West 39th Street Apartments

One Penn Plaza, Box 6121, New York, NY 10119

____________

Dear Prospective Applicant: Thank you for requesting an application for an affordable apartment at West 39th Street Apartments located on West 39th Street, between Eighth and Ninth Avenues, in the Clinton section of Manhattan. Because this project is being constructed through the Inclusionary Housing Program of the New York City Department of Housing Preservation and Development (HPD) and is financed with federal Low Income Housing Tax Credits and tax-exempt bonds issued by New York State Homes and Community Renewal (HCR), forty-one (41) apartments are set-aside for low and very low-income households to be made available through a lottery. The following process will be used to select qualified tenants for this project. Soon after the application deadline of April 14, 2012, a lottery will be conducted. The applications will be opened, logged in and reviewed in numerical order. Ineligible applicants will be sent letters stating the reason for ineligibility. Credit reports will be run for applicants who preliminarily appear to be eligible and those with acceptable credit histories will be scheduled for interviews. The steps in determining final eligibility include: conducting office interviews; performing credit, landlord/tenant court and criminal checks; collecting all necessary documentation and verifications; and conducting visits to the applicants home. Upon a final determination of eligibility, applicants will be selected for apartments according to log number order and availability of the appropriate size apartment. Preference will be given to: Manhattan Community Board #4 residents for 21 units; mobility-impaired persons for two (2) units; visual and/or hearing-impaired persons for one (1) unit; and City of New York municipal employees for two (2) units. Additionally, preference for all units will be given to applicants who live in New York City. Applicants who submit more than one application will be disqualified. Photocopied applications will not be accepted. Additionally, only applications submitted by regular mail will be accepted. Applications postmarked after April 14, 2012 will be set aside for possible future consideration. An applicants eligibility will be based on the applicants circumstances at the time the applicants log number is called up, not circumstances which later change. Further, applicants must continue to qualify throughout processing. At any point in processing, until a lease and move-in affidavit are executed, if an applicant is determined to be ineligible, the application will be terminated. Applicants have the right to a written appeal, which must be submitted within fourteen (14) days of a termination. After all apartments have been rented, all remaining applicants will be sent letters indicating that they are on the waiting list. As low-income units become available, the owner will contact applicants who are on the waiting list, following the same procedures and criteria as during the initial rent-up. All applicants will receive correspondence from the owner at some point, either due to an ineligibility determination, scheduling of an interview, or placement on the waiting list. Depending on your lottery number, this correspondence should occur anywhere from approximately one month to one year after the application deadline. To qualify for the program, the household must meet all requirements established by law, regulation and the owner. The major reasons for an ineligibility determination are: household income either is under the minimum income or over the maximum income for the appropriate household and apartment size; there is no apartment available for the households size; the household is temporarily low-income, not demonstrating a long-term need for this affordable housing; and all adult members of the household do not sign the certification on the last page of the application. Some of the other factors that will be considered in determining eligibility are the applicants/households: student status; credit and payment history; length and stability of employment; consistency and authenticity of documentation; timeliness of appearing for interviews and providing documentation; housekeeping habits; and criminal record. The attached chart details the minimum and maximum incomes for specific household and apartment sizes, as well as the number of each apartment size available and corresponding rent. Prospective applicants should be aware that this is a governmentally assisted housing program. The submission of false or knowingly incomplete information at any point during the application process will result in an applicants disqualification, termination of a lease (if discovery is made after the fact), and referral to the appropriate authorities for further action, including potential criminal prosecution. All paperwork and documents submitted by applicants are subject to review by the New York City Department of Investigation, a fully empowered law enforcement agency of the City of New York. Now that you have an overview of the tenant selection process for an apartment in West 39th Street Apartments, please fill out the enclosed application carefully and completely, and mail it to the address listed on the application. Applications must be postmarked by April 14, 2012. We look forward to receiving your application. Sincerely, West 39th Street Apartments

West 39th Street Apartments

WE HAVE RECEIVED YOUR INQUIRY REGARDING AN APARTMENT. ENCLOSED IS AN APPLICATION. FILL OUT THE APPLICATION AND MAIL IT IN AN ENVELOPE. YOUR APPLICATION MUST BE POSTMARKED BY APRIL 14, 2012 TO BE INCLUDED IN THE LOTTERY. APPLICATIONS WILL BE ACCEPTED BY REGULAR MAIL ONLY! APPLICATIONS POSTMARKED AFTER APRIL 14, 2012 WILL BE SET ASIDE FOR POSSIBLE FUTURE CONSIDERATION. APPLICANTS WHO SUBMIT MORE THAN ONE APPLICATION PER HOUSEHOLD WILL BE DISQUALIFIED. PHOTOCOPIED APPLICATIONS WILL NOT BE ACCEPTED.

WEST 39th STREET APARTMENTS LOTTERY TIMES SQUARE STATION BOX 977 NEW YORK, NY 10108
IF ANY MEMBER OF THE APPLICANT HOUSEHOLD IS MOBILITY, VISUAL, OR HEARING IMPAIRED, PLACE A CHECK MARK () ON THE OUTSIDE OF THE ENVELOPE UNDER YOUR RETURN ADDRESS. SET ASIDE FOR HOUSEHOLDS WITH INCOMES AT OR BELOW 50% OF MEDIAN FAMILY INCOME:

MAIL APPLICATION IN AN ENVELOPE TO:

# APTS AVAILABLE

APARTMENT TYPE

MONTHLY RENT

HOUSEHOLD SIZE

TOTAL GROSS ANNUAL INCOME RANGE

Minimum - Maximum

5 20 9

Studio 1 Bedroom 2 Bedroom

$669 $720 $874

1 1 2 2 3 4

$24,891 - $29,050 $26,674 - $29,050 $26,674 - $33,200 $31,988 - $33,200 $31,988 - $37,350 $31,988 - $41,500

SET ASIDE FOR HOUSEHOLDS WITH INCOMES AT OR BELOW 40% OF MEDIAN FAMILY INCOME:

# APTS AVAILABLE

APARTMENT TYPE

MONTHLY RENT

HOUSEHOLD SIZE

TOTAL GROSS ANNUAL INCOME RANGE

Minimum - Maximum

1 4 2

Studio 1 Bedroom 2 Bedroom

$524 $564 $688

1 1 2 2 3 4

$19,920 - $23,240 $21,325 - $23,240 $21,325 - $26,560 $25,611 - $26,560 $25,611 - $29,880 $25,611 - $33,200

Note: Apartment Type Subject to Occupancy Criteria. Rent Includes Gas for Cooking and Heating. Rents and Income Requirements Subject to Change.

APPLICANTS WILL BE REQUIRED TO MEET INCOME, HOUSEHOLD SIZE AND ADDITIONAL SELECTION CRITERIA. Preference will be given to: Manhattan Community Board #4 residents for 21 units; mobility-impaired persons for 2 units; visual and/or hearing impaired persons for 1 unit; and City of New York municipal employees for 2 units. Preference for all units will go to New York City residents. Note that submission of false or knowingly incomplete information will result in disqualification and referral to appropriate authorities, including the New York City Department of Investigation, for further action, e.g. criminal prosecution.

West 39th Street Apartments

INSTRUCTIONS
1. 2. 3. 4. 5. 6. Log #_______________ FREE APPLICATION--DO NOT PAY ANYONE FOR THIS APPLICATION Mail only one (1) original application per household. You may only be a household member on one (1) application. You will be disqualified if you submit more than one (1) application. Also, photocopied applications will not be accepted. All adult members of the household must sign the certification on the last page of the application. Otherwise, your application will be deemed ineligible. When completed, place the application in an envelope. If any member of the household is mobility, visual or hearing impaired, place a check mark () on the outside of the envelope under your return address. Mail completed application by regular mail only to: West 39th Street Apartments Lottery, Times Square Station, P.O. Box 977, New York, NY 10108. Applications not sent via regular mail (e.g. priority, certified, registered, express or overnight mail) will not be accepted. Your application must be postmarked by April 14, 2012. No payment or fee should be given to anyone in connection with the preparation or filing of this application for housing, and no brokers fee should be given to receive an apartment. This application is to be completely filled out by the applicant. Please answer all questions and write neatly.

SECTION A. GENERAL INFORMATION

Applicant Name: Home Address: Mailing Address, if different: Phone #: (home) In case of emergency, notify: Address: In current unit: Number of bedrooms Briefly describe your reasons for moving: How did you hear about West 39th Street Apartments? (If newspaper, which one?)
1) Are you an employee of the City of New York, the New York City Housing Development Corporation, the New York City Economic Development Corporation, the New York City Housing Authority, or the New York City Health and Hospitals Corporation? Yes No If Yes, please identify the agency or entity at which you are employed: Agency/Entity 2) If you answered "yes" to Question 1 above, have you personally had any role or involvement in any process, decision, or approval regarding the housing development that is the subject of this application? Yes No NOTE: If you answered Yes to Question 1 above, you may be required to submit a statement from your employer that your application does not create a conflict of interest. If you answered Yes to Question 2 above, you will be required to submit a statement from your employer that your application does not create a conflict of interest. Such statement would not be required until later in the application process, after you have been selected through the lottery, when you will also be required to provide other documents to verify your income and eligibility.
Street Street Apt. # Apt. #

e-mail address:
City City State State Zip Zip

(work)

(cell)

Relationship: Daytime Phone: Number of persons living there?

In apartment applying for: How many persons, including yourself, will live here?

SECTION B. HOUSEHOLD COMPOSITION

List ALL persons who will live in the apartment you are applying for. Include all persons for whom this unit will be a permanent residence/address. Student? Yes or No Name Relation to Head Sex Age Birth Occupation If Yes, F/T or P/T? of Household (M/F) Date

Head

ab 9265

Do you anticipate any additions to the household in the next twelve (12) months? Yes If yes, indicate who (name and relationship) Explain: Check if you or any member of your household has a disability: Mobility Visual

No Hearing

Describe any special accommodation needed if you or any member of your household is disabled: Will ALL of the household members (both adults and children) be full-time students during five (5) months or more of 2012 or will they all be full-time students during five (5) or more months of 2013? Yes No If yes, indicate the name(s) of the household member(s) and of the school(s) they are or will be attending:

SECTION C. INCOME
List below ALL current sources of income for ALL HOUSEHOLD MEMBERS, including yourself, listed in Section B. Household Composition, i.e., all persons who will live in the apartment you are applying for. EMPLOYMENT INCOME Include all full-time, part-time and self-employment income. (Self-employment/business income, if applicable, must reflect the amount that would be reported on IRS Form 1040, Line 12, Business Income, and Schedule C, Line 31, Net Profit.) Dates of Employment
(From/To, including Month/Year)

Status
F=Full-Time P=Part-Time S=SelfEmployed

Household Member Name

Name & Address of Employer

Gross Annual Earnings $ $ $ $ $

Total Gross Annual Employment Income =

OTHER INCOME Include gross periodic payments from: public assistance (including housing allowance), AFDC, TANF, unemployment, disability, veterans, social security, SSI, alimony, child support, annuities, pensions, retirement funds, insurance policies, and other regular income. Also, include interest, dividends, net rental income and other income from assets listed in Section D. Assets. Period Received Household Member Name Source of Income $ $ $ $ $ Gross Amount per per per per per
Weekly, Bi-weekly, Semimonthly, Monthly, Quarterly

Annual Gross Amount $ $ $ $ $ $ $

Total Gross Annual Other Income = TOTAL GROSS ANNUAL INCOME: (Employment PLUS Other Income) Do you or any household member anticipate any changes in income in the next twelve (12) months? If yes, explain:

Yes

No

SECTION D. ASSETS
List below the current cash value of all assets held by ALL household members, including yourself, listed in Section B. Household Composition. (Income from these assets must be listed in Other Income in Section C. Income). Include below: cash on hand, checking accounts, savings accounts, savings bonds, certificates of deposit, money market funds, mutual funds, stocks, bonds, IRA accounts, 401K accounts, other retirement and pension accounts, trust funds, life insurance policies (except Term), personal property held as an investment (e.g. jewelry, antiques or art), equity in real estate and all other assets. Household Member Name Institution Name Type of Asset Account # Current $ Value/ Account Balance

TOTAL VALUE OF ASSETS = Do you or any household member have a pension or retirement account other than an IRA or Keogh? If yes, do the terms of the account permit you to withdraw funds from the account now? Yes

Yes No

No

Have you or any household member received any lump sum payments, such as inheritance, gambling winnings, insurance? Yes No If yes, when? ______________________________ How much? _________________________________ Are these funds reflected in your asset list above? Yes No If not, describe why: Do you or any household member own any property, including the home you live in? Yes No If Yes, type of property Location of property Appraised market value $ Mortgage or outstanding loans principal balance due $ If rental property, net annual rental income (amount that would be reported on IRS Schedule E, Line 26): $ Have you or any household member sold/disposed of any property in the last twenty-four (24) months? If Yes, type of property: Date of transaction Market value when sold/disposed $ Amount sold/disposed for $

Yes

No

Have you or any household member disposed of or given away any other assets in the last twenty-four (24) months? (Examples: Given away money to relatives or set up Irrevocable Trust Accounts)? Yes No If yes, describe the asset Date of disposition: Amount disposed $

SECTION E. ADDITIONAL INFORMATION

EMPLOYMENT HISTORY (TWO YEARS)
For any adult household member who has not been with their current employer for at least two (2) years or who is not employed currently, list in order all previous employment for the past two (2) years, starting with your most current employment. Household Member Name Name & Address of Employer Dates of Employment (From/To, including Month/Year)
F= Full-Time, P=PartTime, S=Self-Employed

Status

RESIDENCE HISTORY (FIVE YEARS)

Starting with your current address, list in order all addresses where you have lived for the past five (5) years. Address Dates (From/To) Name, Address and Phone # of Landlord

Current monthly rent or mortgage payment amount: $ Your contribution: $ Check utilities paid by you: Heat Electricity Gas Other (specify) Are you presently receiving transferable rent subsidy? Yes No. If yes, which? Section 8 Other (specify) _______________ Are you or any member of the applicant household currently using an illegal substance? Yes No Have you or any member of the applicant household ever been convicted of a felony? Yes No If Yes, when? Have you or any member of the applicant household ever been evicted from housing? Yes No If Yes, when? Have you or any member of the applicant household ever filed for bankruptcy? Yes No If Yes, when? Do you or any member of the applicant household have any pets? Yes No If Yes, type? If yes to any questions above, explain
The following information is used only for statistical purposes and is optional: PLEASE CHECK THE RACE WHICH BEST DESCRIBES THE HEAD OF HOUSEHOLD: Black/African American American Indian/Alaska Native Asian White IS THE HEAD OF HOUSEHOLD OF HISPANIC/LATINO ORIGIN? Yes, Hispanic/Latino No, not Hispanic/Latino CERTIFICATION Native Hawaiian/Other Pacific Islander

I/We certify that this will be my/our primary residence. I/We understand that eligibility for housing will be based on applicable income limits and management s selection criteria. I/We declare that statements contained in this application are true and complete to the best of my/our knowledge. I/We have not withheld, falsified or otherwise misrepresented any information. I/We fully understand that any and all information I/we provide during this application process is subject to review by the New York City Department of Investigation (DOI), a fully empowered law enforcement agency which investigates potential fraud in City-sponsored programs. I/We understand that the consequences for providing false or knowingly incomplete information in an attempt to qualify for this program may include the disqualification of my/our application, the termination of my lease (if discovery is made after the fact), and referral to the appropriate authorities for potential criminal prosecution.
SIGNATURE(S): ALL ADULT APPLICANTS, 18 OR OLDER, MUST SIGN.

(Signature) (Signature)

(Date) (Date)

(Signature) (Signature)

(Date) (Date)