$
7. Student financial aid (public or private, not including student loans)
$
8. Child support (check yes if you have a court order, even if you are receiving less than the full amount awarded)
$
9. Alimony/Spousal Maintenance
$
10. Social Security income (including unearned income of minor children)
$
11. Disability benefits including social security disability
$
12. Regular payments from pensions (PERA, railroad, etc.)
$
13. Regular payments from retirement benefits
$
14. Death Benefits
$
15. Regular payments from annuities or life insurance dividends.
$
16. Regular payments from inheritance, insurance settlement, lottery winnings, etc.
$
17. Net income from rental property
$
18. Regular cash and non-cash contributions, assistance with paying bills or gifts from individuals not living in
the unit (not including groceries)
$
19. Other (list)
$
20. Other (list)
$
19
HOUSEHOLD ASSET INFORMATION
Yes
No
CURRENT
DOES ANY HOUSEHOLD MEMBER (INCLUDING CHILDREN) HAVE MONEY HELD IN:
BALANCE
22. Savings Accounts
$
$
23. Stocks
$
24. Capital Investments
$
$
21. Checking Accounts (6 month average balance)
25. Bonds
26. Trusts*
$
$
$
27. Securities
28. Whole Life Insurance Policy (do not include term life insurance)
29. 401K*
$
30. IRA/KEOGH Accounts
$
31. Certificates of Deposit
$
32. Pension/Retirement/Annuity accounts
$
33. Money Market Funds
$
34. Treasury Bills
$
35. Safety Deposit Box
$
36. Lump Sum Payment (i.e., inheritance, insurance settlement, lottery winnings, capital gains).
$
37. Are any accounts held jointly with someone not in the unit? Which account and with whom?
38. Other
*Include Trusts, 40IK, etc., only if the accounts are accessible to the household prior to termination of employment, retirement, or death. (If you are unsure, list the account and it will be
verified.
Yes
No
Value
39. Do you now own Real Estate?
If yes, list address(es):
$
40. Do you hold a contract for deed?
$
41. Do you have any coin collections, antique cars, gems/jewelry, stamps or any other items held as an investment
(wedding rings and personal jewelry do not count)?
$
42. Are any assets held jointly with another person? List person and asset(s).
Is combined cash -value of all household assets under $5,000?
From 1-42 above, provide further information for all "YES" checked items.
(If a household member has more than one source of income and/or assets, use a separate line for each source. Use additional sheets, if necessary.)
Item
Number
HH Member
Name and mailing address of company, financial institution or source
Contact Name & phone/fax
number
.
Please attach documentation available to verify income (i.e., divorce/settlement papers, tax returns, social security benefit award letter, etc.)
20
I/We hereby certify that I/we
Have
Have not
sold or given away any assets for less than Fair Market Value during the two year (24 month) period preceding the date of this application. Any assets
sold or disposed of for less than Fair Market Value must be identified below
Household Member
Asset & Estimated Market Value
Date sold/disposed
Amount Received
$
$
MEDICAL EXPENSES
If you are age 62 or older, handicapped or disabled, do you pay for any of the following medical expenses?
Check either YES or NO in response to each Question. Add an explanation below for ail items checked YES.
Yes
No
Do you receive Medicare Benefits?
Do you have a Supplemental Health Insurance policy?
Do you pay "out of pocket" expense for doctors and/or dentists
Do you pay "out of pocket" expense for prescription medications
Do you pay "out of pocket" expense for glasses, hearing aids, etc.
Do you pay "out of pocket" expense for transportation services to/from a medical facility
MISCELLANEOUS
The following questions pertain to yourself and every member of your household who will occupy the unit. Check either YES or NO in response to each question. Add an
explanation below for all items checked YES.
Yes
No
Will any household member, including children, live in the unit on a less than full time basis?
Do you anticipate "any change in your household (someone moving in or out) during the next 12 months?
Does any adult member of the household have zero income?
Does/will the household receive rent assistance? If so, indicate from what source (Section 8, Rural Development RA, etc.).
Does your household have any needs that might be better served by an apartment which is accessible to persons with mobility, hearing or visual impairments?
Explanation:
__________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
SIGNATURES
I/we hereby affirm that the foregoing information is true and complete to the best of my/our knowledge, and authorize the Landlord to make inquiries to verify the statements herein. I/we
further understand that any intentional misrepresentation in this application might result in a default in the rental agreement and/or eviction of this household If any of the aforementioned
information changes, I/we agree to notify Landlord immediately.
All household members age 18 or older (and under age 18 if head, spouse, or co-head of household) must sign and date below:
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
3 0f 3
21
Minnesota Housing Finance Agency
GOVERNMENT DATA PRACTICES ACT
DISCLOSURE STATEMENT
PRINT NAME(s) OF HOUSEHOLD MEMBERS
SIGNING THIS FORM
Minnesota Housing Finance Agency ("MHFA") is asking you to supply information that relates to your
application to occupy, or continue to occupy, a unit in the following property ("Property"):
Some of the information you are being asked to provide to MHFA may be considered private or confidential under the
Minnesota Government Data Practices Act, Minnesota Statutes chapter 13. Section 13.04(2) of that law requires that you
be notified of the matters included in this Disclosure Statement before you are asked to provide that information to
MHFA. The owner of the Property ("Owner") may also ask you to supply information that relates to your application.
The Owner's request for information is not governed by the Minnesota Government Data Practices Act.
1. MHFA is asking for information that is necessary for the administration and management of a State or Federal
program to provide housing for low and moderate-income families. Some of the information may be used to establish
your eligibility to initially occupy, or to continue to occupy, a unit in the Property and/or to receive either State or
Federal rental assistance. Other information may be used to assist MHFA in the evaluation and management of some of
the programs it operates.
2. As part of your application, you are asked to supply the information contained in each of the following
Attachments that are checked with an "X" (all checked boxes apply):
 Attachment 1 - Section 8, 236, and 202 Programs  Attachment 4 - Deferred Loan (other than MARIF)
 Attachment 2 - Housing Tax Credit Program
 Attachment 5 - MARIF
 Attachment 3 - ARM or LMIR First Mortgage
 Attachment 6 - HOME
Each Attachment has two parts: Part A and Part B.
3. The information asked for under Part A of the checked Attachment(s) may be used by MHFA to establish your
eligibility to occupy a unit in the Property or to receive State or Federal rental assistance. If you refuse to supply any
portion of the information asked for under Part A of the checked Attachment(s), you may not qualify for initial or
continued occupancy of a unit in the Property or for receipt of State or Federal rental assistance.
22
4. The information asked for under Part B of the checked Attachment(s) will help MHFA in the evaluation and
management of some of the programs it operates and your supplying of this information will be very helpful to the
MHFA. Your failure to provide any of the information asked for under Part B of the checked Attachment(s) will not
affect whether or not you qualify for initial or continued occupancy of a unit in the Property or for State or Federal rental
assistance.
5. The Owner may also ask for information to determine whether or not it will rent a unit in the Property to you.
Your supplying of, or refusal to supply, any information requested by the Owner will not affect a decision by MHFA, but
could affect the Owner's decision of whether it will rent a unit to you. The determination by the Owner is separate from
MHFA's determination and MHFA does not participate, in any way, in the Owner's decision.
6. All of the information that you supply to MHFA will be accessible to staff of the MHFA and may be made
available to staff of the Office of the Minnesota Attorney General, the United States Department of Housing and Urban
Development, the United States Internal Revenue Service, and other persons and/or governmental entities who have
statutory authority to review the information, investigate specific conduct, and/or take appropriate legal action, including
but not limited to law enforcement agencies, courts and other regulatory agencies. The information may also be provided
by MHFA to the Owner's management agents of the Property. Under certain circumstances the information that you
supply to MHFA may become public data and available, upon written request, to the general public.
7. This Disclosure Statement remains in effect for as long as you occupy a unit in the property and are a
participant in the program(s) identified in #2, above.
I was (We were) supplied with a copy of and have read this Minnesota Housing Finance Agency Government
Data Practices Act Disclosure Statement and the Attachment(s) identified in #2, above.
Head of household, spouse, co-head and all household members age 18 or older must sign below:
Applicant/Tenant Signature
____________________________________
Date
________________________
Applicant/Tenant Signature
____________________________________
Date
________________________
Applicant/Tenant Signature
____________________________________
Date
________________________
Applicant/Tenant Signature
____________________________________
Date
________________________
23
EMERGENCY CONTACT INFORMATION
Property:____________________________________________________________________
Resident:_____________________________________________________________________
Unit #:________________________________________________________________________
Phone #:______________________________________________________________________
Work phone #:__________________________________________________________________
PERSON(S) TO CONTACT IN CASE OF AN EMERGENCY:
_______________________________________________________________________________________
Name
Address
Phone Number
_______________________________________________________________________________________
Name
Address
Phone Number
_______________________________________________________________________________________
Name
Address
Phone Number
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
www.cepcomanagement.com
24
Processing Instructions
Rental Applications
1.
All prospects must be offered an application.
2.
Applications packets are to include the resident selection criteria and be reviewed with the applicant prior to
accepting the application fee.
3.
Application must be processed within 24 hours of receiving the application fee. An application fee can not be
accepted by the site manager unless there is a unit available for that applicant to move into. If an applicant is just
applying for the waiting list, the fee cannot be accepted and the application cannot be processed until there is a unit
available.
4.
Application fee is $25 per person. Money Order or Cashiers Check ONLY. Must be made payable to the property.
NOTE: PROJECT BASED SECTION 8 HUD PROPERTIES DO NOT CHARGE AN APPLICATION FEE.
Call Rental Research 1.800.328.0333
Ask for "Instant Inquiry"
Your account number is ________________________.
The report will be faxed directly to your Property Manager who will make the final determination if the applicant is
approved. This approval is on credit/criminal ONLY, pending the outcome of Income calculations and landlord
references. Your Property Manager will initial the report and mail the original to you.
Fax two Landlord Reference forms to previous landlords.
If references check out good, you can process the applicant for move in.
25
WAITING LIST
WAITING LIST FORM
INSTRUCTIONS FOR COMPLETING WAITING LIST
DENIAL LETTER
WAITING LIST UPDATE LETTER
26
INQUIRY LIST
Property Name:
Date /
Time
of Call
Page:
Date/
Time
Call
Name & Phone # of Caller
How they
heard of us.
Returned
27
Appointment OUTCOME
(rented,
Apartment
set for
Needs
showing /
application
denied,
declined)
RRH APPLICATION/WAITING LIST FOR OCCUPANCY
Project Name: ________________________________________ Location: ______________________________________
Applicant Information
Selection Criteria
PHONE
DATE
&
TIME
NUMBER
NO
ETH
RACE CODES: 1 - American Indian/ Alaskan Native 2
ETHNIC CODES: a
- Non Hispanic
b
- Asian
3
0
RA
LEASE
DATES CONTACTED FOR OCCUPANCY
L M
I
P
Y/N
Y/N
I
2
3
4
& COMMENTS
E
- Black or African American
- Hispanic
28
W/R
DATE &
UN
V
L
UNIT SIZE
HC
HH
NAME/ADDRESS
NO.
L
INCOME
RACE
APP
4 - Native Hawaiian or Pacific Islander
5
– White
UNIT #
DATE
NOTICE OF DENIAL OF APPLICATION
DATE:
Dear _________________:
Please be advised that according to the information we received from your application and from:
Rental Research Services, Inc.
11300 Minnetonka Mills Road
Minnetonka, MN 55305-5151
952/695-2181
your application for housing at
has been rejected for the
following reason(s):
(
)
Your household income exceeds the applicable income limits.
(
)
Your Household size/ composition is not appropriate for the size/type of units that are available.
(
)
Inability to fulfill obligations and comply with all terms of the previous/current Lease Rental Agreement.
(
)
A history of criminal activity involving crimes of physical violence to persons or property, drug related crimes
or a record of other criminal acts which may endanger the health, safety and/or welfare of the other residents.
(
)
Eviction for material noncompliance or "other good cause" from current or previous housing.
(
)
Incomplete application and/or misrepresentation on application or during interview.
(
)
Unfavorable credit history.
(
)
A record of disruptive behavior.
(
)
A record of Destruction of property.
(
)
A record of poor housekeeping habits.
(
)
Other
You may request a meeting to discuss this notice or submit a written response to this office within fourteen (14) days of
this notice. You should also be aware that your response to this notice would not prevent you from exercising other
remedies available to you if you believe you have been discriminated against.
The Fair Housing Act prohibits discrimination in the sale, rental or financing of housing on the basis of race, color,
religion, sex, handicap, familial status, or national origin. Federal law also prohibits discrimination on the basis of age.
Complaints of discrimination may be forwarded to the Administrator, Department of HUD, Washington, D.C. 20250.
Sincerely,
_______________
Site Manager
CEPCO MANAGEMENT INC IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER
29
PO Box 301, Waite Park, MN 56387- Phone 320.202.2967. Fax 320-202-7809
WAITING LIST UPDATE LETTER
DATE:
We have been unable to contact you regarding your application for the
.
In order to maintain your status on the waiting list, you will need to contact us regarding the following.
( )
We do not have a current application in our files for your family. Please fill out and return the enclosed
application so we may put you on the waiting list for any apartments that may come available in the future.
( )
Your current application is not filled out completely. Please fill out the enclosed form completely and return it
to us. You are currently on the waiting list and this will not change your status.
If neither of the above items ale checked, please mark one of the following:
( )
YES - Please keep my name on the active waiting list for an apartment. My current phone
number is
( )
NO - I am no longer interested in moving into an apartment. P1ease remove my name from the
waiting list.
You must return this letter within 10 days after you receive it or your name will be removed from the current waiting list.
You may then re-apply at any time.
The Fair Housing Act prohibits discrimination in the sale, rental or financing of housing on the basis of race, color,
religion, sex, handicap, familial status, or national origin. Federal law also prohibits discrimination on the basis of age.
Complaints of discrimination may be forwarded to the Administrator, Department of HUD, Washington, DC 20250.
RETURN FORM TO:
(AND APPLICATION IF INCLUDED)
30
1 copy to applicant
1 copy in waiting list file
31
CEPCO Management, Inc. would like to welcome you to your new home and
neighborhood. We hope that you will be happy here.
It is a pleasure to present to you this resident's guide which we feel will help you to
learn about our services and facilities. Pleasant living depends largely upon
cooperation and understanding by you and your neighbors. Consideration of your
neighbors, and their consideration of you will make your living here a happy
experience. Please read this guide carefully and keep it handy for easy reference
when you are in doubt about regulations.
Please read again your rental agreement carefully. If there is anything you do not
understand, we would appreciate having you come into the office at your earliest
convenience and discuss it with us.
CEPCO Management, Incorporated manages _______________________________.
Your full cooperation in keeping the operating expenses at a minimum will make it
possible to maintain rents as low as possible.
For your information, the Management Staff and Emergency Services are as follows:
CEPCO Management, Inc.
Management Agent
32
HOUSE RULES
THESE RULES WILL BE MADE AN ADDENDUM TO YOUR LEASE AND VIOLATION OF ANY OF THE
FOLLOWING WILL BE CONSIDERED A LEASE VIOLATION.
HOW TO PAY YOUR RENT
Rent payments must be dropped in the Rent Box at your site or mailed to CEPCO Management, Inc., P.O. Box 456,
Hopkins, MN 55343.
Make payable to_______________________. Rent must be either check or money order and include your name and
apartment number. DO NOT SEND OR BRING CASH to pay your rent.
RENT IS DUE ON OR BEFORE THE FIRST OF EACH MONTH
If rent is not RECEIVED by the fifth of each month, a late rent/termination notice for violation of lease will be given to
you. If rent is unpaid after the FIFTH of the month, a fee will be assessed to your account and added to the delinquent
rent. The Management Agent may initiate an unlawful detainer action at this time with the courts to have you evicted and
regain possession of the rental unit.
If you know you will be having difficulties in a given month, you must contact the Property Manager before the first of
that month to make arrangements for payment.
OCCUPANCY
The only persons authorized to live in your unit are those listed on the lease. You may have guests overnight, but if they
stay with you more than three days in a one month period, you must notify the Management. Allowing persons other
than those listed in your lease to live with you is prohibited, and in violation of your lease. You must promptly notify
Management of any changes in your family size. Anyone staying in your apartment for more than a two week period,
without prior written approval of the management, must contact the Site Manager to apply for residency. A credit and
reference check will need to be done before we can allow them to continue to reside on the property.
Please conduct your activities in and around the building in a manner so as not to interfere with the rights, comforts or
convenience of your neighbors. No musical instruments, radios, televisions, or phonographs shall be operated in a
manner that is disturbing or annoying to other people, nor will loud disturbing noises be tolerated. After 10 P.M. all
noise must be minimal, and should not able to be heard outside your own unit. Residents are responsible at all times for
the conduct and any damage caused by their family and guests.
KEYS
You will be provided with one key to the apartment, mailbox and garage (if required) upon commencement of your
occupancy. You may make additional keys for your own use, but should not give keys out to anyone other than
registered occupants of the unit. Should you lose your keys, report it to the Site Manager immediately? Management
will provide you with a key at a replacement cost of $10.00 for unit key and $5.00 for mailbox or garage key.
RESIDENTS MUST NOT ALTER, CHANGE, OR ADD ANY LOCK ON A DOOR without prior WRITTEN
33
permission of management. If at any time, you find yourself locked out of your apartment without keys, the Resident
Site Manager will let you in the first instance, but if you need to be let in more than once, you will be charged a service
fee $10.00. It is your responsibility to make yourself a key immediately if you lose yours.
RIGHT OF ENTRY
The Management reserves the right to enter your rental unit at reasonable hours to inspect the unit, to check or repair
equipment, and in case of an emergency, to protect the property. This right of entry is reserved whether or not you or any
member of your family is at home. In the event that all family members are to be away for any length of time, you must
notify the Site Manager and give us an address or phone number where you may be reached in an emergency. The
Management Agent may also conduct monthly or annual apartment inspections.
PETS
There is a no pet policy at this property. If you are caught with an animal in your unit, you could face eviction. Please
inform any guests that they are not allowed to bring pets onto the premises for any length of time. If you are aware of any
other residents harboring pets, please notify management. It will be kept confidential.
PARKING LOTS. CARS AND WALKWAYS
Parking space is provided for you throughout the property. We cannot allow cars to be overhauled, motors changed, or
any major repairs made while standing on a parking lot. Oil is not to be changed, drained or disposed of at any place on
the property. There is no driving on the grass. No parking is allowed at any time in handicap parking spaces unless you
are assigned one or have a valid disabled parking sticker.
No unregistered vehicles may be kept on the property premises at any time. Such vehicles will be towed away at the
owner’s expense. Inoperative vehicles will not be allowed on the premises and all vehicles should be locked at night.
Parking space is limited, if you have a garage, we encourage you to keep your vehicle inside, especially during the
winter months to aid in snow removal.
Walks and driveways must not be obstructed or used for storage. This includes BIKES and TOYS. All residents should
instruct their children to store bikes and toys inside garages or at the bike rack if one is provided. If these items are left
out overnight, management may confiscate them and require a $2.00 fee to reclaim them. If these items are left
unattended, it is an open invitation to theft and vandalism and can create dangerous situation if someone trips over one
and gets hurt.
LAUNDRY ROOM
Complete coin-operated laundry facilities are available to you. The Management reserves the right to prohibit the use of
the laundry rooms to anyone failing to comply with normal precautions and regulations. No minors are allowed in the
laundry rooms unless they are accompanied by a parent or guardian. We can not permit laundry of relatives, friends or
outsiders to be done in our facilities. If abuse occurs it will result in higher laundry prices.
34
Washers. Follow recommended loading instructions. Do not overload washers. Use low-suds detergents in correct
amounts. It is the responsibility of each tenant to clean up after themselves. Clean dispenser and lint filter after use. Wipe
off soap, bleach, stains on machine exterior. Do not use for tinting or dyeing. Leave lid or door open after washing is
finished so the Interior may dry.
Dryers. Do not overload. Each tenant must clean lint screen and trap after each load for faster drying. Place delicate
items in laundry net for drying. Remove all objects from clothes prior to drying. Remove wash and wear items from
dryer as soon as cycle ends to prevent re-wrinkling.
Do not leave your clothing in the machines after they are done. Remove immediately so others can use the machines.
Failure to obey these rules could result in your not being allowed to use the laundry facilities.
Please be sure the doors are closed while you are not in the laundry room, and turn off the lights when you leave.
LAUNDRY ROOM HOURS
Laundry room hours are 8:00 AM. to 10:00 P.M. Any clothes left unattended in the laundry room, for more than one
hour, may be removed and placed in storage. It will be necessary to pay a $2.00 fine to recover your clothes. Please time
your washes so you can remove them and avoid the Inconvenience of a charge. This rule is implemented to keep our
laundry facilities neat, to allow others access to the room, and to keep thefts to a minimum.
Each resident should be considerate of others and try to use the laundry no more than two hours at a time. If you need a
machine and there are finished loads in them, you may remove the items and lay them on the table. Please do not remove
items that are still running a cycle.
If you notice anyone who is abusing the laundry rooms, we strongly encourage you to report them to the management.
Vandalism and misuse may lead to the removal of the machines.
TRASH
All garbage shall be deposited in the containers provided for your building. All garbage must be put into plastic bags and
tied before depositing in the building trash container. If RECYCLING BINS are provided for your use, please recycle all
cans, glass, plastic and paper according to instructions posted. Bags that are not thrown into the dumpster will be
checked to obtain the address of the resident and a violation notice will be issued.
Do not allow garbage to accumulate inside your apartment. This will lead to insect and rodent problems.
DO NOT DISPOSE OF tires, household furniture or appliances in the dumpster area. These are your personal
responsibility to dispose of elsewhere. Do not discard broken windows, screens or other items that belong to the
property. Take such items to the Site Manager for replacement or repair.
REPAIRS AND MAINTENANCE
Please notify the Site Manager in writing of any and all necessary repairs and maintenance. Please be sure to date your
request. No repairs can be done without a written work order. Normally, there will be no charge for repairs unless
35
negligence by the tenant has taken place. Please do not attempt to make any repairs yourself. If you need work orders,
contact your Site Manager.
Service calls to outside plumbers and other tradesmen will be placed by the Management only. Any service calls made
by the tenant without authorization from Management will be the sole responsibility of that tenant.
Report all emergencies immediately to the Site Manager. Please be careful on what is flushed down the toilet. Do not
put disposable diapers, sanitary pads or tampons in the toilet. Report all leaky faucets as soon as possible. Failure to
report plumbing problems that result in damage to any apartment will be considered negligence on your part and repairs
will be billed to you.
Damaged or broken doors, windows or screens need to be reported to the Site Manager immediately. DO NOT throw
away any damaged screen or window frames. They are needed to order replacement parts. Contact the Site Managers and
give the Items to them, and request maintenance to repair the item. It is your responsibility to keep your apartment unit in
good condition by letting us know when work is needed.
CARE OF UNIT
Floors. Carpets should be vacuumed THOROUGHLY at least once a week. Most carpet stains from food and beverage
can be cleaned up with a damp sponge and mild detergent. Be sure to do it right away because stains will set in if
permitted to remain for even a few hours. Please contact the Site Managers IMMEDIATELY for stains which will not
come out, and we will help you.
It is the Tenant's responsibility to pay the cost to shampoo their carpet at least once a year by a professional carpet
cleaner. Management will inspect the carpet at your re-certifications time to determine if it is necessary and will make
arrangements to have it done. Possible arrangements may be made by a number of residents to shampoo at the same time
and get a group discount. You are expected to keep the carpet in good condition.
To clean vinyl kitchen floors, use a mild detergent and warm water and rinse well with clean water. If you wish to wax
the floor, be sure the product is for vinyl floors.
Interior Walls. When washing, add two fluid ounces of a light duty liquid detergent to each gallon of water. Apply with
cellulose sponges and very little water. Start at the bottom of the wall and work up, washing a small area so that it may
be rinsed before drying. In stubborn cases a light sprinkle of household ammonia or soft scrub is suggested.
Because of the damage that could occur to ceilings and walls by residents hanging lamps, pictures, or mirrors, we prefer
that such work be done by the management staff, and labor and material charge will be assessed.
Inside walls of the units are drywall: thus the hanging of pictures of a weight not exceeding twenty five (25) pounds can
be done by using a picture hook. Anything heavier than twenty five pounds can be installed by using molly-bolt or
togg1e-bolt. This however will require the drilling of a hole through the drywall and inserting the molly-bolt or togglebolt. It should be pointed out that any drilling of holes either in the ceiling or sidewalls will require patching and painting
at time of move-out.
36
No wallpapering will be allowed whatsoever. Prior consent must be received for painting within the unit. Routine
maintenance cycle painting shall be performed every four years or as needed.
Refrigerators. Wash the food compartment in warm water to which two tablespoons of baking soda have been added for
each quart of water. No frost refrigerators are provided in your unit. If food is too warm or too cold, check the control
valve to see if it may have been moved by mistake. If too much frost is forming, it may be caused by higher than normal
humidity, uncovered dishes in the food compartment, frequent openings or infrequent defrosting. You are to clean the
coils behind or under the refrigerator every three or four months to remove the lint and dust. This will keep your
refrigerator running more efficiently, and save you money.
Ranges. If the oven does not heat properly, make sure that burners or heaters are property installed.
They are removable for easier cleaning, and must be correctly replaced after being cleaned. On a monthly basis, clean the
kitchen exhaust hood and fan, the light bulb, and filter to remove grease or other foreign materials. Clean your oven with
oven cleaner as needed and do not let a build-up accumulate. Report any need for adjustment or repairs immediately.
Countertop Care. Do not place burning objects, cigarettes, range and oven containers directly on the Formica surfaces.
Also, do not chop foods or pound meat directly on the countertops. The purchase of a cutting board is advised. Most
other ordinary marks or stains can be removed by lightly rubbing with a cleanser powder, wiping dry and applying a coat
of wax.
Electrical light bulbs. Light fixtures provided as standard equipment in the units are supplied with light bulbs at the time
of initial occupancy. Residents are responsible for replacement thereafter. However, contact the Site Managers for help
for hard to reach fixtures. (e.g. kitchen fluorescent fixtures). At the time of move-out, you must make sure all light bulbs
are furnished and working.
Sinks and Toilets. Care should be taken to prevent chipping or staining enamel of porcelain fixtures. "Tackle" or Limeaway is what works best without scratching. Especially the shower stall requires this to keep it clean. Do not dispose of
garbage, grease, or coffee grounds in sink drains. If you find you have drippy faucets, or the toilet is stopped, please
contact the Site Managers, and needed repairs will be made.
Telephone. If you desire a telephone, you are to make your own arrangements with the telephone company. The Site
Managers phone is not to be used by residents. Their number is not to be given out as a means of getting in touch with
any tenant.
Security. A dead bolt lock and/or a front entrance door lock offer you a very secure apartment. Remember to lock the
doors and to take a key along whenever you leave your apartment. The management cannot be responsible for your
possessions. We suggest that you carry insurance on your personal property and possessions, as we cannot cover these
under our policy. If you wish to be covered against theft or fire, etc., you must arrange for this yourself.
Water Beds. Because of the excessive weight and the danger of leaking and damage to carpeted areas, water beds cannot
be permitted in any apartment
37
Windows. To enhance the quality appearance of your residence, your drapes must be lined white or show white to the
outside so the appearance of all windows from the outside of the building is the same. Drapery sizes you will need to fit
the existing traverse rods can be obtained from management. Hanging sheets or other materials instead of drapes or
curtains IS NOT ALLOWED. It is the responsibility of the tenant to keep the windows in his/her apartment clean. If you
are unable to do so, you may make arrangements with the Site Managers or other persons to do the cleaning for you at
your own expense.
You must clean out the tracks of the windows whenever dirt accumulates. If left to build up, the dirt will cause the roller
to break making it very hard to open the windows. Upon move-out, you must leave all window tracks and windows
clean.
Heating and Freeze-ups. In order to keep your rent at an affordable level, we need your help in keeping the need for extra
heating fuel at a minimum. Please try not to waste fuel by turning the thermostat higher that normal or leaving windows
open when it is cold outside. Make sure your storm windows are closed tightly. Please do not turn the thermostat to an
off position and leave a window open. This can result in broken water pipes and a large repair bill for you.
UNIT TRANSFERS
It is the policy of management not to allow residents to transfer from one unit to another. A transfer fee may be charged.
We do acknowledge that there are occasions when it may be necessary to do so, such as:
1. Medical need of a handicapped unit
2. Medical need of a first floor vs. second floor
3. Change in family size requiring a different size unit.
4. Other reasons will be evaluated on an individual basis.
PLANNED ABSENCES
It is required that you inform the Site Managers of any planned absences longer than 14 days. In the event of an
unplanned absence greater than 14 days you should attempt to contact management also. Please be prepared to provide
management with an address and phone number where you can be reached and approximately how long you will be
gone.
When you leave your apartment for any length of time, lock your door. Also turn off the TV or radio as to not bother
your neighbors.
It is required by your lease that if your absence is greater than 60 days without prior authorization of Management, your
rent shall Increase to the market rate rent.
RECERTIFICATION OF INCOME AND ASSETS
One of the requirements of your lease, Rural Development's and Low Income Housing Tax Credit occupancy regulations
provide that you must have your income and assets be verified for the purpose of recertifying your occupancy eligibility
38
and rent level at least once a year on the anniversary of the date you moved in. Your failure to complete recertification
will result in your rent increasing to market rate rent. Additionally, you are required to immediately report any changes
in your family composition or change in your income or asset sources. These changes may result in an increase or
decrease in your monthly rent.
MOVING OUT
Your lease requires that you give management thirty days or sixty day (depending on your lease) prior notice to the
expiration of the lease in the event you intend to move from your rental unit. This notice is required in writing, given to
the on-site Site Managers. The termination notice must be for a full rental period. The rental period is from the first day
of the month to the last day of the month. IF YOUR WRITTEN NOTICE IS NOT RECEIVED BY THE MANAGERS
BY NOON of THE LAST OF THE MONTH PRIOR TO THE MONTH YOU PLAN TO VACATE, YOU WILL BE
RESPONSIBLE FOR AN ADDITIONAL MONTH.
Be sure to leave your unit clean, pay all rent and other charges that may be due, and turn in your keys.
A final inspection of your unit is required with you in attendance. All the above are required to assure the return of your
security deposit. Please leave a forwarding address at the Post Office, as well as with the Site Managers for sending the
security deposit.
All residents MUST vacate their rental units by NOON on the last day of the month that their notice was given. Contact
your Resident Managers and set up an appointment for a walk through inspection to be scheduled BEFORE NOON and
return all your keys and give them your forwarding address.
ADDITIONAL REGULATIONS
NO BICYCLES, SKATEBOARDS, ROLLER BLADES OR TOYS ARE ALLOWED INSIDE THE COMMON
AREAS OF THE APARTMENT BUILDING. Roller blades should be put on and taken off OUTSIDE the building.
Bicycles are to be stored in the bike rack and secured for you own protection or in your garages or apartment. Bikes are
not to be left on the sidewalks or in the buildings at any times. Any bikes or toys left outside after 10 PM may be
confiscated by the Site Managers and a $2.00 fee will be due to recover the item. This rule is necessary In Insure
compliance and to curb the theft of your personal items.
Children should be encouraged to remove their boots in the entryways and knock snow off them before carrying them to
their apartment. Do not throw paper, food, bottles or cans on the grounds or in the hallways. Dispose of waste properly to
help keep you home area neat. We encourage parents to make an effort to involve your children in the clean up of the
buildings and grounds and a regular basis. This helps instill pride in their home and teaches them the value of helping
others by giving them a task to perform.
ABSOLUTELY NO SMOKING IN Common Areas of the apartment buildings. THIS INCLUDES THE ENTRY AND
LOBBIES AND ALL LAUNDRY ROOMS. IF FOUND VIOLATING THIS RULE, AN IMMEDIATE EVICTION
NOTICE WILL BE SENT. THERE Will BE NO EXCEPTION TO THIS RULE.
39
If you smoke outside, it is YOUR responsibility to pick up your cigarette butts and dispose of them properly. Do not
throw them in the rocks, grass, or on the walkways.
CHARCOAL GRILLS
Charcoal grilling is not allowed inside any building at any time. All grills must be used at least 15 feet away from any
structure. You may set them on the sidewalks or outside the back doors at the proper distance. These are fire code rules
and must be followed. If you do not cooperate, we be forced to ban any and all grilling anywhere on the premises. If you
have grills, they are not to be left outside after use. You must store them inside your apartment
These rules and suggestions are not meant to restrict you in your new home, but to familiarize you with these items about
which you will want to be informed from time to time. We cannot hope to cover everything in this guide about which
numerous questions will undoubtedly arise. We reserve the right, therefore, to add to, or change, the instructions and
suggestions contained herein.
FIREARMS / FIREWORKS
The discharge of a firearm is not allowed on the property. The definition of a firearm is any apparatus that fires a
projectile (lead, steel, plastic, rubber, BB, etc.) and could cause injury to the resident, other residents or their guests. If a
firearm is to be stored on the property, it must be secured in a locked case at all times.
The discharge of a firearm, or storage in an unlocked case, will be grounds for immediate termination of the lease,
without warning.
We welcome you to your new apartment home, and wish you a pleasant stay in your new home.
Welcome Home!
Your new address is:
Avenue South #
Foley, MN 56329
Please contact Excel Energy and have the electricity hooked up in
Your name @ 1.800.895.4999
Cable TV - US Cable 1.800.642.5509
They only service Foley every other Tuesday so schedule immediately.
Qwest Phone Service: 1.800.244.1111
The controlled access system works through your phone. You do not need phone service for this feature to work! You
will hear 2 short rings. Answer your phone. Press the 9 to allow access to the building. If you are on the phone you will
hear a clicking noise, press the flash or talk button answer the door and push 9.
If you need anything, please feel free to contact me at my office 968-6314 Monday through Friday 8:30 a.m. to 5:00 p.m.
Please leave your telephone number on every voice message so I may return your call if I am not in the office.
40
MOVE-IN CHECKLIST
Area
Condition
Description
Kitchen
Walls
Window/Screens
Shades/Drapes
Woodwork
Floor
Counter Tops
Cabinets
Sink
Range/Oven
Refrigerator
Exhaust Hood
Bedroom – Large
Ceiling/Light
Walls & Doors
Windows/Screens
Shades/Drapes
Closet Doors
Floor/Carpet
Woodwork
Bedroom – Small
Ceiling/Light
Walls & Doors
Windows/Screens
Shades/Drapes
Closet Doors
Floor/Carpet
Woodwork
Bathroom
Ceiling/Light
Walls & Doors
Windows
Mirrors
Floors
Medicine Cabinet
Toilet Bowl
Tub and Shower
Towel Racks
Lavatory (Sink)
Exhaust Fan
Living Room
Ceiling
41
Repairs Needed
Walls & Doors
Windows/Screens
Shades/Drapes
Closet Doors
Floor/Carpet
Woodwork
Dining Area
Ceiling/Light
Walls
Windows/Screens
Shades/Drapes
Floor/Carpet
Woodwork
Other
Keys
Excessive Cleaning
Rubbish
Keys Issued
I HAVE INSPECTED THIS UNIT W ITH A REPRESENTATIVE OF CEPCO MANAGEMENT AND FOUND THE UNTI TO BE IN SAFE, DECENT AND SANITARY
CONDITION. I UNDERSTAND THIS CHECK LIST WILL BE USED IN DETERMINING ANY CHARGES FOR DAMAGES UPON MOVE OUT.
Resident _______________________________________________________________________________________Date ____________________________________
Resident _______________________________________________________________________________________Date ____________________________________
Manager________________________________________________________________________________________Date ___________________________________
42
MOVE OUTS
ACKNOWLEDGMENT OF INTENT TO VACATE
TERMINATION NOTICE
PERFORMANCE DEPOSIT STATUS REPORT
43
TO:
Site Managers
FROM:
Tammy Gehrke
DATE:
March 1, 2005
RE:
VACATING PROCEDURES
Please use the following guidelines when you receive a notice to vacate from a resident:
1.
A notice to vacate can only be accepted when it covers a full rental period. (The notice must be received no later than
the last day of the month for vacating the following end of the month) If the resident wants to leave earlier in the
month, let them know that they will be responsible for the full month's rent.
2.
Give the resident an Acknowledgement of Intent to Vacate packet. (see attached) The last page needs to be
completed, signed and returned.
3.
Complete a TERMINATION NOTICE (see attached)
4.
Send the following forms to me before the 5th of the month: Written Notice to Vacate, Signed Last Page of
Acknowledgement of Intent to Vacate, Termination Notice.
5.
At least two weeks before they vacate, set up a time to do an inspection to see what work may be need to be
completed for turnover. You can begin to schedule the work for the afternoon of the last day of the month. Turnover
goes quickly and smooth when you prepare ahead.
6.
Complete the Performance Deposit Status Report do not put in charges, just information from the move - out
inspection, be very specific. This is due in my office on the 5th of the month.
By law, we must return their security deposit and a listing of any charges we deduct for cleaning, damages with in 21
days.
Our goal is to have the unit clean and rented on the first of the next month with no loss of rental Income.
CEPCO MANAGEMENT INC IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER.
PO Box 301,Waite Park, MN 56387* Phone 320-202-2967 * Fax 320-202-0277
44
ACKNOWLEDGMENT OF INTENT TO VACATE
Resident Name(s):
Property Name and Unit #:
We have received your notice informing us of your intent to vacate your apartment. Please read all the information in
this packet and sign and return the last page to us as soon as possible.
Please keep in mind that check-out time is 12:00 Noon on the last day of the month!!!!!
We encourage you to plan ahead. Your apartment must be cleared of all personal possessions and any and all cleaning
must be done by that time. The most common reason for withholding a portion of a former residents' Performance
Deposit is lack of cleaning. To ensure a proper and complete refund of your Performance Deposit, we have compiled a
list of items that must be cleaned and also some hints and suggestions for doing them.
When you vacate your apartment, an inspection will be done to determine what cleaning and/or damage charges (if any)
will be charged against your Performance Deposit. These charges will be based on the attached replacement and labor
price list. These rates are approximate and could be more or less that the listed rate depending on the situation.
These suggestions will help you ensure a full refund of your Performance Deposit:
W ALLS
All walls must be cleaned and ready to paint. A mild general purpose cleaning solution will remove ordinary dirt and
grease marks. DO NOT fill nail holes in the walls. This will be taken care of by our painting contractors.
FLOORS
All floors must be washed and excess wax removed. If not, any labor cost incurred by the property to clean the floors
will be charged against your Performance Deposit. Mild floor cleaning solutions will work for ordinary dirt and stains.
Use ammonia if you need to strip off old wax and steel wool to remove any dried on stains. All carpeting must be
vacuumed and cleaned. If you have occupied your apartment for less than one year, you are responsible for having you
carpet professionally cleaned.
45
DOORS AND WOODWORK
Both the inside and outside of all doors should be wiped clean and polished. All woodwork should be wiped down. The
tracks on the closet doors should be free of dust and dirt. You can use your vacuum to get the dirt and gravel out of the
tracks.
KITCHEN CABINETS AND DRAWERS
Remove all shelf paper and use a mild cleaning solution to clean all surfaces. Clean both the inside and outside of all
cupboards and drawers.
REFRIGERATORS
Completely clean and wipe out the refrigerator. YOU ARE RESPONSIBLE FOR DEFROSTING THE FREEZER.
Do not use any sharp objects to remove the ice as you may puncture the freezer box. You will be held responsible for any
damage to the refrigerator if it needs repair or replacement due to negligence. Turn the dial to the lowest possible setting.
Do not turn the refrigerator completely off, the site manager will take care of this when they do their final inspection?
You must pull the refrigerator out from the wall, clean the floor and sides of the unit and remove any food that is lodged
in between the counter top and the appliance. Vacuum the coils behind the appliance. There also must be two ice cube
trays when you leave.
RANGE I OVEN I VENT HOOD
The stove and vent hood must be cleaned and all surfaces free from grease. This includes the drip pans, oven racks,
broiler pans and vent hood filter. Use a Standard oven cleaner and a single edge razor to remove all baked on material
from oven walls. Place your oven racks, broiler pan and vent hood filter in a garbage bag, spray them with oven cleaner
and let them set overnight. Baked on material will rinse off easily in the morning. Please make sure that there is a broiler
pan in your oven before you leave to avoid a charge for a new one.
AIR CONDITIONER FILTER AND COVERS
When cleaning the decorative cover, use a mild cleaning solution. If your apartment includes an air conditioner, remove
the front cover by grabbing it from the rear, not the front, they break very easily. Rinse the filter thoroughly with warm
soapy water.
BATHROOM FLOORS AND FIXTURES
Rinse and dry all fixtures thoroughly. Clean the tile around the bathtub. To remove hard water stains from the bathroom
tile, use a non abrasive cleanser and/or toilet bowl cleaner. DO NOT USE TOILET BOWL CLEANER ON ANY
METAL SURFACES, AS IT WILL RUIN THE FINISH. Please make sure that you clean everything out of the
bathroom medicine chest and wipe it down along with the sink, toilet, bathtub, etc.
WINDOWS
The windows must be cleaned on the inside and the sliding tracks wiped out. It is not necessary to clean the outside of
your windows if you are on second floor.
ELECTRICAL FIXTURES
All chandeliers and light fixtures should be washed and dried. You are responsible for leaving working light bulbs in all
of the fixtures. Please replace the chandelier bulbs with similar (clear/frosted) bulbs. All globes should be in the light and
clean. Clean all grease marks off of switch plates and outlet covers.
HEAT REGISTERS
Registers should be wiped clean and vacuumed out.
46
TRASH AND REFUSE
Please dispose of any rubbish or unwanted items properly. You must make arrangements with the caretaker to dispose of
large items such as furniture. All other trash should be placed in containers and put in the dumpster. Any charges
incurred for the disposal of unwanted items will be withheld from your Performance Deposit.
STORAGE UNITS (IF APPLICABLE)
Remove any and all items from your storage unit. You must sweep it clean and wipe down the shelves.
GARAGE STALLS
If you have a garage, you are responsible for removing any and all items from the garage and sweeping it out. Use kitty
litter to absorb any oil on the floor and sweep it up before you leave.
CLEANING AND REPLACEMENT CHARGES
The attached list indicates the appropriate charge if an item is left unclean or damaged. This charge will be deducted
from your Performance Deposit should it be necessary to clean or replace that item. If the charges exceed your
Performance Deposit, you will be billed for the excess amount.
Please contact the Site Manager to arrange a convenient time to complete your final checkout and turn in your keys.
Please make sure that you leave a forwarding address with the Site Manager. The disposition of your Performance
Deposit plus interest, and any refund due, will be mailed to you within twenty-one (21) days from the last day you are
responsible for your apartment.
If you have any questions concerning this letter, please feel free to contact your Site Manager. Good luck in your new
home.
Sincerely,
CEPCO Management, Inc.
47
CLEANING
$15.00/hour
General Cleaning
Kitchen
Stove-Oven
Vent Hood
Refrigerator
Defrost and Clean Freezer
Dishwasher
Sink
Cupboards
Countertops
$20.00
$10.00
$20.00
$10.00
$5.00
$7.00
$30.00
$10.00
Bathroom
Mirrors and Medicine Cabinets
Toilet and Seat
Tub Area
Shower Head
Vanity
$5.00
$10.00
$25.00
$5.00
$20.00
Lights
Light Fixture
Outlet Covers
$15.00
$10.00
Miscellaneous
Windows
Patio Door
Wash Kitchen/Bath Floor
Ceiling Fan
Vacuuming
Rubbish Removal
Furniture Removal
Woodwork
Closets
Registers and Cold Air Returns
Traverse Rod
Air Conditioner
$25.00
$30.00
$25.00
$2.00
$20.00
$25.00
$50.00
$10.00/Room
$15.00/Each
$10.00
$5.00
$20.00
REPLACEMENT COST OF COMMON ITEMS
Kitchen
Broiler Pan
Drip Pans
Burner Ring (Small)
Burner Ring (Large)
Ice Cube Tray
Butter Dish
Crisper Drawer
Crisper Shelf
Sink Stopper
Cabinet Drawers
Chips in Appliances
$15.00
$5.00 Each
$5.00 Each
$7.00 Each
$3.00 Each
$3.00 Each
$70.00
$50.00
$5.00
$40.00
$15.00
Lights
Light Bulb
Globes
$3.00 Each
$5.00 - $25.00
Doors
Door Knocker and Viewer
Apartment Entry Door
Closet Door
Hollow Core
Sliding Wood Panel
Metal Door Panel
Keys
Building, Apartment, Mailbox
Lock Change
$15.00 Each
$50.00
Bathroom
Towel Bar
Vanity Mirror
Toilet Seat
$15.00
$70.00
$15.00
Walls/Ceiling
Painting (Less Than One Year
Occupancy)
$100.00
$20.00
$175.00
Windows
Window Screen
Window Shade
(Bedroom Only)
Curtain Rod
Horizontal Blind
Vertical Blind
$135.00
$180.00
$110.00
Miscellaneous
Intercom Station
Air Conditioner Cover
$30.00
$25.00
$20.00
$30.00
$50.00
$95.00
$30.00
Carpet Replacement
Carpet replacement cost will vary from $500 - $2,500, depending on size of apartment and the extent of the damage.
ACKNOWLEDG EMENT AND ACCEPTANCE
Of the
Acknowledgement of
Intent to Vacate
I / We the undersigned, have read, understood, and accepted the Acknowledgment of Intent to
Vacate unit #
of
.
Name of property
_____________________________________
Signature of Tenant
______________________
Date
_____________________________________
______________________
Signature of Co-Tenant
_____________________________________
Management's Authorized Agent
Date
______________________
Date
If you are moving to another apartment location in town, where are you going? ___________
__________________________________________________________________________
Are you moving out of town, state, or purchasing a home? __________________________
__________________________________________________________________________
Why? ______________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
My/Our forwarding address for the return of the Security Deposit and for our records is:
49
REVISED ( _____________ )
NOTICE OF TENANT
TERMINATION
DEVELOPMENT NAME:
LOCATION:
UNIT NUMBER:
NAME OF TENANT:
EFFECTIVE TERMINATION DATE:
(RESPONSIBILITY FOR RENT)
REASON FOR TERMINATION:
DECEASED
NURSING HOME
EMPLOYMENT
MARRIAGE
UNIT TRANSFER
NEW UNIT #
MOVING OUT OF CITY/STATE
MOVING TO DIFFERENT RENTAL LOCATION IN TOWN
Reason for Move:
PURCHASED PROPERTY
SKIP
EVICTION (EXPLAIN):
OTHER (EXPLAIN):
50
TERMNOT.WKS (05/95)
51
Please utilize the attached form to complete your move-out inspections for vacating residents.
Please complete the area in the Tenant data box. Indicate in the description area the condition you find the unit when
conducting the move-out inspection. Your property manager will complete the cost associated with the cleaning or the
repair charge. Ede will complete the calculation of the security deposit/performance deposit.
Sign the form indicating you inspected the property.
Please forward these forms to our offices as soon as possible after the move-out inspection is completed.
Any questions please call.
52
PERFORMANCE DEPOSIT STATUS REPORT
(Required at time of move -out by MN Statue 504.20)
TENANT DATA
ORGINIAL DEPOSIT
Tenant Name
Social Security #
DOB
Forwarding Address
Performance Deposit
$
Pet Deposit
$
Other
$
Project Name
$
Apartment No.
Starting Lease Date
Date Vacated
Inspected By
TOTAL DEPOSIT
$
Interest from
$
TOTAL DEPOSIT AND INTEREST
$
APARTMENT DAMAGE/CLEANING DESCRIPTION
(Beyond Normal Wear and Tear)
Area
Description
Cost
Area
Description
Cost
Area
Description
Kitchen
Bedroom -Small
Living Room
Ceiling/Light
Ceiling/Light
Ceiling/Light
Walls
Walls & Doors
Walls & Doors
Window/Screens
Window/Screens
Window/Screens
Shades Drapes
Shades/Drapes
Shades/Drapes
Woodwork
Closet Doors
Closet Doors
Floor
Floor/Carpet
Floor/Carpet
Counter Tops
Woodwork
Woodwork
Cabinets
Dining Area
Sink
Bathroom
Ceiling/Light
Range/Oven
Ceiling/Light
Walls
Refrigerator
Walls & Doors
Window/Screens
Exhaust Hood
Windows
Shades/Drapes
Bedroom –Large
Mirrors
Floor/Carpet
Ceiling/Light
Floor
Woodwork
Walls & Doors
Medicine Cabinet
Other
Window/Screens
Toilet Bowl
Keys
Shades/Drapes
Tub and Shower
Excessive Cleaning
Closet Doors
Towel Racks
Rubbish
Floor/Carpet
Lavatory (Sink)
Woodwork
Exhaust Fan
CAUSES OF LEASE VIOLATION
1.
2.
3.
Improper Notice
No Full Lease Term
(Start Lease Date)
Other
Additional Comments:
Authorized Representative
ORIGINAL – CEPCO MANAGEMENT, INC



Total Damage
Rent or Other Owing
(Explain)
Lease Violation Forfeit
Legal Fees
(Explain)
Total Charges
$
$
$
$
$
$
$
COPY – SITE MANAGER
REFUND OR
DUE CEPCO
COPY -- TENANT
53
Cost
MISCELLANEOUS
REQUIRED REPORTS
PROPERTY STATUS
SITE MANAGER PAPERWORK AGENDA
PAPERWORK DISTRIBUTION GUIDE
PETTY CASH
PETTY CASH AGREEMENT
RECAP FORM
INDEPENDENT CONTRACTOR INVOICES
SPENDING LIMITS
TOOLS
POSITION DESCRIPTION
TRAINING SIGN OFF SHEET
54
PROPERTY NAME
SITE MANAGER
DATE
VACANCY
DATE
VACATED
VACANT UNITS
CLEANED
CARPETS
CLEANED
PAINTED
RE RENTED
NAME
APPLICATION
STATUS
MOVE
MOVE OUTS
DATE
UNITS
VACATING
SIGNED
ACKNOWLEDGEMENT
NOTICE TO VACATE
TERMINATION
FORM TO PM
RE RENTED
NAME
APPLICATION
STATUS
<,
MOVE IN DAT
,;;:
PENDING RECERTS
UNIT #
NAME
DELINQUENT RENTS
UNIT # NAME
EFFECTIVE
DATE
INITIAL
INTERVIEW
-
VERIFICATIONS
PACKET SENT TO PM
/COMPLIANCE
CERTIFICATION
RECEIVED FROM
CEPCO
AMOUNT DUE PAYMENT ARRANGEMENT I COMMENTS
55
CERTIFICAT
SIGNED & M
CEPCO
Monthly Paperwork Agenda
Site Manager
Date
Paperwork
Send To
1
Perform Move -In Inspections
Have Leases Signed & Collect Rent & Deposit from
new move-ins.
Forward all move in paperwork
Compliance Department
2
Update Door Rosters & Tenant Phone Lists
3
Deliver Acknowledgement to Vacate & have
tenants Sign. Do Termination Notice & send copy
Property Manager
to P.M.
4
Complete & Forward Performance Deposit Status
Reports
Property Manager
5
Write up rent checks &
Mail rents, laundry money, rosters & copies of late
notices
Accounting Department
6
7
Begin Recerts Due in 90 Days
8
Follow Up on Recerts
- Obtain Verifications
9
10
11
12
13
14
15
16
17
18
19
20
Report Delinquent Rents to P.M.
Review Up-coming Vacants w/ P.M.
Property Manager
Finish Recertifications
Finish Recertifications
Finish Recertifications
Finish Recertifications
Compliance Department
Compliance Department
Compliance Department
Compliance Department
Inspect Units of Residents who gave notice to
vacate. Schedule Contractors, order paint &
supplies needed to turn unit. Schedule Move - Out
Inspections
21
22
23
24
25
Check All Bulletin Boards for Required Posters.
Perform Property Inspection & Forward Report
Property Manager
26
27
28
Update Waiting List
Property Manager
29
30
Pre Dare Move
- In Packets
Do Scheduled Move
- Out Inspections
31
_
Remember: Copy EVERYTHING for your records. NEVER ACCEPT CASH I
_
56
PETTY CASH DISBURSEMENT
AGREEMENT
Date:
Property:
I/We, _________________, acknowledge the receipt of a Petty Cash Fund in the amount
of $____________for the above named property. This fund is to be used for the sole purpose of purchasing supplies for the above
named property. An accurate and complete accounting of all purchases along with receipts for such purchases shall be kept at all
times.
I acknowledge that I am responsible for the full amount of the Petty Cash Fund. Upon termination of my employment from CEPCO
Management, Inc., the Authorized Management Agent for the above named property, I will return the Petty Cash Fund in full, less
the amount of any outstanding purchases. Such outstanding purchases must be verified with receipts.
Site Manager
Date
Site Manager
Date
CEPCO Management, Inc.
Date
Authorized Management Agent
57
PETTY CASH RECAP -- ***FOR INTERNAL USE ONLY***
PROPERTY
FOR THE MONTH OF:
ADDRESS
PAID TO:
PURPOSE:
AMOUNT:
TOTAL
BY:
, RESIDENT MANAGER
(RECEIPTS FOR ALL DISBURSEMENTS MUST BE ATTACHED)
PTTYCASH(05/95)
58
Date
INVOICE
Work Performed At:
Contractor:
(Name and Address)
Social Security # / Tax I.D. #:
Date
Unit
Description
Hours
Rate
Total Due
59
Total
PETTY CASH
You will be issued a check for $50 for a petty cash fund. This cash is to be used for postage, supplies, and property items. You must have cash
and or receipts available for audit at all times.
Use the attached PETTY CASH RECAP form to keep track of your purchases. Staple the original receipts to the form. Turn this form and
receipts in to your' property manager at the end of each month or when the fund is below $25.00.
INDEPENDENT CONTRACTOR INVOICE
This form is to be used to bill any extra work performed at the properties. You will only be paid for work that is NOT included in your position
description.
These forms are to be turned in before the total bill exceeds $200. I will not approve invoices that are held for 2-3 months that exceed $200. In
the past site managers have waited to use for a vacation or Christmas money and turned in a six month bill for $1200. This offsets our budget
and monthly financial reports. Invoices are to be turned in when the work is completed.
SPENDING LIMIT
Site managers have a spending limit of $100 with out Property Manager approval. Site Managers are not authorized to enter into or execute
contracts with vendors. Each property has a budget of $1 per month per unit for administrative expenses. This includes pens, pencils,
paperclips, postage, copies, etc.
CHARGE ACCOUNTS
Property Charge accounts are to be used for the property only. Personal items may not be charged to the charge account. If you have a
questionable item you need to clear it with your property manager first.
TOOLS
CEPCO Management Inc. does not allow the purchase of tools.
CEPCO MANAGEMENT INC IS AN EQUAL OPPORTUNITY PROVIDER AND EMPLOYER
PO BOX 301, Waite Park, MN 56387 * Phone 320-202-2967 * Fax 320-202-0277
60
DUTIES AND RESPONSIBILITIES OF SITE MANAGERS
Duties
1)
Act as first source for resident and applicant contact; handle all calls and walk-up inquiries in a professional manner. Show
apartments to prospective residents. Contact property manager or appropriate maintenance person as necessary. The residents
are our customers.
2)
Receive, collect and account for all rents and other income. Note amounts paid on tenant accounts receivable page along
with any written explanations. Forward rents in a timely manner to Capo, PO Box 456, Hopkins, MN 55343, by 1st class
mail. Make personal visits to residents’ homes to collect unpaid rents or to deliver violation, termination or other notices.
3)
Complete and maintain the following accurate resident files at the property and forward tenant certifications to Cepco for
review and submission to the appropriate government agency.
a)
Applications, Verifications, Performance Deposit Receipts, Tenant Certifications, Leases, House Rules, Move-in
Condition Checklists, 90 and 30 Day Recertification Letters, Recertifications, Apartment Condition Checklists, Violation
Notices, Tenant's 30-day Move-Out Notices, Notices to Terminate, Move-Out Checklists and Performance Deposit
Reports.
b) Official Inquiry and Waiting Lists. (Updated Monthly)
c)
Maintain list of telephone numbers of all residents and send copy to Cepco.
d) Maintain maintenance log of all work completed on units and property.
e)
Maintain daily log of significant occurrences and complaints at the property.
4)
Perform routine and preventive maintenance and repairs on units and the property.
5)
Supervise all routine operations that arise from outside vendors, suppliers or repair people that come onto the property.
Coordinate with property manager and check on allowable dollar amount that site manager is authorized to disburse.
6)
Along with property manager, identify someone as a backup source for residents if the site manager is indisposed.
7)
At least one month prior to any inspection by government agency, inspect residents units and complete any required
maintenance.
8)
Notify resident at least 24 hours in advance, in writing, except in an emergency, when entering a resident’s home to perform
repairs. In all case, when possible, schedule when resident is home.
9)
Be knowledgeable of and follow pertinent government laws & regulations. Understand and abide by the Fair Housing Laws.
Responsibilities
DAILY
1) Inspect and pick up all common areas, entryways, halls, stairways, laundry rooms, mechanical rooms, trash areas, parking
lots and grounds. Be mindful of property security and anything out of order.
2) Shovel snow from sidewalks as needed. Keep sidewalks clear of ALL ice and compacted snow. (Use ice-melt that does not
damage the concrete).
3) Inspect all common and exterior lighting, including emergency and exit lights. Replace or repair as needed.
4) Water grass as needed.
5) Pick up litter and debris from grounds and trash area at least every other day. Pick up interior common areas on a daily basis.
WEEKLY
1) Clean, vacuum and dust all interior common areas. Thoroughly clean trash collection area.
2) Clean high traffic common areas more often if required. Damp mop entryways. More often if needed in winter.
3) Clean entryway windows. Clean more often, if needed.
4) Cut lawn weekly or more often if needed.
5) Trim grass around building, curbs and garden areas every other week. Remove weeds from shrubbery.
61
MONTHLY
1) Oil mechanical equipment as necessary (circulating pumps, lawnmowers, snow blowers, etc.). Keep log in mechanical room
of all servicing.
2) Switch from one circulating heat pump to the other.
3) Thorough cleaning and waxing of entryways.
4) Inspect common areas for cobwebs and remove as necessary.
5) Test all common area and hallway fire alarms. Notify residents in writing at least 24 hours
prior to testing alarm.
6) Turnover vacant units or assist in turning over vacated rental units.
SEMI-ANNUALLY
1) Have parking lot swept
2) Clean common area windows.
3) Clean storage and utility buildings.
4) Drain hot water heaters - approximately 2 or 3 gallons from bottom.
5) Weed and feed lawn.
ANNUALLY
1) Flush hot water heaters.
2) Have forced air furnaces inspected and cleaned on a rotating year basis.
3) Check emergency call and light systems.
4) Inspect all apartments' interiors. Inspect more often if directed to do so by property manager.
5) Discuss and perform fire drill with available residents during weekday in May during daytime hours.
6) Memo all residents one week in advance.
7) Rake lawns to remove leaves and debris before winter.
62
COMPENSATION
Compensation shall be $
/Mo. Increases in salary are based upon performance and are subject to approval.
EXTRA DUTIES PERFORMED BY SITE MANAGER
Painting a vacant unit
Ceiling
1 Bedroom
$ 150/Unit
2 Bedroom
$175 Paint
$ 75
Cleaning a vacated unit
$ 10/hr.
After exceeding allowable vacancy clean time.
1 Bedroom = 2 Hours, 2 Bedroom = 3 Hours, 3 Bedroom = 4 hours.
Any extra labor not included in job description
/Unit
$ 10/hr.
(with prior approval of Property Manager)
The attached has been read and understood by the Site Managers
Site Manager Signature
Site Manager Signature
Date
Property Manager
63
LEASE VIOLATION
GENERIC LEASE VIOLATION
HOUSEKEEPING LEASE VIOLATION
UTILITY LEASE VIOLATION
64
NOTICE OF LEASE VIOLATION
RESIDENT'S NAME:
COMMUNITY NAME:
APT. #
COMMUNITY LOCATION:
DATE OF NOTICE:
It has come to our attention that you are in violation of your Lease Agreement with the above named property,
Specifically SECTION
,#
.Your violation is as follows:
According to the terms and provisions of your Lease, you are required to correct the situation by
(date) using the following measures:
Failure to do so may result in the termination of your Lease, and we may seek eviction by bringing forth a Judicial Action against you at which
time you may present a defense. Should you have any questions or would like to meet with us concerning the above matter, you may contact
me at
(phone) between the hours of 8:00am and 5:00 PM Monday through
Friday.
THREE VIOLATIONS IN A TWELVE MONTH PERIOD WILL RESULT IN TERMINATION OF YOUR LEASE!
Sincerely,
Managing Agent
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343*Phone 952-935-0359* Fax 952-935-9612
www.cepcomanagement.com
65
NOTICE OF HOUSEKEEPING CONDITION
RESIDENT NAME:
APT.#
COMMUNITY NAME:
COMMUNITY LOCATION:
DATE OF NOTICE:
It was noted during an inspection of your unit on
that you are in violation of this
section of your lease.
The following conditions were noted:
According to the terms and provisions of your lease, you are hereby requested to correct the situation
by_______(date), using the following measures:
Failure to do so may result in the terminating of your lease. Should you have any questions, please contact
me at the following number:
Sincerely,
Site Manager
HOUSEKE.WPS
(05/95)
1 copy to resident
1 copy in resident file
66
We are changing the procedures on how we handle utility invoices that are received at our offices and are deemed to be a tenant's
responsibility.
The following is a change to procedure on the handling of utility invoices that are received at the home office, as follows:
1.
Accounting reviews individual utility bills to determine property versus tenant's responsibility.
2.
If it is determined that a tenant is responsible for part or the entire utility invoice; the accounting department will apply
appropriate charges to the tenant ledger. This entry will be indicated by the utility type and timeframe for responsibility, see
attached sample of tenant ledger.
3.
The accounting department will then enter the invoice as a property payable to schedule payment against this expense.
4.
The accounting department will produce three copies of a Winning Edge generated invoice for the particular utility charges, see
attached sample of invoice.
5.
One invoice will be sent directly to the tenant, the second copy will be sent to the Site Manager, and the third copy will be filed in
the tenant file at our office.
6.
The invoice will indicate that the tenant is responsible for these charges and that they need to put the utility in their name as soon
as possible. The invoice will also include verbiage concerning failure to change utility service will result in lease violations and
could jeopardize their occupancy at our property.
7.
Site Manager's responsibility is to follow-up with tenant to ensure that the tenant has put the utility in their name and address.
8.
Upon the second utility invoice received that still has not been put in the tenant's name; the accounting department will send
another invoice to the tenant, Site Manager, and file a copy in tenant file. The accounting department will also send a memo/email
to the Site Manager to indicate a need for a lease violation for this particular tenant. The accounting staff will copy the Property
Manager on this request for a lease violation.
9.
If the situation continues, the Property Manager, in conjunction with the Site Manager, will take necessary eviction action against
the tenant in question, keeping the accounting staff informed of necessary actions.
67
NOTICE OF LEASE VIOLATION
RESIDENT'S NAME:
COMMUNITY NAME:
APT. #
COMMUNITY LOCATION:
DATE OF NOTICE:
It has come to our attention that you have not put the utility billing in your name. Our records indicate you moved in on
Your rent is calculated with a utility allowance subtracted from the Gross Amount of Rent. Non-payment of a utility is
equivalent to non-payment of rent.
According to the terms and provisions of your Lease, you are required to correct the situation by
(date) using the following measures:
.
Immediately
Pay the enclosed bill. Contact the utility company and have the billing corrected immediately.
PLEASE BE ADVISED THE UTILITY COMPANY HAS BEEN INSTRUCTED TO TERMINATE SERVICE 5
DAYS FROM THE DATE OF THIS NOTICE IF YOU HAVE NOT CHANGED THE BILLING!
Failure to do so will result in the termination of your Lease, and we may seek eviction by bringing forth a Judicial Action
against you at which time you may present a defense. Should you have any questions or would like to meet with us concerning
the above matter, you may contact me at
(phone) between the hours of 8:00am and 5:00 PM Monday
through Friday.
Sincerely,
Managing Agent
1 copy to resident
1 copy in residents file
VIOLATI.WPS
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
www.cepcomana2ement.com
68
ANNUAL RECERTIFICATIONS
THE RECERTIFICATION PROCESS
PACKET FROM COMPLIANCE DEPARTMENT
APPOINTMENT REQUEST LETTER
CERTIFICATION INTERVIEW
INCOME ASSET SUMMARY
VERIFICATIONS
CERTIFICATION SUMMARY WORKSHEET
CALCULATING ANNUAL INCOME
69
Recertification Notice Summary
CEPCO MANAGEMENT INC.
32 TENTH AVENUE SOUTH
09/22/2004
Recertification Date: November 2004
03:32 PM
HOPKINS, MN 55343
Page 1
Applicable Forms
Sub=
1= Business Income
8=AFDC Income
15=Child Care Expense
R=RD
2=Funeral Wage Income
9=General Assistance Income
16=Handicap Assistance Expense
H=HUD
3=Military Wage Income
10=Child Support Income
17=Medical Expense
T=S42
4=Non-Federal Wage Income
11=Indian Trust Income
18=Full-Time Student Status
5=Pension Income
12=Other Non-Wage Income
19=Disability/Handicap Status
6=Supplemental SSI Income
13=Unemployment Income
7=Social Security Income
14=Asset Income
# of Each Applicable Form (detailed above)…
Project
Unit No.
Tenant Name
Sub
I
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19
PRO
2-5
STEPHANIE REKDAHL
R
0
0
0
1
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
PRO
3-5
JESSICA ANDOR
R
0
0
0
1
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
-
'
MOVE INS














RESIDENT FILE CHECK LIST
APPLICATION
CREDIT REPORT
LANDLORD REFERENCES
PERFORMANCE DEPOSIT AGREEMENT
TENANT CERTIFICATION (TIC)

VERIFICATIONS

INCOME ASSET SUMMARY

DATA DISCLOSURE & ATTACHMENTS

RACE ETHNICITY FORM
 CERTIFICATION WORKSHEET
LEASE
CRIME FREE / DRUGFREE LEASE ADDENDUM
SECTION 42 LEASE ADDENDUM
MOVE IN CHECK LIST
HOUSE RULES
EMERGENCY CONTACT FORM
CHECK FOR SECURITY DEPOSIT
CHECK FOR RENT
71
RESIDENT FILE CHECKLIST
NAME:
PROPERTY:
UNIT#
___APPLICATION (fully completed, signed, & dated)
___CREDIT REPORT (Initialed by PM)
___PERFORMANCE DEPOSIT AGREEMENT (payment arrangements must be attached in writing
and signed by resident & site manager)
___LANDLORD REFERENCES (at least two)
___TENANT CERTIFICATION (with ALL verifications)
Certification Form (TIC)
Asset/Income Summary
Data Disclosure with attachment that applies
Race/Ethnicity Form for each person (parents may fill out for children)
Certification Worksheet
Verifications
___LEASE (signed by all adults)
___CRIME FREE / DRUG FREE LEASE ADDENDUM (signed by all adults)
___SECTION 42 LEASE ADDENDUM (signed by all adults)
___MOVE-IN CHECKLIST (signed by resident & site manager)
___HOUSE RULES (return back page only)
___EMERGENCY CONTACT FORM (with new home # & work # )
WPS
(01/04)
72
LANDLORD REFERENCE RELEASE
I/We, hereby authorize my/our landlord,
Landlord Name
Phone
Street Address
City
State
to release information pertaining to my/our rental history to CEPCO Management, Inc.
Date
Zip Code
Applicant Signature
Applicant Signature
Applicant/s
The above identified person has recently applied for residency and has listed your rental unit, at the following
address, as a former residence;
Street
Apt.
City
State
Zip Code
As indicated by the signature/s above, the applicant/s listed consent to the release of information regarding
his/her /their rental history. We would greatly appreciate your cooperation in completing the questions
below. Any additional comments may be put on the back of this form., This information is required as part of our
resident approval process.
1.
How long did the applicant reside at this address?
2.
How many bedrooms?
Number of occupants?
3.
What was the monthly rent?
Subsidized?
4.
Was the applicant ever behind in the payment of monthly rent?
5.
Was the applicant destructive to the apartment or surrounding public areas?
Yes
No
If yes, please explain
6.
Did the applicant maintain desirable living conditions (i.e. well kept home)?
If no, please explain
7.
Did the applicant get along with the other residents of the property?
8.
The applicant's overall conduct while residing at the property would be considered:
Excellent
9.
Good
Fair
Poor
(Please circle one)
The applicant's supervision of / conduct of his/her children while residing in the apartment would be
considered:
Excellent
Good
Fair
Poor
10.
Would you rent to the applicant/s in the future?
11.
If currently renting from you, has a vacate notice been given?
Date
(Please circle one)
If no please explain on back.
Landlord Signature
Effective
Phone
73
EMERGENCY CONTACT INFORMATION
Property:
Resident:
Unit#:
Phone #:
Work phone #:
PERSON(S) TO CONTACT IN CASE OF AN EMERGENCY:
Name
Address
Phone Number
Name
Address
Phone Number
Name
Address
Phone Number
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
www.cepcomanagement.com
Emergency Contact.wps
74
ACKNOWLEDGMENT AND ACCEPTANCE
of the
RULES AND REGULATIONS
for
I / We the undersigned, have read, understood, and accepted the Rules and Regulations and acknowledge that they will
be made a part of my lease.
I / We agree to abide by all rules set forth: in the lease and regulations, and are aware that violations of the lease or
regulations could lead to Management terminating our occupancy.
Signature of Tenant
Date
Signature of Tenant
Date
Date
Management's Authorized Agent
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
"In accordance with Federal Law and U.S Department of Agriculture policy, this institution is prohibited from
discriminating on the basis of race, color, national origin, sex, age or disability. "
www.cepcomanagement.com
75
Race and Ethnic Data
U.S. Department of Housing
Reporting Form
OMB Approval No. 2502-0204
and Urban Development
Project No.
Name of Property
(Exp. 10/31/2004)
Address of Property
Name of Owner/Managing Agent
Type of Assistance or Program Title
Name of Head of Household
Name of Household Member
Date (mm/dd/yyyy):
Ethnic Categories*
Select
One
Hispanic or Latino
Racial Categories*
Select
all that
apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Definitions of these categories may be found on the reverse side.
There is no penalty for persons who do not complete the form.
Signature
Date
Public reporting burden for this collection is estimated to average 10 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. This information is required to obtain benefits and voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a current valid
OMB control number.
This information is authorized by the U.S. Housing Act of 1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing and Community Development Technical Amendments of 1984. This information is
needed to be incompliance with OMB-mandated changes to Ethnicity and Race categories for recording the 50059 Data Requirements to HUD, Owners/agents must offer the opportunity to the head and co-head of each household to
"self certify” during the application interview or lease signing. In-place tenants must complete the format as part of their next interim or annual re-certification. This process will allow the owner/agent to collect the needed
information on all members of the household. Completed documents should be stapled together for each household and placed in the household's file. Parents or guardians are to complete the self-certification for children under the
age of 18. Once system development funds are provided and the appropriate system upgrades have been implemented, owners/agents will be required to report the race and ethnicity data electronically to the TRACS (Tenant Rental
Assistance Certification System). This information is considered non-sensitive and does not require any special protection.
Form HUD-27061-H (9/2003)
76
Drug-Free Housing Agreement (Agreement)
1.
Tenant, any members of the tenant's household or a guest or other person under the tenant's direction/control shall
not engage in criminal activity, including control substance crimes, in the unit or elsewhere on or near the
development as defined in Section 504B.l71 of the Minnesota Statutes, or any substitute or replacement thereof.
Control sub3W1ce crimes are defined in Chapter 152 of Minnesota Statutes and mean the illegal manufacture, sale,
distribution, purchase, use or possession with intent to manufacture, sell, distribute, or use of a controlled substance
(as defined in Chapter 152 of Minnesota Statutes).
2.
Tenant, any members of the tenant's household or a guest or other person under the tenant's direction/control shall
not engage in any act intended to facilitate criminal activity, including control substance crimes, in the unit or
elsewhere on or near the development.
3.
Tenant, or any members of the tenant's household will not permit the dwelling unit to be used for. or to facilitate
criminal activity, including control substance crimes, regardless of whether the individual engaging in such activity
is a member of the tenant's household, or a guest.
4.
Tenant, or any members of the tenant's household will not engage in the manufacture, sale, or distribution of illegal
drugs at any location, whether in the unit or elsewhere on or near the development.
5.
Tenant, any members of the tenant's household, or a guest or other person under the tenant's direction/control shall
not engage in acts of violence or threats of violence, including, but not limited to, the unlawful discharge of
firearms, in the unit or elsewhere on or near the development.
VIOLATION OF THE ABOVE PROVISIONS SHALL BE DEEMED A MATERIAL VIOLATION OF THE LEASE
AND GOOD CAUSE FOR TERMINATION OF TENANCY.
A single violation of any of the provisions of this Agreement shall be deemed a serious violation and material noncompliance with the lease. It is understood and agreed that a sill1de violation shall be good cause for termination of the
lease. Unless otherwise provided by law, proof of the violation shall not require criminal conviction, but shall be by a
preponderance of the evidence.
This Agreement, as part of the development's House Rules, is a legal and binding attachment to the lease.
Tenant's Signature
Date
Co-tenant's Signature
Date
Owner/Management Agent's Signature
Date
Drug-Free Housing Agreement
- Section 8/236
MHF A 2003 *
77
PERFORMANCE DEPOSIT RECEIPT AND AGREEMENT
Received From
Apartment #
Property Name
Bldg #
Address
City
Deposits $
Garage #
State
$
Zip
$
Performance
Pet/Other
Total
PERFORMANCE DEPOSIT:
Applicant agrees that if for any reason he/she is unable to accept the occupancy applied for, a portion of the deposit
stated herein may be withheld to recover any expense related to re-renting the apartment. If applicant is not accepted by
CEPCO Management, Inc., OR the Owners Authorized Agent (Hereinafter referred to as Owner), this deposit will be
returned in full.
Applicant(s) (hereinafter referred to as Occupant(s)), acquires no rights to the apartment applied for until the Owner has
notified Occupant(s) in writing of Owner's acceptance of the application and an Apartment Occupancy Agreement
(Lease) has been signed by both the Occupant(s) and Owner, and Occupant(s) have paid one full month's rent in
advance.
Owner will refund the deposits stated above, together with accumulated interest at the rate of 1.0% per annum to
Occupant(s) within three (3) weeks after proper termination of the Apartment Occupancy Agreement, and receipt of the
Occupant's forwarding mailing address, or delivery instruction, subject to the following provisions:
1.
2.
3.
All terms of the Apartment Occupancy Agreement have been fully complied with including rent paid in full.
The full term of the Apartment Occupancy Agreement has expired.
Written notice of the Occupant's intention to terminate the Apartment Occupancy Agreement is received by the
Owner at least ONE (1) OR TWO (2) FULL MONTH prior to the intended termination date.
4. There is no damage to the apartment beyond normal wear and tear.
5. The entire apartment including range, refrigerator, bathroom, closets, cupboards, and garage are clean and the
refrigerator is defrosted.
6. No permanently attached fixtures, i.e. curtain rods, lighting fixtures, door locks, carpeting, etc. are removed from the
premises.
7. All debris, rubbish, and discards are placed in proper rubbish containers.
In the event either of the following occur, the Owner shall retain the full Performance Deposit and interest as partial
liquidated damages.
1.
2.
Occupant(s) are evicted for cause.
Occupant(s) fail to vacate the premises, on the date and time of expiration, as stated in the Apartment Occupancy
Agreement, or any Addenda to such agreement.
Occupant(s) shall not withhold any portion of the last month's rent as a means of recovering the Performance Deposit.
Minnesota statute 504.21 Sub. 7 (1), states in part "No tenant may withhold payment of all or any portion of rent for the
past payment period of a residential rental agreement on the grounds that the deposit should serve as payment for the
rent." The law provides penalties if the tenant wrongfully withholds rental payments.
Occupant's liability for full compliance with the Apartment Occupancy Agreement and for payment of any damages to
the property, is not limited to the amount the deposits and interest stated above.
CEPCO Management Inc.
Date
78
Occupant #1
Date
Occupant #2
Date


Initial
Recertification
Move-in Date
ELIGIBILITY QUESTIONNAIRE
$___________Rent Amount
Property Name
Address
Unit #
HOVSEHOLD COMPOSITION
Applicants/residents, complete in your own handwriting. List the Head of Household and all other persons who will be living in the unit.
Give the relationship of each family member to the head. Each household member age 18 years or older must sign and date this application.
A household comprised entirely of students will be required to complete a Student Verification, if not otherwise qualified.
HOUSEHOLD MEMBER'S NAME
RELATIONSHIP
1
DATE OF
BIRTH
WILL THIS PERSON BE A
STUDENT IN THE NEXT 12
MONTHS?
YES/NO
SOCIAL
SECURITY NUMBER
HEAD
2
3
4
5
6
7
8
HOUSEHOLD INCOME INFORMATION
For each household member age 18 or older (including family members temporarily absent), list current and anticipated income for the twelve-month period
beginning on the anticipated move-in date or effective date of recertification. All information must be verified.
Include all full time, part time or seasonal income even if completing this application in the off-season.
DO YOU RECEIVE OR EXPECT TO RECEIVE
(check either YES or NO to each item, as applicable, and include gross monthly amount):
YES
NO
Gross Monthly Amount
1. Wages, salaries (include overtime, tips, bonuses, commissions)
2. Does any member work for someone who pays them in cash or has self-employment income
3. Regular pay for a member of the armed forces
4. Public Assistance (MFIP, GA)
$
$
$
$
5. Worker's compensation.
$
6. Unemployment benefits or severance pay.
$
7. Student financial aid (public or private, not including student loans)
$
8. Child support (check yes if you have a court order, even if you are receiving less than the full amount awarded)
$
9. Alimony/Spousal Maintenance
$
10. Social Security income (including unearned income of minor children)
$
11. Disability benefits including social security disability
$
12. Regular payments from pensions (PERA, railroad, etc.)
$
13. Regular payments from retirement benefits
$
14. Death Benefits
$
15. Regular payments from annuities or life insurance dividends.
$
16. Regular payments from inheritance, insurance settlement, lottery winnings, etc.
$
17. Net income from rental property
$
18. Regular cash and non-cash contributions, assistance with paying bills or gifts from individuals not living in
the unit (not including groceries)
19. Other (list)
20. Other (list)
79
$
$
$
HOUSEHOLD ASSET INFORMATION
Yes
No
CURRENT
DOES ANY HOUSEHOLD MEMBER (INCLUDING CHILDREN) HAVE MONEY HELD IN:
BALANCE
$
$
21. Checking Accounts (6 month average balance)
22. Savings Accounts
23. Stocks
$
24. Capital Investments
$
$
25. Bonds
26. Trusts*
$
$
$
27. Securities
28. Whole Life Insurance Policy (do not include term life insurance)
29. 401K*
$
$
$
30. IRA/KEOGH Accounts
31. Certificates of Deposit
32. Pension/Retirement/Annuity accounts
33. Money Market Funds
34. Treasury Bills
35. Safety Deposit Box
36. Lump Sum Payment (i.e., inheritance, insurance settlement, lottery winnings, capital gains).
$
$
$
$
$
37. Are any accounts held jointly with someone not in the unit? Which account and with whom?
38. Other
*Include Trusts, 40IK, etc., only if the accounts are accessible to the household prior to termination of employment, retirement, or death. (If you are unsure, list the account and it will be
verified.
Yes
No
Value
39. Do you now own Real Estate?
If yes, list address(es):
$
40. Do you hold a contract for deed?
$
41. Do you have any coin collections, antique cars, gems/jewelry, stamps or any other items held as an investment
(wedding rings and personal jewelry do not count)?
$
42. Are any assets held jointly with another person? List person and asset(s).
Is combined cash -value of all household assets under $5,000?
From 1-42 above, provide further information for all "YES" checked items.
(If a household member has more than one source of income and/or assets, use a separate line for each source. Use additional sheets, if necessary.)
Item
Number
HH Member
Name and mailing address of company, financial institution or source
Contact Name & phone/fax
number
Please attach documentation available to verify income (i.e., divorce/settlement papers, tax returns, social security benefit award letter, etc.)
80
I/We hereby certify that I/we
Have
Have not
sold or given away any assets for less than Fair Market Value during the two year (24 month) period preceding the date of this application. Any assets
sold or disposed of for less than Fair Market Value must be identified below
Household Member
Asset & Estimated Market Value
Date sold/disposed
Amount Received
$
MEDICAL EXPENSES
If you are age 62 or older, handicapped or disabled, do you pay for any of the following medical expenses?
Check either YES or NO in response to each Question. Add an explanation below for ail items checked YES.
Yes
No
Do you receive Medicare Benefits?
Do you have a Supplemental Health Insurance policy?
Do you pay "out of pocket" expense for doctors and/or dentists
Do you pay "out of pocket" expense for prescription medications
Do you pay "out of pocket" expense for glasses, hearing aids, etc.
Do you pay "out of pocket" expense for transportation services to/from a medical facility
MISCELLANEOUS
The following questions pertain to yourself and every member of your household who will occupy the unit. Check either YES or NO in response to each question. Add an
explanation below for all items checked YES.
Yes
No
Will any household member, including children, live in the unit on a less than full time basis?
Do you anticipate "any change in your household (someone moving in or out) during the next 12 months?
Does any adult member of the household have zero income?
Does/will the household receive rent assistance? If so, indicate from what source (Section 8, Rural Development RA, etc.).
Does your household have any needs that might be better served by an apartment which is accessible to persons with mobility, hearing or visual impairments?
Explanation:
__________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
SIGNATURES
I/we hereby affirm that the foregoing information is true and complete to the best of my/our knowledge, and authorize the Landlord to make inquiries to verify the statements herein. I/we
further understand that any intentional misrepresentation in this application might result in a default in the rental agreement and/or eviction of this household If any of the aforementioned
information changes, I/we agree to notify Landlord immediately.
All household members age 18 or older (and under age 18 if head, spouse, or co-head of household) must sign and date below:
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
3 of 3
81
Minnesota Housing Finance Agency
GOVERNMENT DATA PRACTICES ACT
DISCLOSURE STATEMENT
PRINT NAME(s) OF HOUSEHOLD MEMBERS
SIGNING THIS FORM
Minnesota Housing Finance Agency ("MHFA") is asking you to supply information that relates to your application to
occupy, or continue to occupy, a unit in the following property ("Property"):
Some of the information you are being asked to provide to MHFA may be considered private or confidential under the
Minnesota Government Data Practices Act, Minnesota Statutes chapter 13. Section 13.04(2) of that law requires that you
be notified of the matters included in this Disclosure Statement before you are asked to provide that information to
MHFA. The owner of the Property ("Owner") may also ask you to supply information that relates to your application.
The Owner's request for information is not governed by the Minnesota Government Data Practices Act.
3.
MHFA is asking for information that is necessary for the administration and management of a State or Federal
program to provide housing for low and moderate-income families. Some of the information may be used to
establish your eligibility to initially occupy, or to continue to occupy, a unit in the Property and/or to receive either
State or Federal rental assistance. Other information may be used to assist MHFA in the evaluation and management
of some of the programs it operates.
4.
As part of your application, you are asked to supply the information contained in each of the following Attachments
that are checked with an "X" (all checked boxes apply):
 Attachment 1 - Section 8, 236, and 202 Programs  Attachment 4 - Deferred Loan (other than MARIF)
 Attachment 2 - Housing Tax Credit Program
 Attachment 5 - MARIF
 Attachment 3 - ARM or LMIR First Mortgage
 Attachment 6 - HOME
Each Attachment has two parts: Part A and Part B.
5.
The information asked for under Part A of the checked Attachment(s) may be used by MHFA to establish your
eligibility to occupy a unit in the Property or to receive State or Federal rental assistance. If you refuse to supply any
portion of the information asked for under Part A of the checked Attachment(s), you may not qualify for initial or
continued occupancy of a unit in the Property or for receipt of State or Federal rental assistance.
82
6.
The information asked for under Part B of the checked Attachment(s) will help MHFA in the evaluation and
management of some of the programs it operates and your supplying of this information will be very helpful to the
MHFA. Your failure to provide any of the information asked for under Part B of the checked Attachment(s) will not
affect whether or not you qualify for initial or continued occupancy of a unit in the Property or for State or Federal
rental assistance.
7.
The Owner may also ask for information to determine whether or not it will rent a unit in the Property to you. Your
supplying of, or refusal to supply, any information requested by the Owner will not affect a decision by MHFA, but
could affect the Owner's decision of whether it will rent a unit to you. The determination by the Owner is separate
from MHFA's determination and MHFA does not participate, in any way, in the Owner's decision.
8.
All of the information that you supply to MHFA will be accessible to staff of the MHFA and may be made available
to staff of the Office of the Minnesota Attorney General, the United States Department of Housing and Urban
Development, the United States Internal Revenue Service, and other persons and/or governmental entities who have
statutory authority to review the information, investigate specific conduct, and/or take appropriate legal action,
including but not limited to law enforcement agencies, courts and other regulatory agencies. The information may
also be provided by MHFA to the Owner's management agents of the Property. Under certain circumstances the
information that you supply to MHFA may become public data and available, upon written request, to the general
public.
9.
This Disclosure Statement remains in effect for as long as you occupy a unit in the property and are a participant in
the program(s) identified in #2, above.
I was (We were) supplied with a copy of and have read this Minnesota Housing Finance Agency Government Data
Practices Act Disclosure Statement and the Attachment(s) identified in #2, above.
Head of household, spouse, co-head and all household members age 18 or older must sign below:
Applicant/Tenant
Signature
____________________________________
Date
________________________
____________________________________
Date
________________________
____________________________________
Date
________________________
____________________________________
Date
________________________
Applicant/Tenant
Signature
Applicant/Tenant
Signature
Applicant/Tenant
Signature
83
Attachment 1
Section 8, 236 and 202 Programs
Part A.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Household composition, legal name(s}, age(s) and relationship to the head of household of all household members
Declaration of citizenship or legal non-citizenship of all household members
Social Security Number disclosure of all household members, age 6 and older
Date of birth of all household members
Elderly, disabled or handicapped status of affected members of your household (for program eligibility and/ or
program allowances)
Custody of minor children
Non-immigrant student status
Housing preferences by program or statute
Employment or unemployment status
Amount and source of all earned and unearned income of all household members
Type, value and income derived from all household assets
Type, value and income derived from all household assets disposed of for less than fair market value within the past
2 years
Participation in self-sufficiency programs
Medical expenses (for program allowances)
Handicap assistance expenses (for program allowances)
Child care expenses (for program allowances)
Need for reasonable accommodation for any member of the household
Need for assistive animal and/ or devices
Credit and criminal history background data fall adult household members
Disclosure of the use, sale, distribution or manufacture of illegal drugs of any adult household members.
Disclosure of arrests or convictions of the use or illegal distribution or manufacture of illegal drugs or controlled
substances
Disclosure of arrests or convictions of a felony or misdemeanor (other than a traffic violation)
Disclosure of lifetime registration as a predatory sex offender of any adult household member
Disclosure of a pattern of alcohol abuse of any adult household member that would interfere with other tenants'
rights
Disclosure of receipt of previously received government housing subsidy
Disclosure of termination of housing assistance for fraud, non-payment of rent or utilities or failure to cooperate
with recertification procedures
Current and previous residency
Part B
1.
2.
3.
4.
5.
6.
Race
Ethnicity
Gender of head of household
Marital Status
Occupation
Receipt of Public Assistance
Ver 4/05
(MHFA-Gnrc Dta Prctcs (Tnnssn) Frm)
84
TENANT CERTIFICATION SUMMARY WORKSHEET
Project:
Unit#:
Tenant:
Effective Date:
1. Assets:
Balance
CD’s
$
Checking Account
$
Savings
$
Real Estate Property
$
Business
$
Contract for Deed
(Interest Only)
$
Other
$
(Assets disposed of over the past two years)
Total Assets
Total Income from Assets
2. Income:
Gross Wages, Salaries
Overtime, Commission, Bonuses
Social Security (Including Medicare)
Pensions & Annuities
Assistance (MFIP, General Assistance
Other (Child support, Familial Support, and misc.)
Deductions
Date:
Int.Rate
Income
x
x
x
x
x
%=
%=
%=
%=
%=
$
$
$
$
$
x
x
%=
%=
$
$
$
$
$
+$
$
+$
$
$
=$
=$
A. Is anyone in the household, 18 years or older and a student? Yes
(If the answer is yes; resident needs to complete student verification)
No
B. Family child care expense which allows Tenant or Co-Tenant to work or attend school.
$
C. Is anyone in the household age 62, disabled or handicapped? Yes
No
(CONTINUE)(STOP)
Medicare Payments
Supplemental Insurance Payments
$
NOTE: List Only Expenses Not Covered by Insurance
Doctor and Dentists
Prescriptions
Mileage for Medical Purposes
Other – glasses, hearing aids, etc.
$
Total Medical Expenses
$
$
$
$
$
I/We certify that the above information Is true and correct to the best of my/our knowledge.
Tenant Signature
Co-Tenant Signature
I certify that all information has been verified.
Manager Signature
YOU ARE REOUIRED TO HAVE VERIFICATIONS FOR !VERY FIGURE USTED ABOVE. IN YOUR OFFICE FILES. AT THE TIME OF THE
CERTIFICATION. .
85
TENANT CERTIFICATION SUMMARY WORKSHEET
Project:
Unit#:
Tenant:
Effective Date:
1. Assets:
Balance
CD’s
$
Checking Account
$
Savings
$
Real Estate Property
$
Business
$
Contract for Deed
(Interest Only)
$
Other
$
(Assets disposed of over the past two years)
Total Assets
Total Income from Assets
2. Income:
Gross Wages, Salaries
Overtime, Commission, Bonuses
Social Security (Including Medicare)
Pensions & Annuities
Assistance (MFIP, General Assistance
Other (Child support, Familial Support, and misc.)
3. Deductions
Date:
Int.Rate
Income
x
x
x
x
x
%=
%=
%=
%=
%=
$
$
$
$
$
x
x
%=
%=
$
$
$
$
$
+$
$
+$
$
$
=$
=$
A. Is anyone in the household, 18 years or older and a student? Yes
(If the answer is yes; resident needs to complete student verification)
No
B. Family child care expense which allows Tenant or Co-Tenant to work or attend
school.
$
C. Is anyone in the household age 62, disabled or handicapped? Yes
Medicare Payments
Supplemental Insurance Payments
NOTE: List Only Expenses Not Covered by Insurance
Doctor and Dentists
Prescriptions
Mileage for Medical Purposes
Other – glasses, hearing aids, etc.
Total Medical Expenses
No
(CONTINUE)(STOP)
$
$
$
$
$
$
$
I/We certify that the above information is true and correct to the best of my/our knowledge.
Tenant Signature
Co-Tenant Signature
I certify that all information has been verified.
Manager Signature
YOU ARE REOUIRED TO HAVE VERIFICATIONS FOR EVERY FIGURE LISTED ABOVE IN YOUR OFFICE
FILES AT THE TIME OF THE CERTIFICATION. .
86


Initial
Recertification
Move-in Date
ELIGIBILITY QUESTIONNAIRE
$___________Rent Amount
Property Name
Address
Unit #
HOVSEHOLD COMPOSITION
Applicants/residents, complete in your own handwriting. List the Head of Household and all other persons who will be living in the unit.
Give the relationship of each family member to the head. Each household member age 18 years or older must sign and date this application.
A household comprised entirely of students will be required to complete a Student Verification, if not otherwise qualified.
HOUSEHOLD MEMBER'S NAME
RELATIONSHIP
1
DATE OF
BIRTH
WILL THIS PERSON BE A
STUDENT IN THE NEXT 12
MONTHS?
YES/NO
SOCIAL
SECURITY NUMBER
HEAD
2
3
4
5
6
7
8
HOUSEHOLD INCOME INFORMATION
For each household member age 18 or older (including family members temporarily absent), list current and anticipated income for the twelve-month period
beginning on the anticipated move-in date or effective date of recertification. All information must be verified.
Include all full time, part time or seasonal income even if completing this application in the off-season.
DO YOU RECEIVE OR EXPECT TO RECEIVE
(check either YES or NO to each item, as applicable, and include gross monthly amount):
YES
NO
Gross Monthly Amount
1. Wages, salaries (include overtime, tips, bonuses, commissions)
2. Does any member work for someone who pays them in cash or has self-employment income
3. Regular pay for a member of the armed forces
4. Public Assistance (MFIP, GA)
$
$
$
$
5. Worker's compensation.
$
6. Unemployment benefits or severance pay.
$
7. Student financial aid (public or private, not including student loans)
$
8. Child support (check yes if you have a court order, even if you are receiving less than the full amount awarded)
$
9. Alimony/Spousal Maintenance
$
10. Social Security income (including unearned income of minor children)
$
11. Disability benefits including social security disability
$
12. Regular payments from pensions (PERA, railroad, etc.)
$
13. Regular payments from retirement benefits
$
14. Death Benefits
$
15. Regular payments from annuities or life insurance dividends.
$
16. Regular payments from inheritance, insurance settlement, lottery winnings, etc.
$
17. Net income from rental property
$
18. Regular cash and non-cash contributions, assistance with paying bills or gifts from individuals not living in
the unit (not including groceries)
19. Other (list)
20. Other (list)
87
$
$
$
HOUSEHOLD ASSET INFORMATION
Yes
No
CURRENT
DOES ANY HOUSEHOLD MEMBER (INCLUDING CHILDREN) HAVE MONEY HELD IN:
BALANCE
$
$
21. Checking Accounts (6 month average balance)
22. Savings Accounts
23. Stocks
$
24. Capital Investments
$
$
25. Bonds
26. Trusts*
$
$
$
27. Securities
28. Whole Life Insurance Policy (do not include term life insurance)
29. 401K*
$
$
$
30. IRA/KEOGH Accounts
31. Certificates of Deposit
32. Pension/Retirement/Annuity accounts
33. Money Market Funds
34. Treasury Bills
35. Safety Deposit Box
36. Lump Sum Payment (i.e., inheritance, insurance settlement, lottery winnings, capital gains).
$
$
$
$
$
37. Are any accounts held jointly with someone not in the unit? Which account and with whom?
38. Other
*Include Trusts, 40IK, etc., only if the accounts are accessible to the household prior to termination of employment, retirement, or death. (If you are unsure, list the account and it will be
verified.
Yes
No
Value
39. Do you now own Real Estate?
If yes, list address(es):
$
40. Do you hold a contract for deed?
$
41. Do you have any coin collections, antique cars, gems/jewelry, stamps or any other items held as an investment
(wedding rings and personal jewelry do not count)?
$
42. Are any assets held jointly with another person? List person and asset(s).
Is combined cash -value of all household assets under $5,000?
From 1-42 above, provide further information for all "YES" checked items.
(If a household member has more than one source of income and/or assets, use a separate line for each source. Use additional sheets, if necessary.)
Item
Number
HH Member
Name and mailing address of company, financial institution or source
Contact Name & phone/fax
number
Please attach documentation available to verify income (i.e., divorce/settlement papers, tax returns, social security benefit award letter, etc.)
88
I/We hereby certify that I/we
Have
Have not
sold or given away any assets for less than Fair Market Value during the two year (24 month) period preceding the date of this application. Any assets
sold or disposed of for less than Fair Market Value must be identified below
Household Member
Asset & Estimated Market Value
Date sold/disposed
Amount Received
$
MEDICAL EXPENSES
If you are age 62 or older, handicapped or disabled, do you pay for any of the following medical expenses?
Check either YES or NO in response to each Question. Add an explanation below for ail items checked YES.
Yes
No
Do you receive Medicare Benefits?
Do you have a Supplemental Health Insurance policy?
Do you pay "out of pocket" expense for doctors and/or dentists
Do you pay "out of pocket" expense for prescription medications
Do you pay "out of pocket" expense for glasses, hearing aids, etc.
Do you pay "out of pocket" expense for transportation services to/from a medical facility
MISCELLANEOUS
The following questions pertain to yourself and every member of your household who will occupy the unit. Check either YES or NO in response to each question. Add an
explanation below for all items checked YES.
Yes
No
Will any household member, including children, live in the unit on a less than full time basis?
Do you anticipate "any change in your household (someone moving in or out) during the next 12 months?
Does any adult member of the household have zero income?
Does/will the household receive rent assistance? If so, indicate from what source (Section 8, Rural Development RA, etc.).
Does your household have any needs that might be better served by an apartment which is accessible to persons with mobility, hearing or visual impairments?
Explanation:
__________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________
SIGNATURES
I/we hereby affirm that the foregoing information is true and complete to the best of my/our knowledge, and authorize the Landlord to make inquiries to verify the statements herein. I/we
further understand that any intentional misrepresentation in this application might result in a default in the rental agreement and/or eviction of this household If any of the aforementioned
information changes, I/we agree to notify Landlord immediately.
All household members age 18 or older (and under age 18 if head, spouse, or co-head of household) must sign and date below:
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
3 of 3
89
Minnesota Housing Finance Agency
GOVERNMENT DATA PRACTICES ACT
DISCLOSURE STATEMENT
PRINT NAME(s) OF HOUSEHOLD MEMBERS
SIGNING THIS FORM
Minnesota Housing Finance Agency ("MHFA") is asking you to supply information that relates to your application to
occupy, or continue to occupy, a unit in the following property ("Property"):
Some of the information you are being asked to provide to MHFA may be considered private or confidential under the
Minnesota Government Data Practices Act, Minnesota Statutes chapter 13. Section 13.04(2) of that law requires that you
be notified of the matters included in this Disclosure Statement before you are asked to provide that information to
MHFA. The owner of the Property ("Owner") may also ask you to supply information that relates to your application.
The Owner's request for information is not governed by the Minnesota Government Data Practices Act.
1.
MHFA is asking for information that is necessary for the administration and management of a State or Federal
program to provide housing for low and moderate-income families. Some of the information may be used to
establish your eligibility to initially occupy, or to continue to occupy, a unit in the Property and/or to receive either
State or Federal rental assistance. Other information may be used to assist MHFA in the evaluation and management
of some of the programs it operates.
2.
As part of your application, you are asked to supply the information contained in each of the following Attachments
that are checked with an "X" (all checked boxes apply):
 Attachment 1 - Section 8, 236, and 202 Programs  Attachment 4 - Deferred Loan (other than MARIF)
 Attachment 2 - Housing Tax Credit Program
 Attachment 5 - MARIF
 Attachment 3 - ARM or LMIR First Mortgage
 Attachment 6 - HOME
Each Attachment has two parts: Part A and Part B.
3.
The information asked for under Part A of the checked Attachment(s) may be used by MHFA to establish your
eligibility to occupy a unit in the Property or to receive State or Federal rental assistance. If you refuse to supply any
portion of the information asked for under Part A of the checked Attachment(s), you may not qualify for initial or
continued occupancy of a unit in the Property or for receipt of State or Federal rental assistance.
90
4.
The information asked for under Part B of the checked Attachment(s) will help MHFA in the evaluation and
management of some of the programs it operates and your supplying of this information will be very helpful to the
MHFA. Your failure to provide any of the information asked for under Part B of the checked Attachment(s) will not
affect whether or not you qualify for initial or continued occupancy of a unit in the Property or for State or Federal
rental assistance.
5.
The Owner may also ask for information to determine whether or not it will rent a unit in the Property to you. Your
supplying of, or refusal to supply, any information requested by the Owner will not affect a decision by MHFA, but
could affect the Owner's decision of whether it will rent a unit to you. The determination by the Owner is separate
from MHFA's determination and MHFA does not participate, in any way, in the Owner's decision.
6.
All of the information that you supply to MHFA will be accessible to staff of the MHFA and may be made available
to staff of the Office of the Minnesota Attorney General, the United States Department of Housing and Urban
Development, the United States Internal Revenue Service, and other persons and/or governmental entities who have
statutory authority to review the information, investigate specific conduct, and/or take appropriate legal action,
including but not limited to law enforcement agencies, courts and other regulatory agencies. The information may
also be provided by MHFA to the Owner's management agents of the Property. Under certain circumstances the
information that you supply to MHFA may become public data and available, upon written request, to the general
public.
7.
This Disclosure Statement remains in effect for as long as you occupy a unit in the property and are a participant in
the program(s) identified in #2, above.
I was (We were) supplied with a copy of and have read this Minnesota Housing Finance Agency Government Data
Practices Act Disclosure Statement and the Attachment(s) identified in #2, above.
Head of household, spouse, co-head and all household members age 18 or older must sign below:
Applicant/Tenant
Signature
____________________________________
Date
________________________
____________________________________
Date
________________________
____________________________________
Date
________________________
____________________________________
Date
________________________
Applicant/Tenant
Signature
Applicant/Tenant
Signature
Applicant/Tenant
Signature
91
Race and Ethnic Data
U.S. Department of Housing
Reporting Form
and Urban Development
Office of Housing
Project No.
Name of Property
OMB Approval No. 2502-0204
(Exp. 10/31/2004)
Address of Property
Name of Owner/Managing Agent
Type of Assistance or Program Title
Name of Head of Household
Name of Household Member
Date (mm/dd/yyyy):
Ethnic Categories*
Select
One
Hispanic or Latino
Racial Categories*
Select
all that
apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Definitions of these categories may be found on the reverse side.
There is no penalty for persons who do not complete the form.
Signature
Date
Public reporting burden for this collection is estimated to average 10 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. This information is required to obtain benefits and voluntary. HUD may not collect this information, and you are not required to complete this form, unless it displays a current valid OMB control
number.
This information is authorized by the U.S. Housing Act of 1937 as amended, the Housing and Urban Rural Recovery Act of 1983 and Housing and Community Development Technical Amendments of 1984. This information is needed to
be incompliance with OMB-mandated changes to Ethnicity and Race categories for recording the 50059 Data Requirements to HUD, Owners/agents must offer the opportunity to the head and co-head of each household to "self certify”
during the application interview or lease signing. In-place tenants must complete the format as part of their next interim or annual re-certification. This process will allow the owner/agent to collect the needed information on all members of
the household. Completed documents should be stapled together for each household and placed in the household's file. Parents or guardians are to complete the self-certification for children under the age of 18. Once system development
funds are provided and the appropriate system upgrades have been implemented, owners/agents will be required to report the race and ethnicity data electronically to the TRACS (Tenant Rental Assistance Certification System). This
information is considered non-sensitive and does not require any special protection.
Form HUD-27061-H (9/2003)
92
CERTIFICATION INTERVIEW CHECKLIST
Effective Date of Certification:
Property:
Tenant:
Address:
Unit:
Type of Certification: Move In
Annual
Interim
Date Certification Interview was Held:
Income/Asset Summary Completed and Signed
Minnesota Data Privacy Act (Attachment), Authorization Form
DUD 9887 and 9887-A (HUD Properties Only)
Tenant Certification Summary Worksheet
Race/Ethnicity Form
Type and Dates of Verifications were Sent/Faxed:
Date Sent
Name of Verification
1st, 2nd, 3rd Request
Date Certification Package was mailed to Cepco:
93
Date Received
To Annualize Income
Weekly x 52 Weeks = Annual Income
Bi-Weekly x 26 pay periods = Annual Income
Bi- Monthly x 24 pay periods = Annual Income
Monthly x 12 Months = Annual Income
94
VERIFICATIONS
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LANDLORD REFERENCE RELEASE
ALIMONY/CHILD SUPPORT (AGENCY)
ALIMONY /CHILD SUPPORT (PAYOR)
ASSET 401K
UNDER 5K ASSET CERTIFICATION
BANK VERIFICATION
CHANGE IN HOUSEHOLD COMPOSITION
DISABILITY / HANDICAPPED VERIFICATION
DIVESTITURE OF ASSET VERIFICATION
EMPLOYMENT VERIFICATION
EVIDENCE OF INCOME
LIVE IN AIDE AGREEMENT
DRUG FREE HOUSING AGREEMENT
MILITARY PAY VERIFICATION
NET VALUE OF ASSETS WORKSHEET
CERTIFICATION OF ZERO INCOME
PENSION /ANNUITY VERIFICATION
PHONE VERIFICATION /CLARIFICATION
PUBLIC ASSISTANCE VERIFICATION
RACE AND ETHNIC DATA REPORT FORM
REAL ESTATE VERIFICATION
VERIFICATION OF REGULAR CONTRIBUTIONS
VERIFICATION OF SECTION 8 ELIGIBILITY
SELF EMPLOYMENT VERIFICATION (EXISTING)
SELF EMPLOYMENT VERIFICATION (NEW BUSINESS)
SOCIAL SECURITY /SSI VERIFICATION
NEED FOR UNIT WITH SPECIAL FEATURES
STOCKS/BONDS VERIFICATION
STUDENT VERIFICATION
UNEMPLOYMENT COMPENSATION VERIFICATION
TRANSFER OF UNIT WITHIN THE SAME BUILDING
VETERAN'S BENEFITS VERIFICATION
CHILD/DEPENDENT CARE VERIFICATION
MEDICAL MILEAGE
PRESCRIPTION DRUG
HEALTH INSURANCE
CONTRACT FOR DEED MORTGAGE INTEREST
PERSONAL CHARACTER REFERENCE
NON PAYMENT OF ALIMONY/CHILD SUPPORT
DOCTOR/HOSPITAL/CLINIC VERIFICATION
95
Bank Verification
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my asset information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The
information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial
and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY FINANCIAL INSTITUTION
SAVINGS ACCOUNT:
SAVINGS ACCOUNT:
Acct #:
Acct #:
Current Balance
$ ____________________
Current Balance
$ ____________________
Current % Rate
_____________________
Current % Rate
_____________________
Joint Account? ____No ____Yes with ____________
Joint Account? ____No ____Yes with ____________
CHECKING ACCOUNT:
Average Balance for the Past Six Months:
Rate of Interest: _______________
$
%
Current Balance:
$
Joint Account? ____No _____ Yes with _____________________________
Please list other asset accounts below (Certificates of Deposit, Money Market Funds, Trust, IRA's, etc.)
Account
Number
Balance
Type of
Account
Rate of
Interest
Cash Value*
$
%
$
$
%
$
$
%
$
Are any joint accounts? _____No ____ Yes Account(s)___________ with ________________________
*NOTE: CASH VALUE IS THE CURRENT VALUE MINUS PENALITIES FOR EARLY WITHDRAWAL.
Signature:
Date:
Print your name:
Tel. #:
Bank Name
Address
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.
Bank Verification
MHFA HTC 1/07
96
EMPLOYMENT VERIFICATION
THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT.
TO:
(Name & address of employer)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my employment information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information
provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employer, please fill in all blanks. Enter N/A if an item is not applicable to the above employee.
Employee Name:
Presently Employed:
Job Title:
Yes _____
Date First Employed ___________
Current Wages/Salary: $ ______________(circle one) hourly
weekly
No _____ Last Day of Employment ________________
bi-weekly
semi-monthly
monthly
yearly
other ________
Average # of regular hours per week: _____
Year-to-date earnings: $ ______________ through ___/___/____
Overtime Rate: $ _______per hour
Average # of overtime hours per week: ___________
Shift Differential Rate: $ _______per hour
Average # of shift differential hours per week: ________
Commissions, bonuses, tips, other: $ ______(circle one) hourly weekly bi-weekly semi-monthly monthly yearly other ______
List any anticipated change in the employee’s rate of pay within the next 12 months: ________________; Effective date: __________
If the employee’s work is seasonal or sporadic, please indicate the layoff period(s): ________________________________________
Does this employee have a 401k, 403b or other retirement account? ______ If the answer is yes, can the employee withdraw the funds in this
account? _______.
Additional remarks: ___________________________________________________________________________________________
Employer’s Signature
Employer’s Printed Name
Date
Employer [Company]Name and Address
Phone #
Fax #
E-mail
NOTE: 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.
Employment Verification
MHFA HTC (1/07)
97
ALIMONY / CHILD SUPPORT VERIFICATION (Enforcement Agency)
TO: (Name & address)
Date:
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY SUPPORT ENFORCEMENT AGENCY
I hereby certify that $_________ per ______(week, month) is court ordered to be paid for the support of:
______________________________________________________________________________________
Name(s) of person/child(ren) for whom support is paid
______________________________
________________________
______________
___________
Address
City
State
Zip Code
Does this person receive the full amount of the award?
YES _______
NO _____
If NO, has every reasonable effort been made by the applicant to collect any amount which may be due, including, but not limited to, filing
with the appropriate courts or agencies responsible for the enforcement of any payments?
YES _______ NO _____
Total amount received during the last 12 months: $ ____________
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
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.
Alimony/Child Support Verification
MHFA HTC 1/05
ALIMONY / CHILD SUPPORT VERIFICATION (Payor)
TO: (Name & address)
Date:
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY PERSON PAYING ALIMONY/CHILD SUPPORT
I hereby certify that I pay $_________ per ______to the support of:
______________________________________________________________________________________
Name(s) of person/child(ren) for whom support is paid
______________________________
Address
________________________
City
Signature:
Date:
Print your name:
Tel. #:
______________
State
___________
Zip Code
Title:
Address
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.
Alimony/Child Support Verification
MHFA HTC 1/05
99
ALIMONY / CHILD SUPPORT SELF CERTIFICATION
Applicant's Name
Social Security #
Address
City
I hereby certify that I receive $
per
State
Zip Code
(week, month, year) to the support of:
Name(s)
Address
City
State
Signature:
Date:
Print your name:
Tel. #:
Zip Code
Relationship:
Address

This form is to be used only if third party verification has been attempted. but cannot be obtained.

This form is not required (nor is any other alimony/child support verification) if tenant states on their application that there is no
court order and support is not received or expected to be received.
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.
MHFA HTC 1/05
Alimony/Child Support Self Certification
100
DISABILITY/HANDICAPPED STATUS VERIFICATION
Applicant's Name
Address
Social Security #
City
TO:
State
Zip Code
FROM:
PLEASE RETURN THIS FORM TO THE PERSON LISTED HERE
Thank you for your cooperation. All information is confidential. If you have any questions, please contact: ____________ at
(
)_______________.
PERMISSION FOR RELEASE OF INFORMATION
YOU DO NOT HAVE TO SIGN THIS FORM IF EITHER THE REOUESTING ORGANIZATION OR THE ORGANIZATION SUPPLYING THE
INFORMATION IS LEFT BLANK.
RELEASE:
I hereby authorize the release of the requested information. Information obtained under this consent is limited to
information that is no older than 12 months. There are circumstances which would require the owner to verify information that is up to 5 years old, which
would be authorized by me on a separate consent attached to a copy of this consent.
Signature
Date
To the Applicant's/Tenant's Medical Doctor:
Please review the definitions below and indicate whether or not the applicant is disabled as defined in Section 223 of the Social Security
Act, or Section 102 (b)(5) of the Developmental Disabilities Services and Facilities Construction Amendment of 1970, or as defined in 24
CFR Section 5.403.
A
B
Inability to engage in any substantial, gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to result in death
or which has lasted or can be expected to last for a continuous period of not less than
12 months.
D
No
Yes
No
Yes
No
Yes
No
In the case of an individual who has attained an age of 55 and is blind (within the meaning of
“blindness" as defined in Section 416 (i) (1): inability by reason of such blindness to
engage in substantial gainful activity in which he/she has previously engaged with
some regularity and over a substantial period of time.
C
Yes
A disability attributable to mental retardation, cerebal palsy, epilepsy, or another
neurological condition of an individual found by the Secretary (of Health, Education,
and Welfare) to be closely related to mental retardation or to require treatment similar
to that required for mentally retarded individuals, which disability originates before
such individual attains age twenty-two, which has continued or can be expected to
continue indefinitely, and which constitutes a substantial handicap to such individual.
A handicapped person as defined in 24 CFR Section 5.403: a person having a
physical or mental impairment which (1) is expected to be of long-continued and
indefinite duration, (2) substantially impedes his/her ability to live independently, and
(3) is of such nature that such a disability could be improved by more suitable
housing conditions.
sability/Handicap Status Verification
page 1 of 2
MHFA HTC 1/05
101
If you are unable to complete this form, please indicate reason:
I certify that this form is completed in response to a direct and explicit request of the patient.
Doctor's Name (Print or type)
(
Signature of Doctor
)
Date
Telephone Number
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.
Disability/Handicap Status Verification
page 2 of 2
MHFA HTC 1/05
102
EMPLOYMENT VERIFICATION
THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY TENANT.
TO: (Name & address of employer)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my employment information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
RETURN FORM TO:
THIS SECTION TO BE COMPLETED BY EMPLOYER
Employer, please fill in all blanks. Enter N/A if an item is not applicable to the above employee.
Employee Name:
Presently Employed:
Job Title:
Yes _____
Date First Employed ___________
Current Wages/Salary: $ ______________(circle one) hourly
weekly
No _____ Last Day of Employment ________________
bi-weekly
semi-monthly
monthly
yearly
other ________
Average # of regular hours per week: _____
Year-to-date earnings: $ ______________ through ___/___/____
Overtime Rate: $ _______per hour
Average # of overtime hours per week: ___________
Shift Differential Rate: $ _______per hour
Average # of shift differential hours per week: ________
Commissions, bonuses, tips, other: $ ______(circle one) hourly weekly bi-weekly semi-monthly monthly yearly other ______
List any anticipated change in the employee’s rate of pay within the next 12 months: ________________; Effective date: __________
If the employee’s work is seasonal or sporadic, please indicate the layoff period(s): ________________________________________
Does this employee have a 401k, 403b or other retirement account? ______ If the answer is yes, can the employee withdraw the funds in this account?
_______.
Additional remarks: ___________________________________________________________________________________________
Employer’s Signature
Employer’s Printed Name
Date
Employer [Company]Name and Address
Phone #
NOTE:
Fax #
E-mail
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.
Employment Verification
MHFA HTC (1/07)
103
_
EVIDENCE OF INCOME
Applicant's Name
Social Security #
Property Name
Property Location
Applicant/Tenant Name
Present Address
The above named applicant/tenant personally presented as evidence of income (describe documents):
S/He receives $
___per week
; month
; year
___ from (list sources of income):
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
Evidence of Income
MHFA HTC 1/05
104
DIVESTITURE OF ASSET VERIFICATION
I/We hereby certify that I/we
have
have not sold or disposed of any assets for less than Fair Market Value during
the two year (24 month) period preceding the effective date of my/our certification or recertification. Any assets sold or disposed of for
less than Fair Market Value are identified below.
1.
I have disposed of more than $1,000 in assets for less than Fair Market Value within the two-year period preceding the effective
date of my certification or recertification.
2.
The asset(s) I/we disposed of was:
a)
b)
c)
d)
e)
3.
The CASH VALUE* of the asset(s) I/we disposed of was:
a)
b)
c)
d)
e)
4. --
The amount(s) received for the asset(s) I/we disposed of was:
a)
b)
c)
d)
e)
*CASH VALUE is the market value of the asset minus reasonable costs incurred in selling or converting the asset to cash. Such reasonable
costs include:
1.
penalties for withdrawing funds before maturity;
2.
broker/legal fees for the sale or conversion of assets; and
3.
settlement costs for real estate transactions.
Signature of Applicant
Date
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.
Divestiture of Asst Verification
MHFA HTC 1/05
105
Investment
OR
Pension
OR
Annuity Verification
(To be completed by insurance agent)
TO:
RE:
Name
Social Security Number
FROM:
Thank you for your prompt response. All information is confidential.
Please contact ________________________________________
At (
) _____________if you have any questions.
PERMISSION FOR RELEASE OF INFORMATION
You do not have to sign this form If either the requesting organization of the organization supplying the Information is left blank. Release: I hereby authorize the release of
the requested information. Information obtained under this consent is limited to information that is no older than 12 months. There are circumstances, which would require
the owner to verify information that is up to 5 years old, which would be authorized by me on a separate consent, attached to a copy of this consent.
Signature
Date
INSURANCE AGENT/ADMINISTRATOR – PLEASE COMPLETE APPLICABLE SECTIONS.
Type of account:
Fixed
Deferred
Market Value:
Variable
Life
Surrender or
Other
Withdrawal Fee:
Is this person receiving regular payments?
If yes, what is the gross amount? $
Yes
$
$
No
per (circle one) Month / Quarter / Other
Date benefits began:
Effective date of current amount:
Deductions from gross amount for medical insurance premiums:
$
Total amount holder has invested in this account:
$
Total amount holder has received in payments to date:
$
If no, does the holder receive interest income?
Yes
If yes or reinvested into account, what is the interest rate?
No
________%
Reinvested into account
Fixed
Variable
1f variable, provide current rate.
Is the holder able to withdraw the balance of the annuity/account?
If yes, what is the amount? $________________
Yes
No
What is the tax rate?______________%
What is the tax penalty, if any _______________
Is the individual reimbursed for medical costs?
Yes
No
Signature of Agent/Administrator ____________________________ Date ____________________________
Print your name
____________________________ Tel. # ___________________________
Address
___________________________________ _____________ ______ __________
City
State
Zip
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.
Pension/ Annuity Verification
MHFA HTC 1/05
106
STUDENT FINANCIAL AID VERIFICATION
TO: (Name & address)
RE:
Print Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my financial aid information.
Date
Signature of Student Applicant/Tenant
Student ID#
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
RETURN FORM TO:
THIS SECTION TO BE COMPLETED BY FINANCIAL AID PROVIDER AND/OR EDUCATIONAL INSTITUTION
Please provide the information requested below:
Student Currently attends school: (please circle one)
Full Time
Part Time
Total scholarships, grants, etc. (public or private, excluding student loans) received is:
Source
Amount
Beginning Date
Scholarships Grants
________________
$_________
___________
__________
Grants
________________
$ _________
____________
___________
$ _________
_____________
___________
Cost of Tuition
Ending Date
Expected Date of Graduation: _________________________________
I hereby certify that the statements above are true and complete to the best of my knowledge.
Signature:
____________________________ Date ____________________________
Print your name:
____________________________ Tel. # ___________________________
Title:
____________________________
107
Live-in Aide Housing Agreement
A Live-in Aide is a person or persons who:

Resides with an elderly, handicapped or disabled person or persons;

Is determined to be essential to the care and well being of the Tenant;

Is not obligated for the support of the Tenant; and,

Would not be living in the unit except to provide the necessary supportive services.
Name of Tenant:
Unit #
Name of Household member requiring assistance:
Name of Live-in Aide:
The Tenant and Live-in Aide acknowledge and agree as follows:

The Live-in Aide is not a tenant of the Landlord. The Live-in Aide shall not become a tenant of the Landlord regardless of the
length of his /her stay in the unit or his/her relationship to the Tenant. Relatives who meet the definition and qualify as a Live-in
Aide relinquish all rights to the unit as a "remaining member" of the Tenant's household.

The Live-in Aide shall be living in the unit solely to provide support services to the household member requiring assistance. If the
household member requiring assistance no longer resides in the unit, the Live-in Aide shall have no rights or privileges to remain
on the premises.

If the household member requiring assistance dies, the Live-in Aide shall vacate the unit within 10 days of said household
member's death. If the household member requiring assistance moves out, the Live-in Aide shall vacate the unit no later than said
household member’s vacate date. Upon the termination of the Live-in Aide's services for any other reason, the Live-in Aide shall
vacate the unit within 24 hours.

The Live-in Aide shall not violate any of the House Rules. The Landlord may evict the Live-in Aide if s/he violates any of the
House Rule
____________________________________
Tenant's Signature
__________________________________
Date
____________________________________
Live-in Aide's Signature
__________________________________
Date
____________________________________
Owner/Management Agent's Signature
__________________________________
Date
Live-in Aide Agreement
MHFA HTC 1/05
108
Military Pay Verification
TO: (Name & address)
RE:
Print Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information
provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY THE MILITARY
INCOME
Base Pay and Longevity Pay
Proficiency Pay
Sea and Foreign Duty Pay
Hazardous Duty Pay
Subsistence Allowance
Separate / Commuted Rations* (if meal card, enter N/A)
Quarters Allowance (Include only amt. contributed by Government)
Number of Dependents Claimed
Other (Explain) ______________________________________________
_____________________________________________________________
_____________________________________________________________
TOTAL AMOUNT RECEIVED MONTHLY
PAY PER MONTH
$ ________________
$_________________
$_________________
$_________________
$_________________
$_________________
$_________________
_________________
$_________________
$_________________
*It is our understanding that the commuted rations are received monthly unless the soldier is in the field.
Please indicate the number of days the soldier is anticipated to be in the field in the next 12 months. _________________
Military Personnel Officer
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
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.
Military Pay Verification
MHFA HTC 1/05
109
Public Assistance Verification
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
________________________________________________________
Applicant/Tenant Address/City/State/Zip Code
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information
provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY PUBLIC AUTHORITY
Does the above address match your records?
YES _____
NO _____
Number of Persons on Grant:
ADULT(S) _______
CHILD(REN) ________
Monthly Amount
Full Grant
Minnesota Families Investment Program
$ ____________________
General Assistance
$ ____________________
YES _____ NO _____
_____
_____
Other Assistance: Type _______
$ ____________________
_____
_____
Effective date of grant: ____________. If this person is not receiving the full grant, please explain why: _____________
__________________________________________________________________________________________________.
When do you anticipate the full grant will be reinstated? _______________________
Other known household income?
NO _____
YES _____ Describe: _____________________________
If YES, what is the monthly amount?
$ _____________
Does this person receive child support?
YES _____ NO _____
If YES, what is the monthly amount? $___________. Total amount received during the last 12 months: $________
If NO, has every reasonable effort been made by the applicant to collect any amount which may be due, including, but not limited to, filing
with the appropriate courts or agencies responsible for the enforcement of any payments?
YES _____ NO _____UNKNOWN _____
Department of Social Services
Date:
Tel. #:
Signature:
Print your name:
Title:
Address
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.
Public Assistance Verification
MHFA HTC 1/06
110
PHONE VERIFICATION/CLARIFICATION RECORD
Applicant's Name
Unit #
Property Name
VERIFICATION/CLARIFICATION RECEIVED BY TELEPHONE
Person contacted:
Title:
Company Name:
Telephone #:
Item Clarified/Verified:
Information Requested:
Clarification of the above entries and/or other pertinent information:
(Telephone verifications must be followed up with written verification.)
Date:
Tel. #:
Signature:
Print your name:
Title:
Address
Phone Verification
MHFA HTC 1/07
111
Real Estate Verification
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
Description of Property: (acreage, type of structures, etc.)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Address or location (street address or legal description):
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
THIS SECTION TO BE COMPLETED BY REALTOR, MORTGAGEE OR CLOSING COMPANY.
Market Value $___________________
Total Assessed Value $ ________________
If this property were sold, please estimate expenses below:
Broker Fee $______________
Settlement Costs: $_______________
Legal Fees $______________
Other (Specify)
Balance on Loan $_____________________________
$_______________
Cash Value $______________________
Date:
Tel. #:
Signature:
Print your name:
Title:
Company Name
Address
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.
Real Estate Verification
MHFA HTC 1/05
112
VERIFICATION OF REGULAR CONTRIBUTIONS
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY PERSON PROVIDING REGULAR CONTRIBUTIONS.
I hereby certify that I pay $_________ per _________(Month/W eek) to the support of:
_____________________________________________________________________________________________
Name
_________________________ _____________________ ____________________ ______________
Address
City
State
Zip Code
Notes/additional information: _____________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signature:
Date:
Print your name:
Tel. #:
Title/Relationship:
Company Name
Address
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.
Regular Contributions Verification
MHFA HTC 1/06
113
Self-Employment Verification (Existing Business)
______________________________________
____________________________________
Applicant's Name
Social Security #
__________________________________________
_____________________
____________ ___________
Address
City
State
Zip Code
Name of Business: _____________________________________________________________________________
Type of Business: _____________________________________________________________________________
Date Business Opened: _________________________________________________________________________
The following statement of income is based upon business transacted during the period of __________________, _______
(DATE) to _________________,_______(DATE).
1.
Gross income:
$ __________
2. Expenses:
3.
a.
Interest on Loan(s)
$ __________
b.
Cost of Goods/Materials
$ __________
c.
Business Rent
$ __________
d.
Utilities
$ __________
e.
Wages and Salaries
$ __________
f.
Employee Withholding Tax
$ __________
g.
Federal Withholding Tax
$ __________
h.
State Withholding Tax
$ __________
i.
FICA
$ __________
j.
Sales Tax
$ __________
k.
Other (Itemize on Reverse)
$ __________
l.
Straight Line Depreciation
$ __________
Total Expense
$ __________
Net Income
Based on the above figures, I expect to earn $
__________, ________ (date)).
$ ____________
for the upcoming 12 months (from ____________, _____(date), to
The information provided is substantiated by attached copies of my Federal Individual Income Tax return including Schedule C.
Under penalties of perjury, I certify that the information presented in this Self-Certification is true and accurate to the best of my
knowledge and belief. The undersigned further understands that providing false representations herein constitutes an act of fraud. False,
misleading or incomplete information may result in termination of the lease agreement.
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
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.
Self-Employment Verification
MHFA HTC 1/07
114
Self-Employment Certification (for new business)
______________________________________
____________________________________
Applicant's Name
__________________________________________
Address
Social Security #
_____________________
City
____________
___________
State
Zip Code
Name of Business: _____________________________________________________________________________
Type of Business: _____________________________________________________________________________
Date Business Opened: _______________________(If this date is in a previous tax year, it will be assumed that the business owner
has filed a tax return for that year, in which case the Self-Employment Certification for existing business must be completed.)
This certifies that I, ____________________________, receive a total of $___________________ per month for the following work:
______________________________________________________________________________________________________.
1.
Expected Gross Annual Income:
2.
Anticipated Expenses:
a.
Interest on Loan(s)
b.
Cost of Goods/Materials
c.
Business Rent
d.
Utilities
e.
Wages and Salaries
f.
Employee Withholding Tax
g.
Federal Withholding Tax
h.
State Withholding Tax
i.
FICA
j.
Sales Tax
k.
Other (Itemize on Reverse)
l.
Straight Line Depreciation
Total Expense
Expected Net Income
3.
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
$ ____________
Based on the above figures, I expect to earn $
(enter the amount in #3, above) for the upcoming 12 months (from
____________, _____ (date), to __________, ________ (date)).
Under penalties of perjury, I certify that the information presented in this Self-Certification is true and accurate to the best of my
knowledge and belief. The undersigned further understands that providing false representations herein constitutes an act of fraud. False,
misleading or incomplete information may result in termination of the lease agreement.
.
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
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.
Self-Employment Verification II
MHFA HTC 1/06
115
SELF-CERTIFICATION OF UNBORN CHILD/ADOPTION/CUSTODY
Applicant's Name
Address
Social Security #
City
State
Zip Code
For purposes of determining the income limit and/or number of bedrooms applicable for my household size, I hereby certify that I am:
Expecting a child (or children). The due date is: ______________________________.
In the process of adopting a child (or children).
In the process of obtaining custody of a child (or children).
Explanation:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Under penalties of perjury, I certify that the information presented in this Self-Certification is true and accurate to the best of my
knowledge and belief. The undersigned further understands that providing false representations herein constitutes an act of fraud. False,
misleading or incomplete information may result in termination of the lease agreement.
Signature:
Date:
Print your name:
Tel. #:
Current Address
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.
Self Certification of Unborn Child/Adoption/Custody
MHFA HTC 1/05
116
Social Security/ SSI Verification
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY SS/SSI ADMINISTRATOR(S)
COMPLETE AS APPLICABLE
Gross monthly payment
Deductions for Medicare premiums
Net amount of payment
$ __________
$ __________
$ __________
TYPE OF BENEFITS:
1.
Social Security
( ) Retirement
2.
( ) Disability
( ) Widow(er)
( ) Child(ren)
( ) Blind
( ) Other
Supplemental Security Income
( ) Old Age
( ) Disability
The above amount became effective on ________________________________________.
We are unable at this time to verify information requested:
( ) Claim still pending
( ) No record based on identifying information
( ) Other
- see reverse side of form
SOCIAL SECURITY ADMINISTRATION:
Signature:
Date:
Print your name:
Tel. #:
Title:
Address:
SS/SSI Verification
MHFA HTC 1/05
117
STOCKS / BONDS VERIFICATION
TO: (Name & address)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of the requested information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY BROKER OR AUTHORIZED OFFICIAL.
STOCKS:
Name of Stock Company: ___________________________________________________
Current Market Value minus broker/legal fees for conversion to cash: $ ____________
Total dividends paid in previous 12 months (included even if reinvested): $____________
Name of Stock Company: ___________________________________________________
Current Market Value minus broker/legal fees for conversion to cash: $____________
Total dividends paid in previous 12 months (included even if reinvested): $____________
BONDS:
Name of Issuing Agent: ___________________________________________________
Current Market Value minus broker/legal fees for conversion to cash: $____________
Total interest paid in previous 12 months: $ ____________
Name of Issuing Agent: ___________________________________________________
Current Market Value minus broker/legal fees for conversion to cash: $ ____________
Total interest paid in previous 12 months: $____________
Signature of Broker or Authorized Official
Signature:
Date:
Print your name:
Tel. #:
Title:
Company Name
Address:
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.
STOCKS/BONDS VERIFICATION
MHFA HTC 1/05
UNEMPLOYMENT COMPENSATION VERIFICATION
TO: (Name & address of employer)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my employment information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY INSURANCE PROVIDER
Gross weekly payment: $____________________________
Date of Initial Payment: _____________________
Is the client entitled to an extension of benefits? Yes _____
Ending Date, if known _______________
No _____
If yes, for how long?______________________________________________
If no, what is the termination date of benefits? _________________________________
REMARKS: ____________________________________________________________________________________
_______________________________________________________________________________________________
INSURANCE PROVIDER
Signature:
Date:
Print your name:
Tel. #:
Title:
Address
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.
Unemployment Compensation Verification
MHFA HTC 1/05
119
Documentation of Unit Transfer
(For use when transferring households when at least one unit in at least one building is a tax credit unit)
Name of Tenant: ______________________________________________________________________
Date of Unit Transfer: __________________________________________________________________
Transferring From BIN: MN- __________
Transferring To BIN: MN- _________________
Transferring From Unit: #: ____________
Rent Amount: $ _____________
Transferring To Unit #: _______________
New Rent Amount: $ ______________
Last (Re)Certification Date: ______________
Annual Income: $ _________________
BIN and Unit # of original unit this household occupied, if different: MN-_______________#__________
Compliance status of transferring household at time of transfer (check one):
_____Not a Section 42 household (market rate)
______First Section 42 household to qualify unit after Placed in Service (month from
______ to _________)
_____Section 42 household (qualified tax credit unit)
_____Section 42 household (qualified tax credit unit) with recertified income over 140% (Unit subject to Available Unit Rule)
Compliance status of vacant unit to which household is transferring (check one):
_____Not a Section 42 unit (market rate)
_____Qualified vacant unit (Section 42 household was previous occupant)
_____Designated Section 42 unit never occupied by qualified household (month from
-
to_)
Remember: units "swap" status when the household lease is transferred. Since a household can qualify only one unit for Section 42 status,
it is important to note carefully any transfers between units where at least one of the units has never been occupied by a qualified
household. If a household with recertified income that exceed 140% of the applicable income limit transfers to a new unit in a different
building, the new building becomes subject to the Available Unit rule.
Place a copy of this form in each respective unit file and update the HTC 13 Tax Credit Summary Report.
Do not use this form when a partial household moves to a new unit. Members of the previous household who move are considered new
move-ins and must meet all current HTC guidelines, including full Initial Certifications.
Notes:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Manager signature:
Date:
Print your name:
Tel. #:
Title:
MHFA HTC Documentation of Unit Transfer 1/06
120
VETERAN'S BENEFITS VERIFICATION
TO: (Name & address of employer)
RE:
Applicant/Tenant Name
Social Security Number
Unit # (if assigned)
I hereby authorize release of my employment information.
Date
Signature of Applicant/Tenant
The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will
remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
Project Owner/Management Agent
MAIL OR FAX THIS FORM TO:
THIS SECTION TO BE COMPLETED BY VETERANS ADMINISTRATION
Compensation (Service Connected):
( ) Disability
( ) Death
( ) Dependency and Indemnity
Pension (Non-Service Connected):
( ) Disability
( ) Death
Effective date of current award: ______________________________
Current Compensation Received:
Changes:
$ _______________________per month
If any change is contemplated, please check here (
VETERAN'S ADMINISTRATION CENTER
Signature:
Print your name:
) and explain on reverse side.
Date:
Tel. #:
Title:
Address
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.
VETERANS BENEFITS VERIFICATION
MHFA HTC 1/05
121
CERTIFICATION OF ZERO INCOME
(To be completed by adult household members only, where applicable.)
Resident Name: __________________________________
Unit No. ___________________________
Development Name: ______________________________
City: ______________________________
Do you receive income from any of the following sources? Answer YES or NO for each item.
All information is subject to verification from third party source.
_____Wages (including bonus/commissions, tips, fee, etc.)
_____Income from operation of a business
_____ Unemployment Benefits
_____ Interest/ dividends from assets
_____Worker's Compensation
_____ Annuities, insurance policies, stocks, etc.
_____Disability Payments
_____ Pensions, IRA, 401K
_____Alimony
_____ Rental Income
_____Child Support
_____ Sales from Mary Kay, Tupperware, etc.
_____ Gifts from persons not living in your household
_____ Any other source not identified above
_____I currently have no income of any kind and there is no imminent change expected in my financial status or
- employment status
during the next 12 months.
In addition to the above claim of no income, please provide a written explanation as to how your household intends to pay for
living expenses, certain services and/or necessities. Complete all that apply (write N/A if not applicable):
Rent: ________________________________________________________________________
Utilities: ______________________________________________________________________
Food: ________________________________________________________________________
Family clothing: _______________________________________________________________
Children's school supplies: _______________________________________________________
Telephone and/ or cable expense: _________________________________________________
Medical care: _________________________________________________________________
Prescription and/ or over-the-counter drug expense: ______________________________________
Personal care products (toilet paper, toothpaste, etc.): ______________________________________
Vehicle insurance, gasoline, maintenance and up-keep: _________________________________
Other transportation needs: _______________________________________________________
Garage rental: _________________________________________________________________
Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge.
The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or
incomplete information may result in the termination of a lease agreement.
________________________
__________________________
________________________
Signature of Applicant/Tenant
Printed Name of Applicant/Tenant
Date
Certification of Zero Income
MHFA HTC (1/07)
122
Initial Tenant Payment Transmittal
Property: ______________________________________________________________
Unit: _________________________
Tenant Name: ______________________________________________________________
Move-in date: _________________________
Application Fee Required
Amount Received
Check/Money Order
$___________
$ __________
# _____________
Security Deposit Required
Amount Received
Check/Money Order
$___________
$ __________
# _____________
First Month's Required Rent
Amount Received
Check/Money Order
$___________
$ __________
# _____________
Prorated Rent Required
Amount Received
Check/Money Order
$___________
$ __________
# _____________
I have collected the entire Security Deposit along with Prorated or First Month's rent prior to or on the tenant's move-in date. I
understand that no one is allowed to move into a CEPCO Management property without the payment of the Security Deposit and
Prorated or First Month's rent.
*Note* Application fee, Security Deposit and Rent amounts must all be on separate checks. Any checks received that have combined
payments will be returned to site managers to be reissued by the tenant.
Attach all checks to this sheet and submit to Accounting at CEPCO Management Inc.
_____________________________________________
___________________
Site Manager
Date
CEPCO Management Inc. is an Equal Opportunity Provider and Employer
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343 * Phone 952-935-0359 * Fax 952-935-9612
123
________________________________
Property Name
CO
RENTAL APPLICATION
APPLICANT NAME: _____________________________________________________________________________
CURRENT ADDRESS: ____________________________________________APT.NO. ______________________
CITY, STATE, ZIP CODE: _________________________________________________________________________
HOME PHONE #: ____________________________________WORK #: ___________________________________
MARITAL STATUS:
MARRIED ______SINGLE_______PRIOR HOMELESSNESS:
YES _____NO_______
CURRENT LANDLORD: ________________________HOW LONG? ____________PHONE # _________________
LANDLORD'S ADDRESS: _________________________________________________WHAT RENT? ___________
PREVIOUS LANDLORD: ________________________HOW LONG? ____________PHONE # ______________
LANDLORD'S ADDRESS: _________________________________________________WHAT RENT? ___________
PRIOR APPLICANTS ADDRESS: _________________________________________________________________
NEAREST RELATIVE: _______________________PHONE #: ________________RELATION: ______________
ADDRESS: ______________________________________________________________________________________
CURRENT HOUSING STATUS
How many people live in your home now? _________How many bedrooms do you have?___________
_____Yes _____ No
Do you wish to move? What notice do you need to give?______________________________
_____Yes _____ No
Are you being evicted?
_____Yes _____ No
Are you being displaced from your home?
_____Yes _____ No
Do you require a Handicapped Apartment?
_____Yes _____ No
Do you want to claim Handicapped/Disability Status?
_____Yes _____ No
Will there be any changes in household composition within the next 12 months?
HOUSEHOLD COMPOSITION AND CHARACTERISTICS
MEMBER’S FULL NAME
LAST, FIRST, MIDDLE INT.
1.
2.
3.
4.
5.
6.
STUDENT STATUS:
_____Yes _____ No
RELATIONSHIP
DATE OF
BIRTH
AGE
SEX
SOCIAL
SECURITY#
HEAD
Is anyone in the household.18 years or older and a student? ________________________
ELDERLY FAMILIES ONLY:
_____Yes _____No
Do you have medicare? _____ If yes, what is your Medicare premium? _______________________
_____Yes _____No
Do you have any other kind of medical insurance? _________________________________________________
If yes, give policy number and amount? _________________________________________________________
_____Yes _____No
_____Yes _____No
_____Yes _____No
Do you receive medical assistance through the welfare department?__________________________
Do you have any outstanding medical bills on which you are. paying?________________________
Do you expect to have any medical expenses during the next 12 months? _____________________
If yes, amount of medical expenses____________________________________________________
TDD Telephone #(800) 627-3529
124
INCOME INFORMATION
Please answer each of the following questions. For each "yes” answer, provide the details in the chart below.
Does any member of your household now receive or expect to receive income from any of the following
sources:
Yes
No
____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____ Employment, full-time, part-time, or seasonal?
_____ Unemployment Compensation?
_____ Child Support Payments?
_____ Alimony Payments?
_____ Welfare Assistance?
_____ Social Security Benefits?
_____ Pension or Annuity?
_____ Regular cash contributions from individuals not living in the unit?
_____ Income from any other agencies?
_____ Interest from checking and savings accounts. interest and dividends from certificates of deposit, stocks or bonds,
income from rental property?
_____
_____ Income from a dependent?
_____
_____ Did the family receive an earned income tax credit from their federal taxes?
_____
_____ Other Income?
For each Type of income that your household receives from above, give the source of the income and to whom it applies and amount.
FAMILY MEMBER
SOURCE OF INCOME/TYPE OF
INCOME
ANNUAL INCOME
1.
2.
3.
ASSET INFORMATION
Please check each asset that applies to you or a family member. For each one checked provide the details in the chart below.
_____Checking Account
_____Savings Account
_____Stocks
_____Bonds
_____Certificate of Deposit
_____Money Market Funds
_____Property
_____IRA
_____Keough Accounts
_____Pension Funds
_____Personal property held as an investment
FAMILY MEMBER
SOURCE OF ASSET/TYPE OF ASSET
VALUE
1.
2.
3.
Note: You must also include assets disposed of for less than fair market value during the past two years.
EXPENSES
_____Yes _____No
Do you pay for child care which enables you or another family member to work or go to school? If yes,
give name and address of' child care provided, weekly costs, and name of family member enabled to work.
_______________________________________________________________________
HANDICAPPED FAMILIES ONLY:
_____Yes _____No
Do you pay for a care attendant or for any equipment for the handicapped member of the family necessary
to permit that person or someone else in the family to work? If yes, describe expenses _____________
___________________________________________________________________________________
An application fee in the amount of ________ is required by the management for the purpose of checking the applicant's past credit,
criminal and rental history.
Which of the following units are you interested in? 1BR _______ 2BR _______ 3BR _______
I (we) certify this housing is/will be my (our) permanent residence.
I (we) do/will not maintain a separate subsidized rental unit in a different location.
I (we) certify all household and income information is correct.
_____________________________________
_______
_________________________________________
_____________________________________
_______
_________________________________________
(SIGNATURE)
(SIGNATURE)
The following information (a.b.c.) is requested by us in order to assure the Federal Government, acting through its Farmers Home Administration, that Federal Laws prohibiting discrimination against tenant applicants tenant
applicants on the basis of race, national origin, familial status, age, handicap and sex are compiled with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating
your application of to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/national origin and sex of individual applicants on the basis of visual observation or
surname.
a.
_____White, non-Hispanic
_____Black, non-Hispanic
_____Hispanic
b.
_____Asian or Pacific Islander
_____American Indian or Alaskan Native
c.
_____Sex of Tenant
_____Male
_____Female
125
Cepco Management
PO Box 456
Hopkins, MN 55343
Phone: 952.935.0359
Fax: 952.935.9612
Toll Free: 1-888-552-3726 (1888Cepco)
Accounting:
Rent Checks
Rent Rosters
Security Deposits
Application Fees
Jeanne Thomas
Compliance:
Recertifications
Verifications
Move in Packets
Stephanie David
Property Manager:
Invoices
Security Deposit Status Report
Delinquent Rent Report
Waiting List
Inquiry List
Bids / Proposals / Contracts
Approval of spending above $100
Problems with Accounting or Compliance Departments
Tammy Gehrke
PO Box 301
Waite Park, MN 56387
Phone: 320.202.2967
Fax: 320.202.7809
Cell: 320.493.0562
General Manager:
Questions when P.M. is unavailable
Problems with Property Manager
Robert Carlson
Stacy Nelson
PO Box 456
Hopkins, MN 55343
(952) 935-0359 x108
(952) 935-9612
320.630.2819
Manager Updates
We just had a staff meeting at our office and we have decided to put a few policies into place to help things run a bit smoother
here. I know that some have not had the best training so use this as a guide to these few topics.
Rents

Rents should be put in order they are listed on the rent roll when you send them in.

Laundry money should be written in on the bottom of the rent roll and sent in monthly with the rents.

Please write on the check what the money is for rent, deposit, laundry, damage, application fee or whatever it may be
for.

Please have the residents and applicants make their checks and money orders payable to the PROPERTY, not
CEPCO Management.

Please fax me a copy of the rent roll as soon as you mail the rents in.

If someone doesn't pay rent, find out why, knock on doors, make phone calls, doing it every day until they pay.
Applications

If at all possible, have the applicant fill out the application at your office.

You will want to make sure they sign a "landlord reference verification" when they apply too as it can be difficult to get
a reference without a signed release.

Please make sure that they give you the landlord’s phone number for us to call and verify the reference.

Check two landlord references prior to running the application through Rental Research.

Do not run applications without the application fee.

Please make sure the applicant gives you at least two addresses, the current and previous one.

Please make sure the application is COMPLETE.
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343* Phone 952-935-0359* Fax 952-.935-9612
www.cepcomanagement.com
127
Recert Process
DO NOT JUST HAND OUT RECERT PACKETS

Recerts and verifications should be filled out and signed WITH THE SITE MANAGER PRESENT.

Make a Recert appointment with the tenant to complete the process

Make the appointment to go and do the recert at the TENANT'S UNIT (it gives you the opportunity to see what condition
the unit is in)

The 90 day recert notice is to be given to the tenant

If after one attempt they put you off or "no show" for an appointment, give them a lease violation.

Don't wait to make a second appointment, make another appointment immediately.

If you are having recert problems, please contact the property manager IMMEDIATELY.

Look through the recert packet once it has been completed

Anything checked with "yes" on the ASSET SUMMARY needs third party verification

When you receive the verifications back, look them over to make sure they are COMPLETE, every blank should have
something in it, even if it is N/A.

If the verification is not complete, please contact the person who filled out the verification and get clarification, have them
correct the information.

We would like the COMPLETED RECERT PACKET back to the RECERTIFICATION DEPARTMENT 45 days prior to the
actual recert date.
- SIGNED AND DATED
Move-In Process

Deposit, Deposit, Deposit, get a deposit from the person prior to them moving in, actually a deposit should be paid at the
time the application is accepted.

Utilities MUST be put in tenants name at move-in time. When the tenant comes to move in, have them call right there and
then to have the utilities put in their name.

Do not transfer or move anyone in without a signed lease and full payment. The Compliance Department will make two
Copies of the Tenant Certification will be mailed to the Site Manager, one for placement in the tenant file and one copy to be given to
the tenant.
The Compliance Department files will contain all ORIGINAL documents. The Compliance Department will be responsible for maintaining
these files in an orderly fashion. The site files will contain copies of the application, references, credit report, lease, performance deposit
agreement, asset/income summary, data disclosure release, receipt of house rules, move-in inspection and all certifications.
All Annual certifications must be signed and returned to the home office one full month prior to the due date.
NO EXCEPTIONS
128
INTERIM CERTIFICATIONS:
The tenant is responsible for contacting the Site Manager regarding::

Change of Household members

Change of income
When the tenant contacts the site manager to setup a time to start the recertification process the following steps must be taken:

The Site Manager must sit down with the tenant and complete in full the Income/Asset Questionnaire.

Have the tenant sign and date the Government Data Practices Act Disclosure Statement.

Mark each item on the Income/Asset Questionnaire yes or no. If the item is marked YES, the tenant must complete the
top portion of the third-party verification.

It is the Site Manager responsibility to mail, fax the verification to the proper agencies.

When the Site Manager has received all the verifications, completed in full, the Tenant Certification Summary Worksheet
must then be completed.
The above documents must be stapled together and mailed to the home office the day they are completed in full.
The Compliance Department will review the recertification to make sure all the information is attached and complete. The Tenant Certification
will be generated and sent to the Site Manager. The Site Manager is responsible for contacting the tenant to setup a time to meet with the tenant
to sign and date the Tenant Certification. The effective date should be pointed out at this time.
Two Copies of the Tenant Certification will be mailed to the Site Manager, one for placement in the tenant file and one copy to be given to the
tenant.
The Compliance Department files will contain all ORIGINAL documents. The Compliance Department will be responsible for maintaining
these files in an orderly fashion. The site files will contain copies of the application, references, credit report, lease, performance deposit
agreement, asset/income summary, data disclosure release, receipt of house rules, move-in inspection and all certifications.
Two Copies of the Tenant Certification will be mailed to the Site Manager, one for placement in the tenant file and one copy to be given to the
tenant.
The Compliance Department files will contain all ORIGINAL documents. The Compliance Department will be responsible for maintaining
these files in an orderly fashion. The site files will contain copies of the application, references, credit report, lease, performance deposit
agreement, asset/income summary, data disclosure release, receipt of house rules, move-in inspection and all certifications.
ANNUAL CERTIFICATIONS:
Annual certifications will be accomplished by using the following process.
The Compliance Department will generate a list of residents due for certification 90 days in advance. The Compliance Department will also
print any necessary 90-Day Notices and send them to the respective Site Managers. The 90 Day Notice lets the resident know of the need to
recertify and explains that the resident’s rent will be adjusted to the Market/Note Rate Rent if they fail to contact the Site Manager to complete
the certification. The Site Manager will be responsible for delivering the notices to residents. 90-day notices must be delivered at least 90
days prior to the resident’s anniversary date.
129
The Site Manager is responsible for contacting the Tenant to begin the recertification process.

If the site manager does not hear from the tenant within 30 days after the 90-day notice was given, the site manager will then proceed
to give the tenant a 60-day notice. A copy of the 60-day notice that was given to the tenant must be filed in the tenant's file and a copy
given to the property manager.

If the tenant still has not contacted the Site Manager within 30 days after the 60-day notice was given, the site manager will then
proceed to give the tenant a 30-day notice. A copy of the 30-day notice that was given to the tenant must be filed in the tenant's file
and a copy given to the property manager.
When the Site Manager contacts the Tenant to setup a time to start the recertification process the following steps must be taken:

The Site Manager must sit down with the tenant and complete, signed and dated in full the Income/Asset Questionnaire. (Separate
Income/Asset Questionnaire for each tenant of 18 years old)

Have the tenant sign and date the Government Data Practices Act Disclosure Statement.
 Mark each item on the Income/Asset Questionnaire yes or no. If the item is marked YES the tenant must complete the top portion of the
third-party verification.
 It is the Site Manager’s responsibility to mail, fax the verification to the proper agencies.

When the Site Manager has received all the verifications, completed in full, the Tenant Certification Summary Worksheet must then
be completed. (If you need assistance please call the Compliance Department or your Property Manager.)
The above documents must be stapled together -and mailed to the home office the same day they are completed in full.
The Compliance Department will review the recertification to make sure all the information is attached and complete. The Tenant Certification
will be generated and sent to the Site Manager. The Site Manager is responsible for contacting the tenant to setup a time to meet with the
tenant, preview Asset & Income Information and to get Tenant Certification signed and dated.
130
NEW MOVE-INS:
The Site Manager must have the following items completed for all prospective tenants and then mail to the home office. A lease and
Initial Certification will be issued upon completion of the following documents:
1.
A completed, signed and dated Application.
2.
Two completed Landlord Reference checks.
3.
An Instant Inquire Report from Rental Research.
4.
Make sure Tenant qualifies by income limits.
5.
A signed and dated Government Data Practices Act Disclosure Statement.
6.
A completed, signed and dated Income/Asset Questionnaire.
7.
All completed Third Party Verifications for the items checked YES on the Income/Asset Questionnaire.
8.
Any household member 18 years of age or older not claiming income, must complete all zero income forms.
9.
a.
All Properties - Budget Form, Certification of Zero Income
b.
Section 8 properties - hardship exemption form
A completed Tenant Certification Summary Worksheet.
The above documents must be stapled together and mailed to the home office as soon as they are completed in full. The Compliance
Department will then generate the move in paperwork and mail it back to the site. The Site Manager has SEVEN (7) DAYS to get the
paperwork signed, dated and mailed back to the home office.
The following documents must be signed (By all Adult Household Members) and stapled together and mailed to the home office the
same day they are completed in full. The Lease and Tenant Certification must be signed by the tenant before a key can be issued
and the tenant moves into a unit on the property.
1.
A signed and dated Initial Tenant Certification.
2.
A completed, signed and dated Performance Deposit Agreement.
3.
Signed receipt page of the House Rules.
4.
A signed and dated Drug Free Housing form.
5.
A completed, signed and dated Race and Ethnic Data form. (For each household member)
6.
A completed, signed and dated Tenant Declaration Format. (For each household member)
7.
Copies of Social Security/Birth Certificates. (For each household member)
8.
A completed, signed and dated Lease.
9.
A completed, signed and dated Move-in Inspection.
(Please get first month's rent and security deposit on two separate checks or money orders)
10. First Month's Rent (Check or money order - made payable to the property)
11. Security Deposit (Check or money order - made payable to the property)
The Site Manager will be responsible for:

Acquiring all the verifications indicated on the Income/Asset Questionnaire

Completing the Tenant Certification Summary Worksheet

Having the certification form and lease signed by the tenant.

Allowing new residents to move into an apartment without the properly SIGNED documentation or authorizations will be
grounds for termination.
131
During the last couple of weeks, I have noticed that the "curb appeal" at some of our properties is below standards.
1. Lawns that were not cut.
2. Lawns not trimmed.
3. Shrubs and hedges not trimmed.
4. Weed and fertilizer not applied.
5. Rock/mulch beds not weeded.
6. Rock/mulch beds in need of more rock/mulch.
7. Trees not trimmed.
8. Litter not picked up on a regular basis.
The following are standards for lawn care and flower/shrub beds at our properties:

All grassy areas are to be mowed and trimmed on a weekly basis, maintained at a height of 3", not to exceed 5" between
mowings.

Weeds and small "volunteer" trees around foundations of buildings, fences, and dumpsters areas to be trimmed when the
grass is mowed.

Shrubs or other plantings will be mulched/rocked to a depth of 3".

Trees and bushes should be pruned/trimmed as needed on an annual basis.

Litter/debris on lawn, parking lot, and play lots, will be picked up on a daily basis.

Lawn fertilizer and weed control will be applied three times during the growing season.
(Spring, Mid-Summer, Fall applications).

Lawns need to be watered on a regular basis.

Weeds will not be visible in rock/mulch beds.
These standards must be maintained at all times. Please stay on top of your Site Managers to ensure a safe and attractive environment
for our residents and our neighbors.
132
A complete individual unit inspection must be completed prior to inspection for maintenance issues. Please let me know when you
have it scheduled for. Please send in a copy of all inspections upon completion. (tenant & S/M signed)
Pre-Inspection checklist
 Waiting List (previous 3 years)
 Maintenance Logs (3 years)
 Emergency Lights (All lights working)
 Clean Hallway Light Fixtures
 Exit Lights (all lights working)
 Fire Extinguishers (check for expiration pate)
 Clean Behind Wash Machines and Dryers
 No Weeds
 Mulch/Rock Beds should be totally free of weeds
 Flowers?
 Mulch/Rock Beds should be full of Mulch/Rocks with no bare spots
 Make sure Fire Doors close by themselves
 Make sure ALL doors close by themselves
 Make sure door handles are tight
 Make sure all handles on doors are tight
 Clean out Dumpster area with bleach or cleaner
 Make sure dumpster gates close easily, are not damaged and locked
 Smoke detectors in all units must be in working condition
 Make sure there is no water dripping or leaking anywhere
 Property Sign should have phone number on it, handicap sign & EHO logo
 Cheek to see if sign needs painting, weeding or landscaping Improvements
 Screens should be in all windows and not ripped or bent
 Check Bulletin Boards
 New "Grievance Procedures"
 "AFHMP" (Affirmative Fair Housing Marketing Plan) *check date_________
 "Justice for ALL" poster
 "Fair Housing" poster
 Property Management contact sign and is current
 Mailboxes clearly/neatly marked with resident's name and/or unit number
 Check Laundry Room exhaust fans for proper operation
 Clean out all Storage Rooms
 Clean out all Mechanical Rooms
 Make sure water softeners are full of salt
 Check Electrical Room; make sure it's accessible to turn off/on power main
 Make sure handicap parking signs are posted and access aisle is striped
 Check all faucets for "lever" handles
 Check landscaping for dead trees/shrubs and landscaping needs
 Check siding and fascia for any problems
 Check outdoor electrical .outlets for covers (all must have covers)
 Check and clean all thermostat boxes (all thermostats must have covers)
 Look for any shingle problems
 Check intercom systems for any problems or buttons missing
 Check concrete sidewalks and steps for deterioration .
 Community Rooms/Bathrooms need the pipes and supply line wrapped
PO Box 456, 32 Tenth Ave. S, Hopkins, MN 55343*Phone 952-935-0359* Fax 952-935-9612
133
RENT COLLECTION
 RENT ROLL
 DELINQUENCY REPORT
 LATE NOTICES
 NSF CHECKS
 ADJUSTMENT TO RENTAL ACCOUNT
Reserve this page for sample document.
134
TO:
Site Managers
FROM: Bob Carlson
DATE: May 20, 2005
RE:
Past Due Rent Collections
We would like to renew our efforts to collect all rental amounts that are due the property. With this in mind, let me remind you of our
policy concerning rent collection:
Before the First of each month:
Accounting sends monthly Rent Rosters to each site manager.
By the First of each month:
Tenant's Rent is due and payable, including any past due rent.
On the Sixth of each month:
Late Fees are applied after the fifth of the month. Late fees vary per
property/program.
Site Manager records rents on monthly rent roster and sends copy of roster
and rents to home office, (including laundry receipts.)
After the Sixth of the month and Before the
Twentieth of each month:
Site Managers will conduct the rent collection process of contacting each
and every resident that has a past due amount. Site Managers will record
their results on the Past Due Rent Collection Report. Upon completion of
rent collection process, Site Managers should send the Past Due Rent
Collection Report to their Property Manager.
Site Manager to send any rent payment received to the home office, upon
receipt.
By the third week of each month:
Accounting Department will prepare and distribute the Aged Delinquent
Report and Delinquent Rent Notices to each Site Manager for review and
distribution.
Upon receipt of the Delinquent Rent Notices, the Site Manager is to
deliver the notice to the resident and ask for payment.
Upon review of Aged Delinquent Report and the Past Due Collection
Report the Property Managers will prepare legal documents for court
submission for all residents with past due rent amounts. Property
Managers will request filing checks from the accounting department.
Property Managers will file Eviction Complaint for all residents in
violation of Cepco's past due rent policy.
Before the end of each month:
Cepco’s policy on uncollected rent is eviction after two months of nonpayment.
135
Things To Remember:

Be polite, but firm with your payment request.

Clearly state to all new residents our expectations of timely rent payments.

Do not accept cash from any resident.

Visit past due residents during evening hours.

Avoid sliding Late Rent/Eviction Notice under resident's door. If you are unable to physically visit a resident; tape notice
visually on resident's unit door.

Don't make any payment plan; property manager will handle those situations.

Remind residents that failure to pay rent will result in credit/collection agency notification. .

Make sure that the process of paying rent is easily accessible to resident.

If Resident disputes rental amount; get their concern and call home office for information. .

Rent and Security Deposit checks are to be made out to the property - not Cepco.
PO Box 456, .32 Tenth Ave. S, Hopkins, MN 55343*Phone 952-935-0359*Fax 952-935-9612
www.cepcomanagement.com
136
PAST DUE RENT COLLECTION REPORT
(Return monthly
collection report with submission of rents and rent roster)
Resident’s Name
Unit #
Past Due $
Contact
Date/Time
Results
(Including Late Fees)
1 __________
____________________ ___________
____________
______________ _____________
2 __________
____________________ ___________
____________
______________ _____________
3 __________
____________________ ___________
____________
______________ _____________
4 __________
____________________ ___________
____________
______________ _____________
5 __________
____________________ ___________
____________
______________ _____________
6 __________
____________________ ___________
____________
______________ _____________
7 __________
____________________ ___________
____________
______________ _____________
8 __________
____________________ ___________
____________
______________ _____________
9 __________
____________________ ___________
____________
______________ _____________
10 __________
____________________ ___________
____________
______________ _____________
PO Box 456. 32 Tenth Ave. S. Hopkins. MN 55343* Phone 952-935-0359 *Fax 952-935-9612
www.cepcomanagement.com
137
RENT PAYMENT PROCEDURES
1. Rent is due and payable by the first of each month.
2. Rent checks or money orders should be delivered to Site Manager's Apt OR Rent drop
box.
3. Make Checks/money order payable to: the property
4. Please include name and unit number on checks.
5. Do not send or bring cash. It will not be accepted.
6. Rent payments not received by the 5th of the month will be assessed late fees.
ALL RENT CHECKS MUST BE MAILED TO CEPCO Management Inc., PO BOX 456,
HOPKINS, MN 55343 AND POSTMARKED NO LATER THAN THE 6TH OF THE
MONTH.
PO 8ox 456, 32 Tenth Ave. S, Hopkins, MN 55343* Phone 952-935-0359*Fax 952-935-9612
www.cepcomanagement.com
138
CEPCO MANAGEMENT, lNC
.............
.LU/.JV/"-VVI
Aged Delinquent
Report
Time:
12:56 PM
Page:
';.
ntlD
Tenant Name
Recur. Rent
Last Pmt
0-30 Days
31-60 Days
6]-90 Days
91+ Days
Total Due
.ty: OGL2 OGILVIE SQUARE TOWNHOUSES
,501
KADLEC, BETHANY
475.00
10/01/2007
0.00
10.00
0.00
0.00
10.00
.139
PETERSON, JACKIE L.
475.00
10/25/2007
485.00
0.00
0.00
0.00
485.00
474
BRUNEAU, DANIEL J.
475.00
10/15/2007
74.88
248.32
0.00
0.00
323.20
464
ARNESON, MASON D.
475.00
1 % 1/2007
155.00
0.00
0.00
0.00
155.00
'ty: OGL2 OGILVIE SQUARE TOWNHOUSES
- Code Summary
LATE FEE
0.00
//
30.00
10.00
0.00
0.00
0.00
UNIT RENT
0.00
II
630.00
223.32
0.00
0.00
0.00
SECURITY DEPOSIT
0.00
II
0.00
25.00
0.00
0.00
0.00
NSF CHECK FEE
0.00
II
25.00
0.00
0.00
0.00
0.00
GAS UTILITY CHARGE-RD
0.00
29.88
0.00
0.00
0.00
0.00
1,429.76
516.64
0.00
0.00
973.20
/I
139
1