Neighbors of Watertown Rental Application

BYNOW MANAGEMENT, LLC
112 FRANKLIN STREET, WATERTOWN, NY 13601
Tel: (315) 782-8497

Checklist - Required Information to Submit With Your Application You Can Not Go On a Property Waiting List Until All Information Has Been Processed

*Your income and sources must be verified for property eligibility

1) Current and/or anticipated income sources.
As example(s) social services (welfare) benefit, social security or supplemental (SSI) income, retirement or pensions, award letters-verification of any and all income sources (i.e. employments, unemployment, if you are self-employed the year end income tax and/or self-employed statements, child support/custody verification, alimony agreements, or cash assistance for any source)

2) Name of ALL Banks you have accounts with.

3) Current information on all assets (i.e. property owner, business operations, and/or equipment).

4) Stock certificates, bonds, quarterly statement from your investment broker.

5) Copies of all insurance policies (i.e. life insurance policies with their cash surrender value: please have your insurance agents name, address, telephone number to verify policies and their cash value).

6) Addresses and phone number for all providers or caseworkers (i.e. assistance of benefit programs (i.e. social services (welfare); CAPC, CREDO, probation Dept., any other information relative to case management)

7) Proof of all household members to include identifications, social security numbers and birth certificates.

8) Out of pocket medical expenses in the last year: Includes receipts, RX copays, insurance, eyeglasses, office visit copays, etc. (Please note this is a HUD requirement only for people applying to our Bugbee, Centennial, or Henry Keep Apartments. It only applies if the head, spouse or co-head is 62 years or older or is disabled).

9) Most recent tax returns.

10 Form 4506-c: Request for Transcript of Tax Return. Download from IRS Here

** All required documents must be submitted within 10 business days.

Documents can be scanned and emailed to This email address is being protected from spambots. You need JavaScript enabled to view it., or dropped off at our office. 112 Franklin St., Watertown, weekdays from 8 am - 4 pm.

Download Required Documents list as PDF.

Applicant

First Name *

Last Name *

SS # *

Marital Status *

Single, Married, Separated, etc.

Date of Birth *

Full Time Student *

Yes

Address *

Address Line 2

City *

State *

Zip *

Primary Phone # *

Email Address *

Additional Household Members

Add household members? *

Yes

First name

Last Name

Relationship

Date of Birth

Full Time Student

Yes

Add household member?

First name

Last Name

Relationship

Date of Birth

Full Time Student

Yes

Add household member?

First name

Last Name

Relationship

Date of Birth

Full Time Student

Yes

Add household member?

First name

Last Name

Relationship

Date of Birth

Full Time Student

Yes

Add household member?

First name

Last Name

Relationship

Date of Birth

Full Time Student

Yes

Income Source for all household members

You are required to enter at least one source of income into the boxes below. You may add more than one income source by clicking the add more checkbox, but this is optional.

Add Income Source *

Yes

Frequency

Income Source

Gross Amount (Before Deductions)

Add additional Income Source

Yes

Frequency

Income Source

Gross Amount (Before Deductions)

Have you ever participated in a rental subsidy program? *

Yes

If so, what Agency?

HUD, HAP, DSS, etc.

Were you 62 or older as of Jan 31, 2010 and did not have a SSN? *

Yes

If Yes, did you recieve HUD assistance at another project on Jan 31, 2010? *

Yes

Have you ever rented from Neighbors of Watertown in the past? *

Yes

If so, when and where?

Optional Information Requested: "The information regarding race, national origin, and sex designation solicited on this application is requested in order to assure the Federal government that federal laws prohibiting discrimination against tenant applications on the basis of race, color, national origin, religion, sex, familial status, age, and handicap are complied with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race/ethnicity and sex of individual applicants based on visual observation and/or surname."

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

Race

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White

Does your household meet the definition of homeless? (Family lacks a fixed regular and adequate night time residence, or has a primary night time residence that is a supervised publicly or privately operated shelter designed to provide temporary living accommodations such as welfare voucher hotels, congregate shelters or transitional housing designed for homeless persons, or a public or private place not designed for, or ordinarily used as a regular sleeping accommodation for human beings) *

Yes

If Yes, a Homeless Verification Form MUST be included with your application. Download here.

Have you or anyone in your household ever been arrested, charged or convicted of any crime? *

Yes

Please Explain

Date of last arrest, charge or conviction

Are you or any member of the household subject to a lifetime sex offender registration? *

Yes

If yes, what state(s)?

Building/Property Desired

# of bedrooms

Date of occupancy you are interested in?

Month

Day

Year

Do you have any pets? *

Yes

What type of pets do you have?

*MOST OF OUR PROPERTIES ARE ONLY APPROVED FOR SERVICE ANIMALS. VET PAPERS REQUIRED PRIOR TO MOVE-IN.

Would you be interested in our apartments in Philadelphia, NY *

Yes

Do you have any out-of-pocket medical expenses? *

Yes

Do you have needs that would require special accomodations? *

Hearing Impaired Unit

Visually Impaired Unit

Wheelchair Accessible Unit

None

Are you mobility impaired? (Will have to be verified by a medical professional) *

Yes

Name of Medical Professional

Rental History

Please List all states in which you have lived *

Current Living Situation

Present Address *

Length of time at this address *

Date Rented *

Date Moved

Amount of Rent (dollars) *

Utilities Included? *

Yes

Landlord Name

Phone

Landlord Address

Reason for moving

Previous Living Situations

Previous Address

Length of time at this address

Date Rented

Date Moved

Amount of Rent (dollars)

Utilities Included?

Yes

Landlord Name

Phone

Landlord Address

Reason for Moving

Add a Previous Address? *

Yes

Previous Address

Length of time at this address

Date Rented

Date Moved

Amount of Rent (dollars)

Utilities Included?

Yes

Landlord Name

Phone

Landlord Address

Reason for Moving

Name of Nearest Relative

Relative that lives closest to the Watertown area, and is not in the household.

Relation

Address

Phone

Were you referred by someone? *

Yes

Name of Referrer

How did you hear about us?

The undersigned hereby certifies that the above information is true and correct to the best of my/our knowledge and belief. I/we give Neighbors of Watertown authorization to check landlord and character references, mobility impairment and other sources as necessary to do credit and/or criminal history checks as required. I/We understand and agree that if I/we have been found to have willfully made mistruths or omissions on this application then I/we will no longer be considered for an apartment.

Signature required for all household members age 18 and above:

Applicant Signature *

Date *

Please Sign

Date

Please Sign

Date

Please Sign

Date

Please Sign

Date

Was this application completed by someone not listed as a member of the applicant household? *

Yes

Please Complete:

Name

Signature

Date