Welcome to Lumine on 28th and Ledges on 29th

Transcription

Welcome to Lumine on 28th and Ledges on 29th, Brand New Inspired Apartments
Within Reach. Managed and Leased by Thistle Communities.
HOW DO I APPLY?
Submit this fully completed application with a fee of $25.00 for each adult over the age of 18. Application fees are nonrefundable and must be paid in certified funds (cashiers check or money order).
Please make payable to Boulder 29th Street, LLC. If you will be mailing your completed application and application fee
please send to:
The Cannery – Att. Chris Zimbelman
15 Third Avenue, #96
Longmont, CO 80501
Once you have submitted your application, Chris will follow up with you. Application processing can take on average three
business days.
We welcome people of all abilities. Please let us know if you are disabled and need assistance accessing our programs. Hearing
impaired individuals can reach us by dialing 7-1-1 or go to http://www.relaycolorado.com/
HOW DO I BECOME APPROVED FOR AN APARTMENT HOME?
Minimum Age: You must be 18 years of age to enter into a lease agreement
Identification Requirements: A valid government issued I.D. Social Security number for all occupants, & Social Security
card is required for all occupants six (6) years of age and older
Rental History: Two (2) years of satisfactory, 3rd party management rental history is required.
Income:
a. combined gross income of three (3) times the monthly rent
b. have a minimum six (6) months steady employment OR a verifiable, sufficient source of income
c. income must not exceed limits based on household size (see chart)
Family Size: 1 Person 2 People 3 People 4 People 5 People
Max Income Allowed: $40,380 $46,140 $51,900 $57,660 $62,280
Criminal:
A criminal background check will be obtained for all adults 18 years of age and older. Applicants may be
denied for felony arrests or convictions within five (5) years or arrests or convictions involving violent or
sexual crimes or a consistent record of arrests, misdemeanors or felonies
Credit:
A credit check will be obtained for all adults 18 years of age and older. Applicants must have no pending
evictions, no evictions within five (5) years, no monies owed to current or previous landlords, no bankruptcy
that has not been discharged, and no wage garnishments which cause the applicant to be outside the rent to
income ratio of 30-40%
Students:
Full time students may qualify if they meet one of the following conditions: participants in AFDC, or a
federal/state/local job training program, single parent, married filing joint tax returns.
5620 Arapahoe Avenue Suite 212, Boulder, CO 80303
Phone: 303.728.9358 Fax: 720.565.0359
www.ledgesboulder.com
[email protected]
ONCE APPROVED
You will sign an offer and acceptance agreement and pay a reservation fee of $150.00 within 24 hours of approval to “hold” the
apartment. Your reservation fee is non-refundable 72 hours after you sign an offer and acceptance agreement. Upon your movein this fee is applied toward your security deposit.
OTHER INFORMATION
Occupancy Standards: 2 persons per bedroom
Lease Terms: Twelve (12) months
Security Deposits: Equal to one months rent
Pets: $250.00 pet deposit and a $150.00 non-refundable pet fee, $20.00 monthly pet rent per pet. Dogs must meet weight and
height requirements and Thistle reserves the right to deny pets based on breed or species. All pets must meet pet policy
requirements. Max allowable weight = 50LBS. Two (2) pets max per apartment home. Pets must be properly licensed &
inoculated for rabies and other usual inoculations for type of animal. Pet must be spayed/neutered. Documentation is
required before pet will be allowed on the property.
Utilities: All utilities included except for communication & cable television
Laundry: Washer and Dryer included
Parking: Each unit will be assigned 1 parking spot, in addition you will receive an ECOPASS
Disclaimer: Pricing, floor plans, design, plan dimensions, square footage measurements, building sizes, and window locations
are all approximate, not to scale, may not reflect the actual finished product and are subject to change without notice. Floor Area
measured to the exterior face of framing or foundation wall on all levels including stairs, mechanical areas, storage areas and
unfinished areas.
5620 Arapahoe Avenue Suite 212, Boulder, CO 80303
Phone: 303.728.9358 Fax: 720.565.0359
[email protected]
RENTAL APPLICATION
This information will be used to determine if your household qualifies for tenancy.. This information is
CONFIDENTIAL, will not be disclosed without your consent, except to your employer(s) for verification of
income and employment, to your financial institution(s) for verification of assets, as required and permitted by
law. You are not required to provide this information, but without it, your tenancy application may be delayed
or denied.
Date of Application: __________
# Bedrooms: ___________
Site applied for: ________________________
An application fee of $ 25.00 per adult over the age of 18 years will be collected at the time that the application is
submitted.
NAME:_____________________________________ADDRESS:_____________________________________________
CITY:______________________________________ STATE: __________________ZIP: _________________________
PHONE: ____________________________________E-MAIL: _____________________________________________
HOW LONG AT PRESENT ADDRESS: ______________ DO YOU: RENT OWN OTHER
IF OTHER PLEASE EXPLAIN: _______________________________________________________________________
HOUSEHOLD COMPOSITION
(List all who are applying for residency and give the relationship of each member to the head of household)
Member
Full Name
Relationship
Birth-date
Social Security Number
Head of
Household
2
3
4
Does anyone not listed above live with you now? Yes
Does anyone not listed above plan to live with you in the future?Yes If you answer “yes” to either question, please explain:
No
No
Other places you have resided during the past two years:
Address: __________________________________________________________________________________________
Address: __________________________________________________________________________________________
1
Please answer the following questions:
1. Do you require any special accommodations? ______________. If so, what type? ______________________________
2. Do you own an animal? ________. Is it a guide or service dog? ________. If yes, what type? _____________________
3. Have you ever been evicted from a place of rental? ________. If yes, when? __________. Why? __________________
4. Do you owe any unpaid rent? ________________. If yes, how much? _______________________________________
5. Have you ever violated a lease, rental agreement, or regulations at your previous place of rent? ___________________
6. Have you ever been charged with misuse or abuse to any rental property? ____________________________________
7. Have you ever been convicted of a crime other than a MOTOR VEHICLE VIOLATION? _____________________
If yes explain: ___________________________________________________________________________________
8. Emergency Contact Name: ________________________________________Phone:____________________________
Address: ______________________________________________________ Relationship: ______________________
EMPLOYMENT INFORMATION FOR ALL ADULT HOUSEHOLD MEMBERS
(Please provide employment information for each working adult in the household)
Applicant:
Employer Name/Address
Phone:
Type of Business
Fax:
Position/Title
Hourly
Salaried
Temporary
Permanent
Self Employed?
part-time
$ @@@@@@@@@@@@
full time
@@@@@@@@@@@@
seasonal
$
@@@@@@@@@@@@
Years on the Job
hourly salary
hourVSHUZHHN
RYHUWLPHERQXVHV
FRPPLVVLRQVSHUZHHN
Years in line of work
annual gross income
$
Co-Applicant:
Employer Name/Address
Phone:
Type of Business
Fax:
Position/Title
Hourly
Salaried
Temporary
Permanent
Self Employed?
part-time
full time
seasonal
$
@@@@@@@@@@@@
@@@@@@@@@@@@
$ @@@@@@@@@@@@
2
Years on the Job
Years in line of work
hourly salary
hourVSHUZHHN RYHUWLPHERQXVHV
FRPPLVVLRQVSHUZHHN
annual gross income
$
Resident acknowledges that rent is restricted by a Low-Income Housing Covenant. Resident expressly agrees that Owner
may adjust the rent at the time of lease renewal by giving Resident signed written notice of the adjustment, provided,
however, that said adjustment shall not exceed the maximum rent permitted by the Covenant or by Section 42 of the
Internal Revenue Code as determined by reference to the most recent survey of Area Median Income for Boulder County
Colorado published annually (usually between March and May) by the United States Department of Housing and Urban
Development (HUD).
AFFORDABLE HOUSING PROVISION
A.
B.
Resident certifies the accuracy of the information provided by Resident in connection with Resident’s application
for this Rent-Restricted Unit, including but not limited to Resident’s annual income.
Resident acknowledges that full and accurate disclosure of Resident’s annual income and other relevant
information pertaining to Resident’s eligibility for rent restricted housing is a substantial and material condition of
Resident’s tenancy. Resident promises to promptly complete and return to Owner such forms from the Colorado
Housing and Finance Authority (CHFA) “Low-income Housing Tax Credit Program Compliance Manual,” (the
“Manual”) as Owner may from time to time request. Failure to promptly complete and return said forms shall be
deemed a substantial and material violation of this Rental Agreement and shall constitute cause for immediate
termination.
The information provided above is true and complete to the best of my/our knowledge and belief. I/we consent to the
disclosure of criminal, credit, landlord, income and financial information from my/our employer and financial reference
for purposes of income and asset verification related to my/our application for tenancy.
Applicant Signature: ________________________________________________
Date: _____________________
Applicant Signature: ________________________________________________
Date: _____________________
3
Exhibit E
AFFIDAVIT OF LEGAL RESIDENCY
I, ________________________________________, swear or affirm under penalty of
perjury under the laws of the State of Colorado that (check one):
____ I am a United States citizen, or
____ I am a Permanent Resident of the United States, or
____ I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for
a public benefit or I am a sole proprietor entering into a contract or purchase order
with the State of Colorado. I understand that state law requires me to provide proof
that I am lawfully present in the United States prior to receipt of this public benefit
or prior to entering into a contract with the State. I further acknowledge that
making a false, fictitious, or fraudulent statement or representation in this sworn
affidavit is punishable under the criminal laws of Colorado as perjury in the second
degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate
criminal offense each time a public benefit is fraudulently received.
__________________________________
Signature
______________________________
Date
__________________________________
Name (Please Print)
______________________________
Exhibit E
AFFIDAVIT OF LEGAL RESIDENCY
I, ________________________________________, swear or affirm under penalty of
perjury under the laws of the State of Colorado that (check one):
____ I am a United States citizen, or
____ I am a Permanent Resident of the United States, or
____ I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I have applied for
a public benefit or I am a sole proprietor entering into a contract or purchase order
with the State of Colorado. I understand that state law requires me to provide proof
that I am lawfully present in the United States prior to receipt of this public benefit
or prior to entering into a contract with the State. I further acknowledge that
making a false, fictitious, or fraudulent statement or representation in this sworn
affidavit is punishable under the criminal laws of Colorado as perjury in the second
degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate
criminal offense each time a public benefit is fraudulently received.
__________________________________
Signature
______________________________
Date
__________________________________
Name (Please Print)
______________________________
certiﬁcation questionnaire
for applicants and recertifying residents
Head of Household Name
Unit Number
The information on this form is needed to certify/recertify your household. Please complete this entire form and leave no blanks. If
there are any questions that you do not understand, please call the apartment manager. Thank you for your cooperation.
part 1 household composition
hh
member
full name
relationship to head of
household (hoh)
1
date of birth
HoH
2
3
4
5
6
student? (includes
grades k-12)
Yes
Yes
Yes
Yes
Yes
Yes

Do you expect any additions to the household within the next 12 months? (check one) If yes, please explain:
No
No
No
No
No
No
if a student: full-time
(ft) or part-time (pt)?
FT
FT
FT
FT
FT
FT

Yes

PT
PT
PT
PT
PT
PT
No
part 2 tenant income
monthly income/
assistance amount
does your household have income, assistance, or beneﬁts from the sources listed below?
Self employment (list nature of self employment)
Yes

No
hh
member #
(use net income from
business)
$
Yes

No
Employment with a third-party receiving wages, salary, overtime pay, commissions,
fees, tips, bonuses, and/or other compensation.If yes, list the information in Part 3
below.
Yes

No
Cash contributions or gifts (including rent or utility payments) received on an ongoing
basis from persons not living with you (exclude food stamps, groceries, and/or day
care costs when the day care center is paid directly by the gift-giver)
$
Yes
Yes

No
Unemployment beneﬁts
$
No
Veteran’s Administration, GI Bill, or National Guard/military beneﬁts/income
$
Educational assistance (for full and part time students) in the forms of grants,
scholarships, or fellowships (exclude student loan awards which must be repaid)
$
Yes

No
Yes
Yes

No
Retirement beneﬁts from Social Security
$
No
Supplemental Security Income (SSI) or Social Security Disability Income (SSDI)
$
Yes

No
Unearned income from family members age 17 or under (example: Social Security,
trust fund disbursements, etc.)
$
Yes
Yes

No
Disability or death beneﬁts other than Social Security
$
No
Public housing assistance/Rental assistance/Section 8 voucher. Housing authority
providing the assistance:
$
Yes
Yes

No
I/we receive public assistance income (example: TANF)
$
No
Child support payments. If yes, for how many children do you receive support?

No
I am entitled to receive child support payments and am currently making efforts to
collect child support owed to us. Describe efforts being made to collect child support:
Yes
Anticipated Amount:
$
07/12.v2
Yes

No
Alimony/spousal support payments
$
Periodic payments from trusts, annuities, inheritance, retirement funds or pensions,
insurance policies or lottery winnings. If yes, list sources:
Yes

No
$
1.
$
2.
Yes

(use net earned income)
No
Income from real or personal property
$
part 3 current employment information (please attach a separate form for additional employment, if needed)
Resident Name
Occupation/Title
Employer Name
Contact Person
Employer Address
City
Date Hired
Salary/Rate of Pay
$
2x a month
Monthly
Hourly

Weekly
Biweekly
State
Zip Code
# Hours Worked
Per Week
Work Phone
Work Fax
Annually
Resident Name
Occupation/Title
Employer Name
Contact Person
Employer Address
City
Date Hired
Salary/Rate of Pay
$
2x a month
Monthly
Hourly

Weekly
Biweekly
Annually
State
Zip Code
# Hours Worked
Per Week
Work Phone
Work Fax
part 4 previous employment information (not required for retired persons)
Resident Name
Occupation/Title
Employer Name
Contact Person
Employer Address
City
Date Hired
State
Ending
Salary/
Rate of Pay
$
Zip Code
2x a month

Weekly
Monthly

Biweekly
Hourly

Annually
Termination
Date
Resident Name
Occupation/Title
Employer Name
Contact Person
Work Phone
Work Fax
Employer Address
City
Date Hired
State
Ending Salary/
Rate of Pay
$
2x a month

Weekly
Monthly

Biweekly
Hourly

Annually
Zip Code
Termination
Date
Work Phone
Work Fax
part 5 student status certiﬁcation
Students include individuals attending public or private elementary schools, middle or junior high schools, senior high schools, colleges,
universities, technical, trade or mechanical schools. Students do not include individuals participating in on-the-job training or
correspondence courses.
section 1 please mark the box below if it correctly describes your individual status
I am not currently a full time student, and I have not been, and will not be a full time student for ﬁve months or more out of the
current calendar year (months need not be consecutive).
section 2 please choose one option below that best describes your household

The household contains no occupants who are students (full time or part time).

The household contains at least one occupant who is not a student and has not been and will not be a student for ﬁve months or more out
of the current calendar year (months need not be consecutive). Please list the names of the occupants who are not students:

The household contains all students, but is qualiﬁed because at least one occupant is a part time student. Veriﬁcation of part time student
status is required. Please list the names of all part time students:

The 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). Please answer all five questions below.
yes
no
Are the students married and entitled to file a joint tax return? (attach an affidavit or tax return)

Is at least one student a single parent with child(ren), and this parent is not a dependent of someone else, and the child(ren) is/are not
dependent(s) of someone other than the parent(s)?

Is at least one student receiving Temporary Assistance to Needy Families (TANF)?

Does at least one student participate in a program receiving assistance under the Job Training Partnership Act, Workforce Investment
Act, or under other similar federal, state, or local laws? (attach veriﬁcation of participation)

Does the household consist of at least one student who was previously under foster care? (provide veriﬁcation of participation)

part 6 asset information certification questionnaire
do you have assets as listed below?
hh
mbr #
account #(s)
interest
rate
cash value
Checking account(s). If yes, list bank(s).
Yes
No
1.
2.
% $
% $
Savings account(s). If yes, list bank(s).
Yes
% $
No
1.
% $
2.
Revocable trust(s). If yes, list bank or trustee name.
Yes
% $
No
1.
% $
2.
Yes
No
Yes
No
I/we own real estate (or hold a mortgage or Deed of Trust). If yes,
provide description.
$
Personal property that is being held as an investment. If yes, describe:
% $
Stocks, bonds, or Treasury bills. If yes, list sources/bank name(s).
Yes
% $
No
1.
% $
2.
Certificate(s) of Deposit (CD) or Money Market account(s). If yes, list
source(s)/bank name(s).
Yes
No
1.
% $
% $
2.
IRA/Lump Sum Pension/Keogh Account/401k. If yes, list bank(s).
Yes
% $
No
1.
% $
2.
I/we have a life insurance policy (exclude term policies). If yes, list
company.
Yes
No
1.
% $
% $
2.
Yes
No
I/we have cash on hand or cash in a safe deposit box.
% $
hh
mbr #
do you have assets as listed below?
account #(s)
interest
rate
cash value
I/we have disposed of assets (i.e., gave away money/assets) for less than
the fair market value in the past two years. If yes, list items and date
disposed.
Yes
$
No
$
I/we have income from assets or sources other than those listed above.
If yes, list type below.
Yes
No
% $
signatures
Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my/our
knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False,
misleading, or incomplete information will result in the denial of application or termination of the lease agreement.
Print Name of Resident
Signature
Date
Print Name of Resident
Signature
Date
Print Name of Other Adult Household Member
Signature
Date
Print Name of Other Adult Household Member
Signature
Date
Reviewed by (Signature of Owner/Representative)
All household members ages 18 or over must sign and date.
Date
EMPLOYMENT VERIFICATION
THIS SECTION TO BE COMPLETED BY MANAGEMENT AND EXECUTED BY RESIDENT
TO:
(Name & address of employer)
Date: ___________________________
Supervisor Name
Fax Number
RE:
Applicant/Tenant Name
Unit # (if assigned)
I hereby authorize release of my employment information.
Signature of Applicant/Tenant
Date
The individual named directly above is an applicant/resident of the federal Housing Tax Credit Program. Federal regulations (IRS Code Section 42)
require that we must verify income in order to determine that the anticipated gross income for the next twelve months may be calculated. The
information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated.
RETURN TO: LUMINE & LEDGES LEASING OFFICE
5620 ARAPAHOE AVE #212, BOULDER, CO 80303
PHONE: 303-728-9358 FAX: 720-565-0359
THIS SECTION TO BE COMPLETED BY EMPLOYER
Please complete all blanks – if question does not apply please indicate by “n/a”
Employee Name:
Presently Employed:
Job Title:
Yes
Date First Employed
Current Wages/Salary: $
Payment Frequency:
(circle one)
(circle one)
weekly
Last Day of Employment
hourly/annually
bi-weekly
Number of regular hours per week:
Overtime Rate: $
No
semi-monthly
monthly
annually
other
Year-to-date earnings: $
per hour
Shift Differential Rate: $
Commissions, bonuses, tips, other: $
through
/
/
Number of overtime hours per week:
(must be a numerical value)
per hour
# of shift differential hours per week:
(circle one)
hourly
weekly
bi-weekly
List any anticipated change in the employee's rate of pay within the next 12 months:
semi-monthly
monthly
yearly
other
; Effective date:
If the employee's work is seasonal or sporadic, please indicate the layoff period(s):
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.
Landlord Reference Inquiry
PLEASE SIGN AND COMPLETE TOP PORTION AND RETURN TO PROPERTY MANANGEMENT OFFICE
I hereby authorize the release of information related to my residency as requested below. Having applied for
a rental unit with Thistle Communities, I understand that this information will be used to determine my
eligibility.
_______________________________________
___________________________________________
Applicant Print Name
Co-Applicant Print Name
_______________________________________
___________________________________________
Signature
Signature
Name of Rental or Mortgage Company: ____________________________________________________
Landlord Name: _____________________________
Phone number: ___________________________
Dates of Residency: from __________to__________
Fax number:______________________________
Address of Residency: __________________________________________________________________
FOR OFFICE USE ONLY: Do not write below this line
HISTORY:
1. Dates of residency? From: ______________ To: _________________
2. If current tenant, what is the dates of the lease? From: ______________ To: _________________
3. Is / was there anyone else on the lease not listed above?_____________ if yes who?__________________
4. Does / did the resident have a pet(s)? _______ If so how many and what type: ______________________
5. Was there any problems with the pet (s)? _______ If yes please explain: ___________________________
PAYMENTS:
1. How much is/was their rent? __________________
2. Was rent paid in a timely manner? Yes: ______________ No: _________________
3. When is / was the rent due? ______________ When is / was the rent late? _________________
4. Total number of late rent payments? _____________
Number of late payments in the last 6 months ________ 12 months _________ 24 months _________
5. What was the total number of NSF checks? _______________
Number of NSF in the last 6 months ________ 12 months _________ 24 months ______________
6. Is there any money owed at this time for current or past resident? ____________
Reason for money owed? ________________________________________________________________
7. If past resident was the security deposit refunded completely? _______________
If not what amount did you keep & why? __________________________________________________
CONDITION OF THE UNIT:
1. Does/ did the resident keep the unit clean? ___________________________________________________
2. Did the resident damage the unit? _________ If yes please explain: _______________________________
_______________________________________________________________________________________
GENERAL INFORMATION:
1. Would you rent to them again? _______ If no why? ___________________________________________
2. Was the resident asked to leave? ________ If yes please explain: _________________________________
2. During their residency were there any lease violations or 3 day demand for possession or compliance
issued? __________ If yes please explain: _____________________________________________________
3. Was / is the applicant under eviction for any reason? ______ If yes please explain: ___________________
4. Did they let anyone live there that was not on the lease? _______ Who? _________________________
5. Were there any issues concerning noise? _______ If yes please explain: ___________________________
6. Was / has proper notice been given to vacate? _________ What notice is required? __________________
Signed:
___________
Date:
Thank you for your time!
Please return to: Lumine & Ledges Leasing Office
5620 Arapahoe Avenue, Boulder, CO 80303
Phone: 303-728-9358 Fax: 720-565-0359
resident statement of assets
Instructions: Please complete both Sections 1 and 2. All adults, except married couples, must complete separate forms. Include any assets you own or co-own.
Assets include, but are not limited to, checking or savings accounts, real estate, stocks, bonds, and retirement accounts.
Resident Name
Unit Number
section 1 please choose one of the following
I/We do not have any assets at this time.
I/We have assets. My/our assets are listed below. [Please note: Certain funds (e.g., retirement, pensions, trusts) may or may not be
fully accessible to you. Include only those amounts which are accessible.]
(a) cash
value*
source
(a x b)
annual
income
(b) interest
rate
(a) cash
value*
source
$
(a x b)
annual
income
(b) interest
rate
Savings Account
$
%
$
Checking Account
%
$
Cash On Hand
$
%
$
Safety Deposit Box
$
%
$
Certificates of Deposit
$
%
$
Money Market Funds
$
%
$
Stocks
$
%
$
Bonds
$
%
$
IRA Accounts
$
%
$
401k Accounts
$
%
$
Keogh Accounts
$
%
$
Trust Funds
$
%
$
Equity in Real Estate
$
%
$
Land Contracts
$
%
$
Lump Sum Receipts
$
%
$
Capital Investments
$
%
$
Value of Life Insurance Policies (excluding Term Life)*
$
Additional Retirement/Pension Funds (not named above)*
$
Value of Personal Property Held for Investment
$
Other Assets (not included above)
$
* Cash value is defined as market value less the cost of converting the asset to cash. Costs may include broker’s fees, settlement costs,
outstanding loans, early withdrawal penalties, etc.
** Personal property held for investment purposes may include, but is not limited to, gem or coin collections, art, or antique cars. Do not
include items such as household furniture, daily-use autos, clothing, active business assets, or special equipment for use by the disabled.
section 2 you must choose one of the following
Within the past two years, I/we have sold or given away assets (including cash, real estate, etc.) for more than $1,000 below their
fair market value (FMV). These assets are included above and are equal to a total of $
asset equals the difference between FMV and the amount actually received for the asset).
(the value to include for each
I/We have not sold or given away assets (including cash, real estate, etc.) for less than the fair market value during the past two
years.
Under penalty of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/
our 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.
Applicant/Resident Signature
Date
Applicant/Resident Signature
Date
02/12.v2
Smoke-Free Lease Addendum: Ledges on 29th Street
Resident and all members of Resident’s family or household are parties to a written lease with Landlord
(the Lease). This Addendum states the following additional terms, conditions and rules which are hereby
incorporated into the Lease.
A breach of this Lease Addendum shall give each party all the rights contained herein, as well as the
rights in the Lease.
1. Purpose of Smoke-Free Policy. The parties desire to mitigate (i) the irritation and known
health effects of secondhand smoke; (ii) the increased maintenance, cleaning and
redecorating costs from smoking; (iii) the increased risk of fire from smoking; and (iv) the
higher costs of fire insurance for a non-smoke-free building.
2. Definition of Smoking. The term “smoking” means inhaling, exhaling, breathing, or carrying
any lighted cigar, cigarette, or other tobacco product or similar lighted product in any manner
or in any form.
3. Smoke-Free Complex. Resident agrees and acknowledges that the premises to be occupied
by Resident and members of Resident’s household have been designated as smoke-free.
Resident and members of Resident’s household shall not smoke anywhere in the unit rented
by Resident, or the building where the Resident’s dwelling is located, or in any of the common
areas or adjoining grounds of such building or other parts of the rental community, nor shall
Resident permit any guests or visitors under the control of Resident to do so.
4. Resident to Promote Smoke-Free Policy. Resident shall inform Resident’s guests of the
Smoke-Free Policy.
5. Resident to Alert Landlord of Violations Smoke-Free Policy. Resident shall promptly give
Landlord a written statement of any incident where tobacco smoke is migrating into the
Resident’s unit from sources outside of the Resident’s apartment unit.
6. Landlord to Promote Smoke-Free Policy. Landlord shall post no-smoking signs at entrances
and exits, or internal hallways. Smoking is only allowed on the property in designated posted
smoking areas.
7. Landlord Not a Guarantor of Smoke-Free Environment. Resident acknowledges that
Landlord’s adoption of a smoke-free living environment, and the efforts to designate the rental
complex as smoke-free, do not make the Landlord or any of its managing agents the guarantor
of Resident’s health or of the smoke-free condition of the Resident’s unit and the common
areas.
Phone: 303.728.9358 Fax: 303.682.8814
8. Landlord to Take Reasonable Steps to Enforce Smoke-Free Policy. Landlord shall take
reasonable steps to enforce the smoke-free terms of its leases. Landlord is not required to take
steps in response to smoking unless Landlord knows of said smoking.
9. Effect of Breach and Right to Terminate Lease. A breach of this Lease Addendum shall
give Landlord all the rights contained herein, as well as the rights in the Lease. A material
breach of this Addendum shall be a material breach of the lease and grounds for termination of
the Lease by the Landlord.
10. Disclaimer by Landlord. Resident acknowledges that Landlord’s adoption of a smoke-free
living environment, and the efforts to designate the rental complex as smoke-free does not in
any way change the standard of care that the Landlord or managing agent would have to a
Resident household to render buildings and premises designated as smoke-free any safer,
more habitable, or improved in terms of air quality standards than any other rental premises.
Landlord specifically disclaims any implied or express warranties that the building, common
areas, or Resident’s premises will have any higher or improve air quality standards than any
other rental property. Landlord cannot and does not warranty or promise that the rental
premises or common areas will be free from secondhand smoke. Resident acknowledges that
Landlord’s ability to police, monitor, or enforce the agreements of this Addendum is dependent
in significant part on voluntary compliance by Resident and Resident’s guests. Residents with
respiratory ailments, allergies, or any other physical or mental condition relating to smoke are
put on notice that Landlord does not assume any higher duty of care to enforce this Addendum
than any other landlord obligation under the Lease.
11. Effect on Current Residents. Resident acknowledges that current Residents residing in the
complex under a prior lease will not be immediately subject to the Smoke-Free Policy until and
unless that current Resident consents in writing to the Smoke-Free Policy. As current
Residents renew their lease, the Smoke-Free Policy will become effective for their unit.
Dated this __________________ day of _______________________, 201__.
_______________________________________________
Thistle Communities
__________________________________________________
Resident
_____________________________________________
Resident
Phone: 303.728.9358 Fax: 303.682.8814
certification of student status
Resident Name
Unit Number
Students include individuals attending public or private elementary schools, middle or junior high schools, senior high schools, colleges,
universities, technical, trade or mechanical schools. Students do not include individuals participating in on-the-job training or
correspondence courses.
section 1 please mark the box below if it correctly describes your individual status
I am not currently a full time student, and I have not been, and will not be a full time student for five months or more out of the
current calendar year (months need not be consecutive).
section 2 please choose one option below that best describes your household

The household contains no occupants who are students (full time or part time).

The household contains at least one occupant who is not a student and has not been and will not be a student for ﬁve months or more out of
the current calendar year (months need not be consecutive). Please list the names of the occupants who are not students:

The household contains all students, but is qualiﬁed because at least one occupant is a part time student. Veriﬁcation of part time student status
is required. Please list the names of all part time students:

The 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). Please answer all five questions below.
yes
no
Are the students married and entitled to file a joint tax return? (attach an affidavit or tax return)

Is at least one student a single parent with child(ren), and this parent is not a dependent of someone else, and the child(ren) is/are not
dependent(s) of someone other than the parent(s)?

Is at least one student receiving Temporary Assistance to Needy Families (TANF)?

Does at least one student participate in a program receiving assistance under the Job Training Partnership Act, Workforce Investment Act, or
under other similar federal, state, or local laws? (attach veriﬁcation of participation)

Does the household consist of at least one student who was previously under foster care? (provide veriﬁcation of participation)

signatures
Under penalties of perjury, I/we certify that the information presented in this 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. I/we understand
that providing false representations constitutes an act of fraud. False, misleading, or incomplete information may result in the termination
of the lease agreement.
A separate form must be signed by each household member age 18 or older.
Resident Signature
Date
07/12.v4