801 Holly Springs Ave Richmond, VA 23224 (804) 230-4004 Fax (804) 230-0401

“Renewing the Neighborhood... One Door at a Time!”

o This form must be filled out completely by each applicant over 18

oWe require a picture id and proof of a social security number with each application.
o Our application fee of $20 must be in the form of a money order or cashier’s check and
accompany each application before processing. No cash is accepted.

Date: ___________

Rental Application

Marital Status (circle one): Single Married Separated

Name: _________________________ Birth Date: ______________ SSN: ___________

Primary Phone #: _________________ Secondary Phone #: ______________________

Full Current Address: _____________________________________________________

Street City State Zip
How long? ____ Years ___ Months Rent Amount? ___________ per _________

Landlord:________________ Landlord Phone #: ______________ Fax #: ___________

Reason for leaving:_______________________________________________________

Previous Address:_________________________________________________________
Street City State Zip
Landlord:________________ Landlord Phone #: ______________ Fax #: __________
Reason for leaving?_______________________________________________________

Have you ever been evicted? ________ Do you have a rental judgment?________

Have you been convicted of a felony within the last seven years? ________

If so, explain:
_______________________________________________________________________
_

Are you now or will you become a FULL TIME student within the next year? ________

Do you have a checking account and/or savings account? ______ Branch? ___________

How did you hear about our community?

_______________________________________________________________________

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 Employment and Income Information

Employer: ______________________ Phone #: ______________ How Long? ________

Position: ________________ Salary: ___________ per _______ Avg. Hours: ________

Additional Income: ______________________________________________________

Previous Employer:____________________Phone #: ____________ How Long? _____

Position: ________________ Salary: ___________ per _______ Avg. Hours: ________

Co-Applicant Information

Marital Status (circle one): Single Married Separated

Name: _________________________ Birth Date: ______________ SSN: ___________

Primary Phone #: _________________ Secondary Phone #: ______________________

Full Current Address: _____________________________________________________

Street City State Zip
How long? ____ Years ___ Months Rent Amount: ___________ per _________

Landlord: ________________ Landlord Phone #: ______________ Fax #: ___________

Reason for leaving: _______________________________________________________

Previous Address:
_________________________________________________________
Street City State Zip
Landlord: ________________ Landlord Phone #: ______________ Fax #: __________

Reason for leaving? _______________________________________________________

Have you ever been evicted? ________ Do you have a rental judgment? ________

Have you been convicted of a felony within the last five years? ________

If so, explain:
_______________________________________________________________________
_______________________________________________________________________
__

Are you now or will you become a full time student within the next year? ____________

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Do you have a checking account and/or savings account? ______ Branch? ___________

Employment and Income Information

Employer: ______________________ Phone #: ______________ How Long? ________

Position: ________________ Salary: ___________ per _______ Avg. Hours: ________

Additional Income: ______________________________________________________

Previous Employer:____________________Phone #: ____________ How Long? _____

Position: ________________ Salary: ___________ per _______ Avg. Hours: ________

List any other household occupants residing with you (anyone under 18 yrs. old)

Name Relationship DOB SSN

Will you be bringing any pets with you? _______ If so, what kind? _________________
Breed: __________________ Age: ___________ Weight: _______________

Does anyone in your household receive now or expect to receive income from this list?
Check all that apply and provide amounts below:

Income Type Yes/No Amount Frequency Who is receiving

the income?
Self-owned
business
Temp/seasonal
employment
Unemployment/
Worker’s Comp
Severance
Pay
Child
Support
Alimony

TANF/AFDC

Social Security/SSI

Disability

Retirement/
Pension Benefits

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Insurance Policy
Payments
Rental Income from
Real Estate
Veteran’s Admin
Benefits
Military
Reserve/National
Guard
Caretaking of
Elderly/Children
Income on behalf of
minors
Educational
Grants/Scholarships
Primary Checking
(avg. 6 mo. balance)
Primary Savings
(avg. 6 mo. balance)
IRA/401K Accounts
(if accessible)
Stocks/Bonds

Treasury Bills

Money Market Funds

Certificate of Deposit

Rental Property

Real
Estate/Mortgages/Land
Contracts
Safe Deposit Box

Deeds or Trust

Annuities

Whole/Univ. Life
Insurance

Income Type Yes/No Amount Frequency Who is receiving

the income?

Authorization for Credit and Reference Inquires

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Applicant(s) authorize landlord or Agent to verify the foregoing information and to make
credit and reference inquiries deemed necessary. Applicant(s) also authorize the release
of information contained on this application or sought by such inquiries. In making this
application, it is understood that an investigative consumer report and criminal report
may be prepared whereby information is obtained through personal interviews.
This inquiry includes information as to the character, general reputation, and mode of
living of Applicant(s).
The parties confirm that in connection with the transaction contemplated by this lease,
Genesis Properties Inc. and its Agents have and are acting as, on behalf of the Landlord
or as Landlord’s Agent.
I/We certify that the information provided herein is true and accurate to the best of
my/our knowledge and fully understand and agree that any information found to be
untrue could result in the refusal by Landlord to lease to me/us and the forfeiture of any
application fee and/or security deposit paid with this application. It is further understood
that should a property be leased to me based on information discovered to be untrue,
Landlord/Realtor maintains the right to terminate my/our lease and to hold Lessee
responsible for any damage to the property and to avail all rights and remedies to which
may be entitled by either law or equity, and to recover reasonable attorney’s fees and
costs as allowed by law.

Signature of Applicant: __________________________________Date: ___________

Signature of Co -Applicant: ______________________________ Date: ___________

Have you worked for Genesis Properties Inc. before? Yes ____ No ___
If yes, sign below

I have applied for a rental/sale property and stated that I am now or was formerly
employed by Genesis Properties Inc. My signature permits verification of this
information.

Signature of Past or Current Employee: _________________________________

Landlord Reference Form

Village South Town homes 801 Holly Springs Ave Richmond, Va 23224
Phone: (804) 230 4004 Fax: (804) 230 0401

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To current/previous landlord: The renter named below has applied for an apartment at the rental
development named above, which is a Low Income Housing Tax Credit development. As managing agents,
we need your help in answering the following questions. Your answers will be used to determine our
prospective resident’s eligibility. Thank you for your cooperation and please contact our office if you have
any questions or concerns about the completion of this form.

___________________________________________
Signature of leasing consultant or residential manager

___________________________________________ _________________________________________
Applicant Signature Co-Applicant Signature

My/Our signature(s) as (an) applicant(s) authorize the release any information pertaining to residential
qualifications.

Renter’s Name: _____________________________ Landlord: ___________________________

Address: __________________________ Office Fax #:________________________
__________________________________

The following information is to be completed by the Landlord:

1. When did they rent this property? From _______________ to: _______________
(Month/year)
2. Do they currently reside there? Yes or No

3. Who was listed on the lease? ___________________

4. What was their monthly rent? __________________

5. Was it paid on time? Yes or No if not, how many times were payments made late in the last 12
months? ________

6. What was their security deposit? $_______ How much of it was refunded? $_______

7. Did they give proper notice to move out? Yes or no

8. Did they maintain proper housekeeping habits? Yes or no

9. Was the property left in rentable condition? Yes or no

10. Was the property damaged during their stay? Yes or no

11. Did they have pets? Yes or no if yes, what type/how many? __________________

12. Would you rent to them again? Yes or no

13. Do they currently have a balance? Yes or no if yes, how much? $____________

14. If there is currently a balance, have they made an attempt to clear the debt via payments? Yes or no

This form was completed by: _______________________ Position: ____________________

ANNUAL STUDENT CERTIFICATION

Effective Date: _______
Move-in Date: ________

This Annual Student Certification is being delivered in connection with the undersigned's
application/occupancy in the following apartment:

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 Head of Household Name: Unit Number:
Building Address:
Check A, B, or C, as applicable (note that students include those attending public or
private elementary schools, middle or junior high schools, senior high schools, colleges
universities, technical, trade, or mechanical schools, but does not include those attending
on-the-job training courses):
1 A. _____ Household contains at least one occupant who is not a student and has
not been/will not be a student for five months or more out of the current and/or upcoming
calendar year (months need not be consecutive). If this item is checked, no further
information is needed. Sign and date below.

1 B. _____ Household contains all students, but is qualified because the following
occupant(s) ___________________________________ is/are a PART TIME student(s).
Verification of part time student status is required for at least one occupant.

1 C. _____ Household contains all FULL TIME students for five months or more
out of the current and/or upcoming calendar year (months need not be consecutive). If
this item is checked, questions 1-5, below must be completed:

1 Are the students married and entitled to file a joint tax return? (attach YES NO
. marriage certificate or tax return)
2 Is at least one student a single-parent with child(ren) and this parent is not YES NO
. a dependent of someone else, and the child(ren) is/are not dependent(s) of
someone other than a parent? (attach student’s and if applicable,
divorce/custody decree or other parent’s most recent tax return)
3 Is at least one student receiving Temporary Assistance to Needy Families YES NO
. (TANF), (provide release of information for verification purposes)
4 Does at least one student participate in a program receiving assistance YES NO
. under the Job Training Partnership Act, Workforce Investment Act, or
under other similar, federal, state or local laws? (attach verification of
participation)
5 Does the household consist of at least one student who was previously YES NO
. under foster care? (provide verification of participation)
Full-time student households that are income eligible and satisfy one or more of the above
conditions are considered eligible. If questions 1-5 are marked NO, or verification does not
support the exception indicated, the household is considered an ineligible student household.
Under penalties of perjury, I/we certify that the information presented in this Annual Student
Certification is true and accurate to the best of my/our knowledge and belief. I/we agree to notify
management immediately of any changes in this household’s student status. The undersigned
further understands that providing false representations herein constitutes an act of fraud. False,
misleading or incomplete information may result in the termination of the lease agreement.

Signature __________________________ Date ________________

Signature __________________________ Date ________________
Race & Ethnicity Data
Reporting Form
Virginia Housing Development Authority (VHDA) requests this information in order to
comply with Title I of the United States Housing act of 1937 which requires annual
reporting of certain information to the United States Department of Housing and Urban
Development. Although VHDA would appreciate receiving this information, you may
choose not to furnish it. You will not be discriminated against on the basis of this
information, or on whether or not you choose to furnish it.

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If you do not wish to furnish this information, please initial below.
Resident/Applicant: I do not wish to furnish information regarding ethnicity and race.
(Initials) ______
Please enter both Ethnicity and Race codes for each household member.

_______________________________________________________
Name of Property Property Address

________________________________________________________________
Name of Owner/Managing Agent Unit #

________________________________________________________________
Name of Head of Household Name of Household Member

Ethnic Categories* Select One

Hispanic or Latino
Not–Hispanic or Latino
Racial Categories* Select All That Apply
America Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other

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Please provide signature and date below to authorize this information to be true and
correct

Sign: _______________________________ Date: __________________________

VILLAGE SOUTH TOWN HOMES/SWANSBORO APARTMENTS

801 Holly Spring Avenue, Richmond, VA 23224
“Renewing the Neighborhood... One Door at a Time!”
Office 804-230-4004 Fax 804-230-0401

Authorization for Release and Consent

Purpose: Village South Townhomes and Swansboro Apartments may use this authorization and
the information obtained with it to administer and enforce rules and policies related to the rental
of property owned and/or managed by the above named organization.

Authorization: I authorize the above-named organization to obtain information about me or my

family that is pertinent to the rental of property owned and/or managed by Genesis Properties.

Inquiries may be made about:

• Child Care Expenses • Handicapped Assistance Expenses
• Credit History • Identity and Marital Status
• Criminal Activity • Medical Expenses
• Family Composition • Social Security Numbers
• Employment/Income/Pension/Assets • Residences and Rental History
• Federal/State/Tribal/Local Benefits

Individuals/Organizations that may release information include:

• Banks and Financial Institutions • Utility Companies
• Courts • Welfare Agencies
• Law Enforcement Agencies • Providers of: Alimony
• Credit Bureaus Child Care
• Previous and Present Employers Child Support
• Landlords Credit
• Schools and Colleges Handicapped Assistance
• U.S. Social Security Administration Medical Care
• U.S. Department of Veteran's Affairs Pensions/Annuities

I agree that the above-named organization may conduct computer matching programs with other
governmental agencies including federal, state, tribal or local agencies. The governmental
agencies include the U.S. Office of Personnel Management, the U.S. Social Security
Administration, the U.S. Department of Defense, the U.S. Postal Service, the State Employment
Security Agencies, and the State Welfare & Food Stamp Agencies. The match will be used to
verify information supplied by the family.

___________________________ ______________________________________
Printed Full Name Signature Date

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___________________________ ______________________________________
Printed Full Name Signature Date
VILLAGE SOUTH TOWN HOMES/SWANSBORO APARTMENTS
801 Holly Spring Avenue, Richmond, VA 23224
“Renewing the Neighborhood... One Door at a Time!”
Office 804-230-4004 Fax 804-230-0401

Privacy Protection Act Disclosure

As provided by the Virginia Privacy Act of 1976, anyone who is requested to provide
information about him/her must be informed whether he/she is legally required to provide
such information or whether he/she may refuse to supply the information requested. As
an applicant for housing, he/she is required to provide certain information that will enable
Village South Town homes and Swansboro Apartments to complete Virginia Housing
Form No. MD 320, “Confirmation of Resident Eligibility.”

The information requested will be used to determine annual income which you and your
family receive from all income sources. This is necessary because the rules and
regulations adopted pursuant to the authority conferred on the Virginia Housing
Development Authority limit eligibility for initial occupancy to families whose adjusted
income does not exceed certain established limits. In addition, it is necessary to know the
composition of your family (number of dependents) so that the proper sized dwelling
may be authorized for you and your family.

Although you are not legally required to provide the information requested, your failure
to do so will result in our inability to determine your eligibility for housing in the
development shown above.

Copies of completed “Confirmation of Resident Eligibility” are sent by this office to the
Virginia Housing Development Authority, 601 South Belvidere Street, Richmond,
Virginia 23220. It is possible that information provided by you will revealed to others for
the purpose of confirmation or for other purposes in accordance with the Virginia
Freedom of Information Act, but any information so supplied are to the safeguards of the
Virginia Privacy Protection Act.

__________________________________________ ________________________
Applicant Date

__________________________________________ ________________________
Applicant Date

__________________________________________ ________________________
Authorized Agent for Genesis Properties Inc. Date

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 Authorization for Release of Background Information
In consideration for residency with Genesis Properties, Inc., candidates must consent and
authorize to a pre-residency verification of background information. Consideration of residency is
contingent upon the results of this reference and background verification. This process may
include verification of credit history as permitted by the Fair Credit Reporting Act; employment
history; a review of any local, county, state, or federal government agency; court public records;
and personal references.

This authorization and release gives permission to Genesis Properties, Inc. or its designated agent
to conduct the background verification. The results of this process will be utilized by Genesis
Properties, Inc. to determine eligibility for residency.

Have you ever been convicted, entered a plea of no contest, had prosecution
deferred, or adjudication withheld for any crime except for minor traffic violations?
YES NO

Please provide a list of cities, including the state and zip code, where you have lived or worked in
the past seven years. Use the back of this sheet if additional space is needed.

_______________________________________ ___________________________________
Current City/State/Zip Current City/State/Zip

_______________________________________ ___________________________________
Previous City/State/Zip Previous City/State/Zip

I, the undersigned, do hereby certify the information provided by me on this form in my

application for rental, or in verbal discussion thus relating to my consideration for residency is
true and complete to the best of my knowledge. I have read and I understand this Authorization
and Consent, and authorize the procurement of information relating to my background, character,
and personal reputation, which may be deemed relevant to my residency.

I request this document in it's original, copied, or faxed form, serve as my valid authorization to
any and all persons, and /or current employers, organizations, credit agencies, law enforcement or
criminal record agencies and other agencies to release information about me and hereby release
all such persons, institutions, agencies, employers, and organizations providing such information
from liability in any or all claims and damages connected with their providing and requesting
information.

___________________________ ______________________________________
Printed Full Name Signature Date

___________________________ ______________________________________
Printed Full Name Signature Date

RESIDENT SELECTION CRITERIA

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Equal Housing: Genesis Properties, Inc. does not discriminate on the basis of race, color,
religion, sex, national origin, elderliness, familial status or disability.

Identification: All prospective residents must provide a valid driver’s license or other photo
identification upon submitting an application. A social security card is also required upon
submitting application. Other acceptable forms of identification are: valid state issued ID card,
military ID card or a valid passport.

Occupancy: An application must be completed and maintained for each applicant 18 years or
older who will be living in the apartment. Two (2) people per bedroom, regardless of age or sex.
The only exception would be a baby born during lease term may remain in parent’s bedroom for
eighteen (18) months.

Qualifying Standards:
All adults (18 or older) must meet the following criteria:
Credit and Rental History: A Landlord verification form will be sent to the last verifiable
property management company to which the applicant(s) resided. With this report, coupled with
credit history, we reserve the right to deny any individual for any one of the following;
1. One judgment not yet remedied
2. One credit obligation which is three or more month’s delinquent.
3. One personal bankruptcy within the last three years.
4. One foreclosure of real estate.
5. One suit not remedied, or a balance due to include, but not limited to, rental balances, and
damages.
6. A history of vacating premises with required notification, damages, eviction charges,
disturbance of neighbors, destruction of property, and/or unsanitary housekeeping.

An applicant declined for unsatisfactory credit is encouraged to obtain a copy of the credit report
from the credit-reporting agency, correct any erroneous information that may be on the report,
and resubmit an application to Genesis Properties, Inc.

Income: Applicants must have a gross income source that can be verified of at least 2.5 times the
monthly rent of the apartment being leased. Acceptable income verification required may include
the last six (6) pay stubs, proof of salary provided by employer and or the most recent W2. Self-
employed applicants may be required to supply the most recent tax return or certified verification
from their company accountant or bank. Unverifiable income must have a notarized statement of
payment and cannot exceed 25% of applicant’s monthly income.

Evaluation: Genesis Properties, Inc. evaluates the above information with a scoring method that
weighs the indicators of future rent payments performance.

__________________________________________ ________________________
Applicant Date

__________________________________________ ________________________
Applicant Date

__________________________________________ ________________________
Authorized Agent for Genesis Properties Inc. Date

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