Studio one-bedroom and two-bedroom rentals available through the affordable housing program for qualifying future residents at A val on Clinton

HOUSEHOLDS MUST BE WITHIN THE INCOME LEVELS BELOW TO QUALIFY Monthly rent is based on the Area Median Income (AMI)

40 PROGRAM STUDIO $732 PER MONTH 1 person household $17568 - $31840

Avalon Clinton residents are responsible for electric phone and cable utilities Additional monthly fees apply for the fitness center storage and pets An increased security deposit will be required for households with pets

AVALON CLINTON

AVALONCLINTONCOM 510 WEST 52ND STREET NEW YORK NY 10019

avalonclintonavalonbaycom

2 person household $17568 - $36400

ONE-BEDROOM $781 PER MONTH 1 person household $18744 - $31840 2 person household $18744 - $36400 3 person household $18744 - $40960

TWO-BEDROOM $931 PER MONTH 2 person household $23344 - $36400 3 person household $23344 - $40960 4 person household $23344 - $45480 5 person household $23344 - $49120

ALL WAITLISTS ARE CURRENTLY OPEN

Rents subject to change at anytime without notice Apartments contain FHA compliant features for persons with disabilities

~t~JORK Homes and ~11Nm_ Community Renewal Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

Avalon Clinton South amp North Very Low Income Affordable Housing Waiting List OpenshyImmediate availability for 4 studio apartments

1 and 2 bedroom waitlist also open

Amenities 24-hour attended lobby fitness center roof-top sun decks with seating and grills resident lounge on-site resident manager (additional fees apply) Two buildings operated as one community

Transit Trains A C E Buses M50 QM4 No application fee bull No brokers fee bull Smoke-free

buildingbull More information wwwAvalonClintoncom

NYHousingSearchgov

RENTS AND INCOME REQUIREMENTS

Unit Size -l ~

Monthly Rent1 Household Size2 Annual Household lncome3

Minimum - Maximum4

Studio Waitlist w l 0

$732 1 person $17568 - $31840

1 bedroom Waitlist

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$781 1 person

2 people

$18744 - $31840

$18744 - $36400

2 bedroom Waitlist

l lt( w 0 lt(

~ 0

0 lit

$931

2 people

3 people

4 people

$23344 - $36400

$23344 - $40960

$23344 - $45480

1 Rent includes gas for cooking Rents and Income l1m1ts are subJect to change 2 Household size includes everyone who will live with you including parents and children Subject to occupancy criteria 3 Household earnings includes salary hourly wages tips Social Security child support and other income 4 Minimum income listed may not apply to applicants with Section 8 or other qualifying rental subsidies

To request a waitlist application Go to wwwavalonclintoncom or call 212-957-8200 email avalonclintonavalonbaycom or visit Avalon Clinton at 510 w_ 52 nd Street NY NY 10019

To Submit a Completed Waitlist Application In Person or By Mail Avalon Clinton 510 w_ 52nd Street NY NY 10019By Email avalonclintonavalonbaycom

Applicants with disabilities may request modifications to the rental unit andor accommodations to our rules policies practices or services if such modifications or accommodations are necessary to afford equal opportunity to

use and enjoy the premises

A valonBay Communities Inc does not discriminate in the selection of applicants on the basis of race color national origin disability age ancestry children familial status genetic information marital status public

assistance recipiency religion sex sexual orientation gender identity veteranmilitary status or any other basis prohibited by law

--------------------

wvoRK Homes and TEOF oRruNrv Community Renewal

Avalon Clinton South amp North Lista de Espera para Vivienda de Bajos Ingresos Aceptando Aplicaciones 4 Unidades mono ambientes disponible inmediatamente

Tamano de la unidad

I w I

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Renta mensual1

$732

$781

$931

Tamano del grupo familiar2

1 persona

1 persona

2 personas

2 personas

3 personas

4 personas

lngresos anuales del grupo familiar3

Minima - Maximo4

$17568 - $31840

$18744-$31840

$18744 - $36400

$23344 - $36400

$23344 - $40960

$23344 - $45480

List a de Espera de 1 amp 2 habitaciones tambien aceptando solicitudes

Servicios vestibulo con vigilancia las 24 horns centro para acondicionamiento fisico terraza en la azotea con asientos y parrillas

salon para residentes administrador residente en el sitio (aplican tarifas adicionales)Transporte publico trenes A C E autobuses M50 QM4

La solicitud no tiene ningun costo bull El servicio de agente no tiene ningun costo bull Edificio libre de humo

Mas informacion wwwAvalonClintoncom NYHousingSearchgov

UNIDADES DISPONIBLES Y REQUISITOS DE INGRESOS

1 La renta incluye el gas para cocinar Los limites de las rentas y de los ingresos estan sujetos a cambios 2 El tamafio de la familia incluye a todas las personas que viviran con usted entre ellas padres e hijos Sujeto a criterios de ocupaci6n 3 Los ingresos familiares incluyen el salario los pagos por hora las propinas el Seguro Social la manutenci6n de menores y otros ingresos 4 Los ingresos minimos indicados pueden no aplicarse a los solicitantes con subsidies para la renta de la Secci6n 8 u otros subsidies para la renta que cumplen los requisites Tambien se aplican limites de actives

LComo puedo pedir una solicitud Pide su solicitud en linea en persona o por telefono Para pedir su solicitud en linea visita la pagina web wwwavalonclintoncom Para peder una solicitud en persona la direccion es Avalon Clinton- 510 W 52nd Street New York NY 10019

0 por telefono Harne a 212-957-8200 Tambien puede mandar un correo electronico a avalonclintonavalonbaycom

i Como puedo presentar una solicitud Presente su solicitud en persona por correo o correo electronico Para presentar una solicitud en persona o por correo la direccion es

Avalon Clinton- 510 W 52nd Street New York NY 10019 Mande su solicitud por correo electronico avalonclintonavalonbaycom

Solicitantes con discapacidades pueden pedir modificaciones al apartamento o alojamientos a las reglas normas practicas o servicios si las modificaciones o alojamientos son necesarios para perrnitir el uso del local y igualdad de oportunidades

AvalonBay Communities Inc no discrimina en las seleccion de solicitantes sabre la base de raza color origen nacional discapacidad edad ascendencia hijos estado familiar informacion genetica estado civil recibimiento de asistencia publica religion

sexo orientacion sexual identidad de genera estado militarveterano o cualquier otro base prohibido por ley

~t~JORK Homes and ~ 11Nm_ Community Renewal Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

Avalon Clinton South amp North 11regAaJ~fli~fli~yenJJi800iamp- [9~yen~~fzflP aJffl

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~ ~JORK Homes and ~llINrnt_ Community Renewal Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

AvalonBayCommunitiesInc f~~IHJllm~ ~iiL ~~ $~ IfnML -5~ JgM55L il1$1~ )~L frU~M55L 0tilIrltlJ5cbulll~55L ~ tttl1J ttDltiJ iitl1Ji2liil il311i~J~$~ffisectlt51~~Ltiyenlif

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-----------------------------------

------------------------

Avalon Clinton North Affordable Housing WAITLIST Application Free TranslationLanguage Assistance Available Upon Request

Applicants with disabilities may request modifications to the rental unit andor accommodations to our rules policies practices or services if such modifications or accommodations are necessary to afford an

equal opportunity to use and enjoy the premises

NAME OF PRIMARY APPLICANT ________________________

E-MAIL

PHONE________________ CELL_______________

CURRENT ADDRESS

Street Number amp Name City St Zip

1 How did you hear about us________________________

2 What size apartment home(s) are you interested in Studio One Two 3 Are you an employee of AvalonBay (circle one) Yes No 4 Are you either a spouse sibling child grandparent (natural step half or in-law) or significant

other of an AvalonBay employee (circle one) Yes No 5 Do you have a voucher (circle one) Yes No

IfYes Housing Authority Name 6 Do you have a disability need for a reasonable accommodation or modification Yes No If yes

please explain

7 How many people will be occupying the apartment (all adults and children)

9 Family Composition- List all those who will occupy the apartment including yourself

HOUSEHOLD MEMBER NAME

Date of

Birth

Age Relationship

Full Time

Student

(YN)

1 Head

2

3

4

5

--1~Jo1ult IHomes and ~nJNrrv Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

10 Race amp Ethnicity Requesting this information is required by state law your response is voluntary There is no penalty for not providing this information Although minority identification is optional by doing so you may be considered for entry in additional pools Please select ( 1 any applicable categories in the chart below for the head ofhousehold and any other adult household members You may select more than one category

White Black or African

American Asian

Hispanic or

Latino

American Indian or

Alaskan Native

Native Hawaiian or other Pacific Islander

Other (specify)

Head Other Adult Members

Decline to answer

11 Do you file taxes (circle one) Yes No If no please explain

12 Household Income Source- Does any house hold member receive Income from employment Yes No

SSASSI Yes No

TANF Yes No

AlimonyChild Support Yes No

Scheduled PensionRetirement Yes No

Unemployment Yes No

Veterans BenefitsMilitary pay Yes No Cashhelp pay bills from friendsfamily Yes No

From above List the person and ALL income received below

Household Member Name Income Source Monthly

Gross Earnings (before Taxes)

Annual Gross Earnings (before

Taxes)

What is your combined total household gross annual income from all sources $__________ (Annual before taxes)

13 Will there be any changes to the household income in the next year This may include but is not limited to a new job the loss of a job or changes in child support gift income or family support (circle one) Yes No If yes explain

--1~iou IHomes and ~n Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

14 Household Assets -Answer as applicable for all members of the household

Checking Account YES NO Savings or Money Market Account YES NO

Certificate of Deposit (CD) YES NO

401 K or other retirement account YES NO

IRA YES NO

Mutual Funds YES NO

Stocks or Bonds YES NO

Cash on hand YES NO

Trust YES NO

Life Insurance Policy with cash value YES NO

Real Estate YES NO

IfYes is it rented YES NO

IfYes is it for sale YES NO

From above List person and ALL assets below

Household Member Name Asset Type Current Balance

I certify that the information furnished in this application is true and complete to the best of my knowledge and belief Signed under the pains andpenalties ofperjury(signature required for all house members 18 and older)

Head of Household Signature ____________________ Date_____

Co-Applicant Signature Date _____

Co-Applicant Signature Date _____

Co-Applicant Signature Date_____

Please call 212-957-8200 or email AvalonClintonavalonbaycom with any questions or requests for additional applications or consent form The A valonBay Level One Call Center associates available 24 hours a day by calling the contact number on our website are trained to accommodate relay calls for applicants andor households that need TTY services

--1~JORK IHomes and ~IVNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

-----------------------------------

------------------------

Avalon Clinton North Affordable Housing WAITLIST Application Free TranslationLanguage Assistance Available Upon Request

Applicants with disabilities may request modifications to the rental unit andor accommodations to our rules policies practices or services if such modifications or accommodations are necessary to afford an

equal opportunity to use and enjoy the premises

NAME OF PRIMARY APPLICANT ________________________

E-MAIL

PHONE________________ CELL_______________

CURRENT ADDRESS

Street Number amp Name City St Zip

1 How did you hear about us________________________

2 What size apartment home(s) are you interested in Studio One Two 3 Are you an employee of AvalonBay (circle one) Yes No 4 Are you either a spouse sibling child grandparent (natural step half or in-law) or significant

other of an AvalonBay employee (circle one) Yes No 5 Do you have a voucher (circle one) Yes No

IfYes Housing Authority Name 6 Do you have a disability need for a reasonable accommodation or modification Yes No If yes

please explain

7 How many people will be occupying the apartment (all adults and children)

9 Family Composition- List all those who will occupy the apartment including yourself

HOUSEHOLD MEMBER NAME

Date of

Birth

Age Relationship

Full Time

Student

(YN)

1 Head

2

3

4

5

--1~Jo1ult IHomes and ~nJNrrv Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

10 Race amp Ethnicity Requesting this information is required by state law your response is voluntary There is no penalty for not providing this information Although minority identification is optional by doing so you may be considered for entry in additional pools Please select ( 1 any applicable categories in the chart below for the head ofhousehold and any other adult household members You may select more than one category

White Black or African

American Asian

Hispanic or

Latino

American Indian or

Alaskan Native

Native Hawaiian or other Pacific Islander

Other (specify)

Head Other Adult Members

Decline to answer

11 Do you file taxes (circle one) Yes No If no please explain

12 Household Income Source- Does any house hold member receive Income from employment Yes No

SSASSI Yes No

TANF Yes No

AlimonyChild Support Yes No

Scheduled PensionRetirement Yes No

Unemployment Yes No

Veterans BenefitsMilitary pay Yes No Cashhelp pay bills from friendsfamily Yes No

From above List the person and ALL income received below

Household Member Name Income Source Monthly

Gross Earnings (before Taxes)

Annual Gross Earnings (before

Taxes)

What is your combined total household gross annual income from all sources $__________ (Annual before taxes)

13 Will there be any changes to the household income in the next year This may include but is not limited to a new job the loss of a job or changes in child support gift income or family support (circle one) Yes No If yes explain

--1~iou IHomes and ~n Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

14 Household Assets -Answer as applicable for all members of the household

Checking Account YES NO Savings or Money Market Account YES NO

Certificate of Deposit (CD) YES NO

401 K or other retirement account YES NO

IRA YES NO

Mutual Funds YES NO

Stocks or Bonds YES NO

Cash on hand YES NO

Trust YES NO

Life Insurance Policy with cash value YES NO

Real Estate YES NO

IfYes is it rented YES NO

IfYes is it for sale YES NO

From above List person and ALL assets below

Household Member Name Asset Type Current Balance

I certify that the information furnished in this application is true and complete to the best of my knowledge and belief Signed under the pains andpenalties ofperjury(signature required for all house members 18 and older)

Head of Household Signature ____________________ Date_____

Co-Applicant Signature Date _____

Co-Applicant Signature Date _____

Co-Applicant Signature Date_____

Please call 212-957-8200 or email AvalonClintonavalonbaycom with any questions or requests for additional applications or consent form The A valonBay Level One Call Center associates available 24 hours a day by calling the contact number on our website are trained to accommodate relay calls for applicants andor households that need TTY services

--1~JORK IHomes and ~IVNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

10 Race amp Ethnicity Requesting this information is required by state law your response is voluntary There is no penalty for not providing this information Although minority identification is optional by doing so you may be considered for entry in additional pools Please select ( 1 any applicable categories in the chart below for the head ofhousehold and any other adult household members You may select more than one category

White Black or African

American Asian

Hispanic or

Latino

American Indian or

Alaskan Native

Native Hawaiian or other Pacific Islander

Other (specify)

Head Other Adult Members

Decline to answer

11 Do you file taxes (circle one) Yes No If no please explain

12 Household Income Source- Does any house hold member receive Income from employment Yes No

SSASSI Yes No

TANF Yes No

AlimonyChild Support Yes No

Scheduled PensionRetirement Yes No

Unemployment Yes No

Veterans BenefitsMilitary pay Yes No Cashhelp pay bills from friendsfamily Yes No

From above List the person and ALL income received below

Household Member Name Income Source Monthly

Gross Earnings (before Taxes)

Annual Gross Earnings (before

Taxes)

What is your combined total household gross annual income from all sources $__________ (Annual before taxes)

13 Will there be any changes to the household income in the next year This may include but is not limited to a new job the loss of a job or changes in child support gift income or family support (circle one) Yes No If yes explain

--1~iou IHomes and ~n Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

14 Household Assets -Answer as applicable for all members of the household

Checking Account YES NO Savings or Money Market Account YES NO

Certificate of Deposit (CD) YES NO

401 K or other retirement account YES NO

IRA YES NO

Mutual Funds YES NO

Stocks or Bonds YES NO

Cash on hand YES NO

Trust YES NO

Life Insurance Policy with cash value YES NO

Real Estate YES NO

IfYes is it rented YES NO

IfYes is it for sale YES NO

From above List person and ALL assets below

Household Member Name Asset Type Current Balance

I certify that the information furnished in this application is true and complete to the best of my knowledge and belief Signed under the pains andpenalties ofperjury(signature required for all house members 18 and older)

Head of Household Signature ____________________ Date_____

Co-Applicant Signature Date _____

Co-Applicant Signature Date _____

Co-Applicant Signature Date_____

Please call 212-957-8200 or email AvalonClintonavalonbaycom with any questions or requests for additional applications or consent form The A valonBay Level One Call Center associates available 24 hours a day by calling the contact number on our website are trained to accommodate relay calls for applicants andor households that need TTY services

--1~JORK IHomes and ~IVNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

14 Household Assets -Answer as applicable for all members of the household

Checking Account YES NO Savings or Money Market Account YES NO

Certificate of Deposit (CD) YES NO

401 K or other retirement account YES NO

IRA YES NO

Mutual Funds YES NO

Stocks or Bonds YES NO

Cash on hand YES NO

Trust YES NO

Life Insurance Policy with cash value YES NO

Real Estate YES NO

IfYes is it rented YES NO

IfYes is it for sale YES NO

From above List person and ALL assets below

Household Member Name Asset Type Current Balance

I certify that the information furnished in this application is true and complete to the best of my knowledge and belief Signed under the pains andpenalties ofperjury(signature required for all house members 18 and older)

Head of Household Signature ____________________ Date_____

Co-Applicant Signature Date _____

Co-Applicant Signature Date _____

Co-Applicant Signature Date_____

Please call 212-957-8200 or email AvalonClintonavalonbaycom with any questions or requests for additional applications or consent form The A valonBay Level One Call Center associates available 24 hours a day by calling the contact number on our website are trained to accommodate relay calls for applicants andor households that need TTY services

--1~JORK IHomes and ~IVNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

-------------------------

AVALON Solicitud para Avalon Clinton North Lista de Espera de Vivienda

Asequible Servicios de Traduccion LibreAsistencia de Idiomas Disponible a Pedido

Solicitantes con discapacidades pueden pedir modificaciones al apartamento o alojamientos a las reglas normas practicas o servicios si las modificaciones o alojamientos son necesarios para permitir el uso del local e igualdad de oportunidades

NOMBRE DE APLICANTE PRIMARIO ________________________

CORREO ELECTONICO ______________________________

TELEFONO_________________ CELL_______________

DIRECCION PRESENTE

Numero de cale amp Nombre Ciudad Estado Zip

1 lC6mo te enteraste de nosotros

2 lEn que tipo(s) de habitaci6n esta interesado Mono ambiente Uno Dos 3 lEres un empleado de AvalonBay (elige uno) Si No 4 lEres un esposo(a) hijo relaci6n familiar (natural o marital) o novio de un empleado de

AvalonBay (elige uno) Si No 5 l Tiene un subsidio de renta ( elige uno) Si No

Si tiene un subsidio de renta cual es la agencia responsable _______________

6 lNecesitas un alojamiento o modificaci6n razonable por una discapacidad Si No Explica que clase de modificaci6n necesitas

7 lCuantas personas van a habitar el apartamento (todos adultos y ninos) ________

8 Composici6n Familiar- Liste toda las personas que van a habitar el apartamento incluyendo usted

NOMBRE DE MIEMBRO Fecha de

Nacimiento

Edad Relacion

Estudiante

Tiempo

Completo

(SiNo)

1 Cabeza

2

3

q wvoRK Homes and TEOF

oRTUNITY Community Renewal Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

--------------------------------------

AVALON~ 4

5

9 Raza amp Etnia Solicitando esta informaci6n es requerido por la ley del estado su respuesta es voluntario No hay ninguna penalidad si no pruebas esta informaci6n Identificaci6n de ser minoria es opcional pero probando esta informaci6n puede darte consideraci6n por otras oportunidades En la siguiente tabla seleccione ( 1 cualquier categoria aplicable de las miembros de la casa

1 Puede seleccionar masque una categoria

Blanco Afro

Americano o Negro

Asiatico Hispano

0

Latino

India Americano o Nativo de Alaska

Hawaiano nativo u otro Islefia Pacifica

Otro (especifica)

Cabeza Otros Miembros Adultos

Niego a responder

2 Llenas sus impuestos anuales (income taxes) (elige uno) Si No Explique la raz6n si no los llenan

3 Origen de Ingreso - Seleccione cualquier ingreso recibido por los miembros de las casa Ganancias de ser empleado Si No

SSASSI Si No

TANF Si No Pension Alimenticia Manutencion de los hijos Si No

Pensi onRetiro Si No

Compensacion por Desempleo Si No

Beneficios para veteranospago militar Si No

Dinero en efectivoayuda familiar para pagar cuentas

Sis No

De la tabla arriba Anote los miembros con todo forma de ingreso recibido

Nombre del Miembro de la Casa

Origen de lngreso Ganancias

mensuales antes de impuestos

Ganancias Anuales antes de impuestos

wvoRK Homes and rEOF

oRTUNllY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

---------------------- ------

------

------

AVALON Que es el total de ingreso anual antes de impuestos combinado de la casa $___________ (Anual antes de impuestos)

4 lEn el siguiente afio anticipan cambios del ingreso anual de la casa Estos cambios pueden incluir un cambio de trabajo o cambios en apoyo familiar o en manutenci6n de los hijos (elige uno) Si No Explique la razon si anticipan cambios

5 Bienes del Hogar - Seleccione cada respuesta aplicable para el hogar

Cuenta de cheques SI NO

Cuenta de ahorros SI NO Certificado de deposito (CD) SI NO

401 K o cuenta de retiro SI NO IRA SI NO Cuenta de fondos mutuos SI NO

Acciones o Bonos SI NO

Dinero en mano SI NO

Fideicomiso SI NO Poliza de seguro de vida con valor en efectivo SI NO Bienes Raices SI NO lSi respondes que si se renta SI NO lSi respondes que si se vende SI NO

De la tabla arriba Anote los miembros con el tipovalor de sus bienes

Nombre del Miembro de la Casa Tipo de Biene BalanceNalor Actual

Yo certifico que la informaci6n probada en esta solicitud es verdadero y completo a lo mejor de mi conocimiento Firmado bajo los doores y sanciones de perjurio (Firma requerida de todos miembros del hogar con la edad 18 o mayor)

Firma Cabeza del Hogar Fecha

Firma de Co-solicitante Fecha

Firma de Co-solicitante Fecha

wvoRK Homes andTIOF

Community Renewal oRTUNITY

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

------------------------ ------

AVALON Firma de Co-solicitante Fecha

Llame a 212-957-8200 mantle un correo electr6nico a AvalonClintonavalonbaycom si tiene cualquier pregunta o necesitas mas aplicaciones El centro de llamadas de AvalonBay Nivel Uno esta disponible 24 horas al dia y pueden ser contactados al 866-868-5565 Los socios son entrenados para ayudar aplicantes que necesitan servicios telescritor

WYORK Homes andrEOF ORTUNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

--------------------------------------

AVALON~ 4

5

9 Raza amp Etnia Solicitando esta informaci6n es requerido por la ley del estado su respuesta es voluntario No hay ninguna penalidad si no pruebas esta informaci6n Identificaci6n de ser minoria es opcional pero probando esta informaci6n puede darte consideraci6n por otras oportunidades En la siguiente tabla seleccione ( 1 cualquier categoria aplicable de las miembros de la casa

1 Puede seleccionar masque una categoria

Blanco Afro

Americano o Negro

Asiatico Hispano

0

Latino

India Americano o Nativo de Alaska

Hawaiano nativo u otro Islefia Pacifica

Otro (especifica)

Cabeza Otros Miembros Adultos

Niego a responder

2 Llenas sus impuestos anuales (income taxes) (elige uno) Si No Explique la raz6n si no los llenan

3 Origen de Ingreso - Seleccione cualquier ingreso recibido por los miembros de las casa Ganancias de ser empleado Si No

SSASSI Si No

TANF Si No Pension Alimenticia Manutencion de los hijos Si No

Pensi onRetiro Si No

Compensacion por Desempleo Si No

Beneficios para veteranospago militar Si No

Dinero en efectivoayuda familiar para pagar cuentas

Sis No

De la tabla arriba Anote los miembros con todo forma de ingreso recibido

Nombre del Miembro de la Casa

Origen de lngreso Ganancias

mensuales antes de impuestos

Ganancias Anuales antes de impuestos

wvoRK Homes and rEOF

oRTUNllY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

---------------------- ------

------

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AVALON Que es el total de ingreso anual antes de impuestos combinado de la casa $___________ (Anual antes de impuestos)

4 lEn el siguiente afio anticipan cambios del ingreso anual de la casa Estos cambios pueden incluir un cambio de trabajo o cambios en apoyo familiar o en manutenci6n de los hijos (elige uno) Si No Explique la razon si anticipan cambios

5 Bienes del Hogar - Seleccione cada respuesta aplicable para el hogar

Cuenta de cheques SI NO

Cuenta de ahorros SI NO Certificado de deposito (CD) SI NO

401 K o cuenta de retiro SI NO IRA SI NO Cuenta de fondos mutuos SI NO

Acciones o Bonos SI NO

Dinero en mano SI NO

Fideicomiso SI NO Poliza de seguro de vida con valor en efectivo SI NO Bienes Raices SI NO lSi respondes que si se renta SI NO lSi respondes que si se vende SI NO

De la tabla arriba Anote los miembros con el tipovalor de sus bienes

Nombre del Miembro de la Casa Tipo de Biene BalanceNalor Actual

Yo certifico que la informaci6n probada en esta solicitud es verdadero y completo a lo mejor de mi conocimiento Firmado bajo los doores y sanciones de perjurio (Firma requerida de todos miembros del hogar con la edad 18 o mayor)

Firma Cabeza del Hogar Fecha

Firma de Co-solicitante Fecha

Firma de Co-solicitante Fecha

wvoRK Homes andTIOF

Community Renewal oRTUNITY

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

------------------------ ------

AVALON Firma de Co-solicitante Fecha

Llame a 212-957-8200 mantle un correo electr6nico a AvalonClintonavalonbaycom si tiene cualquier pregunta o necesitas mas aplicaciones El centro de llamadas de AvalonBay Nivel Uno esta disponible 24 horas al dia y pueden ser contactados al 866-868-5565 Los socios son entrenados para ayudar aplicantes que necesitan servicios telescritor

WYORK Homes andrEOF ORTUNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

---------------------- ------

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AVALON Que es el total de ingreso anual antes de impuestos combinado de la casa $___________ (Anual antes de impuestos)

4 lEn el siguiente afio anticipan cambios del ingreso anual de la casa Estos cambios pueden incluir un cambio de trabajo o cambios en apoyo familiar o en manutenci6n de los hijos (elige uno) Si No Explique la razon si anticipan cambios

5 Bienes del Hogar - Seleccione cada respuesta aplicable para el hogar

Cuenta de cheques SI NO

Cuenta de ahorros SI NO Certificado de deposito (CD) SI NO

401 K o cuenta de retiro SI NO IRA SI NO Cuenta de fondos mutuos SI NO

Acciones o Bonos SI NO

Dinero en mano SI NO

Fideicomiso SI NO Poliza de seguro de vida con valor en efectivo SI NO Bienes Raices SI NO lSi respondes que si se renta SI NO lSi respondes que si se vende SI NO

De la tabla arriba Anote los miembros con el tipovalor de sus bienes

Nombre del Miembro de la Casa Tipo de Biene BalanceNalor Actual

Yo certifico que la informaci6n probada en esta solicitud es verdadero y completo a lo mejor de mi conocimiento Firmado bajo los doores y sanciones de perjurio (Firma requerida de todos miembros del hogar con la edad 18 o mayor)

Firma Cabeza del Hogar Fecha

Firma de Co-solicitante Fecha

Firma de Co-solicitante Fecha

wvoRK Homes andTIOF

Community Renewal oRTUNITY

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

------------------------ ------

AVALON Firma de Co-solicitante Fecha

Llame a 212-957-8200 mantle un correo electr6nico a AvalonClintonavalonbaycom si tiene cualquier pregunta o necesitas mas aplicaciones El centro de llamadas de AvalonBay Nivel Uno esta disponible 24 horas al dia y pueden ser contactados al 866-868-5565 Los socios son entrenados para ayudar aplicantes que necesitan servicios telescritor

WYORK Homes andrEOF ORTUNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO

------------------------ ------

AVALON Firma de Co-solicitante Fecha

Llame a 212-957-8200 mantle un correo electr6nico a AvalonClintonavalonbaycom si tiene cualquier pregunta o necesitas mas aplicaciones El centro de llamadas de AvalonBay Nivel Uno esta disponible 24 horas al dia y pueden ser contactados al 866-868-5565 Los socios son entrenados para ayudar aplicantes que necesitan servicios telescritor

WYORK Homes andrEOF ORTUNITY Community Renewal

Andrew M Cuomo Ruthanne Visnauskas Governor CommissionerCEO