Willingboro Township Affordable Townhomes Application

Name:

Current Address:      City      State      Zip Code

Mailing Address, if different from above:

Home Phone:         Cell Phone:         E-mail:

Number of Bedrooms? One Two Three                            Do you require a handicap accessible home? Yes No

HOUSEHOLD COMPOSITION
List ALL sources of income, including, but not limited to salary, dividends, social security, child support, alimony and pensions, for everyone who will occupy the unit.
Full Name (First & Last) Relationship Date of Birth Sex Annual Income
1. Head of Household $
2. $
3. $
4. $
5. $
TOTAL $

Do you currently receive rental assistance? Yes No

I certify that the information submitted in this application is true and complete to the best of my knowledge and belief and that any misrepresentation of income or household size herein shall be cause for program disqualification.  In submitting this application  I understand that this information is to be used only for determining my eligibility for referral to an affordable housing unit and does not obligate me in any way.  Triad Associates shall not release any information gathered during this process to any third party without your consent. 

I have read and agree with the terms above.

Date