WINNIPEG RIVER APPLICATION FORM

WINNIPEG RIVER LIONS MANOR INC.

Application for RENT-GEARED-TO-INCOME ONLY

(LIFE LEASE residents should not fill out this application)

27 Laura Street

Powerview, Manitoba

A Seniors Life Lease Project. - Developed by ACORN Managed by MURDOCH

I/We _______________________________________________________, hereby make an application for subsidized housing in the Winnipeg River Lions Manor Inc. Housing Project located at 27 Laura Street, Powerview, Manitoba. I/We understand that acceptance into this Housing Project is subject to my/our eligibility, the approval of the Board of Directors and the availability of accommodation.

I/We understand that there is a requirement for a Damage Deposit.

A CERTIFIED COPY of the last INCOME TAX RETURN form for ALL potential occupants of the suite is required to be submitted along with this completed application.

I/We agree to complete the Housing Corporation's Housing Occupancy Agreement, and to comply with the Corporation's Rules and Regulations for residents of the Housing Project.

By signing this application I/We provide My/Our consent to the securing of any information, or documents from any source which may be deemed necessary to assess My/Our eligibility.

Signature of Applicant:	Date:
Signature of Co-Applicant:	Date:

Answering all of these questions to the best of your ability will assist us in determining your eligibility for housing. All information will be held in the strictest of confidence.

PERSONAL

Applicant Name:				S.I.N.#
Date of Birth:			Home Phone: Work Phone:
Apt/St No.	Street Name:
City		Province:			Post Code:
Co-Applicant Name:				Co-Applicant S.I.N.#
Date of Birth:			Home Phone: Work Phone:
Apt/St No.	Street Name:
City		Province:			Post Code:

PREVIOUS LANDLORD

1) How long have you resided at the above address?	2) Are you Canadian Citizen? Yes or No
3) What is your current Rent/Month: ______________________________________	4) If you are a renter, what is your CURRENT Landlord/Agent's Phone: _________________
5) and your CURRENT Landlord/Agent's Address: ______________________________ ______________________________________	6) What was your PREVIOUS Address: ______________________________________ ______________________________________

HOUSEHOLD AND DEPENDENTS

Please list all of the people in your household who will reside with your. (PLEASE PRINT).
Surname	Given Name	Relationship to applicant	Date of Birth

ACCOMMODATION REQUIRED.

1 Bedroom_____	2 Bedrooms (not available for subsidized renters)
Parking Required Yes or No ______	Number of Stalls ______
Vehicle Make __________	Year ____________
Desired Date of Occupancy _______________

FINANCIAL INFORMATION:

Employed Yes/No _____		Full Time____ Part Time____
Employer Name_________________________________________________________________
Retired Yes/No _______	Other (Please specify) ____________________________________
Gross Household Annual Income from all sources before deductions (Including all household members' income): $____________/Year (Before Deductions)
Sources of income (annual): (Circle Applicable Sources)
A. Employment (Including self-employment)		B. Unemployment Insurance
C. Workers Compensation		D. Provincial Social Allowance
E. Municipal Social Assistance		F. Student Assistance/Allowance
G. Maintenance/Alimony Payments		H. Old Age Security
I. Guaranteed Income Supplement (GIS)		J. 55 Plus
K. Canada Pension Plan		L. Veteran Allowance and Income Supplement
M. Private Retirement Pension		N. Interest Income From Savings, Investments, Canada Savings Bonds
O. Other_______________________________________________________________________
If receiving social assistance:
Worker's Name ________________________		Worker's Phone ___________________
Contact Revenue Canada @ 983-6530 to obtain a CERTIFIED COPY OF YOUR INCOME TAX RETURN If employed, you are required to supply your last three months payroll stubs.

REFERENCES (Please list two)

(1) Name: __________________________	Address: ___________________________
(1) Telephone: ______________________	Relationship: ________________________
(2) Name: __________________________	Address: ___________________________
(2) Telephone: ______________________	Relationship: ________________________

OTHER INFORMATION PERTINENT TO THIS APPLICATION (I.E. Special Needs)

FOR OFFICE USE ONLY

References Checked By:	Date:
Interview Performed By:	Date:
Application Recommended By:
Management:	Date:
Membership Committee Chair:	Date:
Approved by the Board of Directors at a meeting of the Board held on:
(Signing Officer)	Date:

Please Return This Completed Application To Our Property Management Office by E-Mail to: info@lifelease.ca or Canada Post to:

WINNIPEG RIVER LIONS MANOR INC.

C/O MURDOCH MANAGEMENT INC.

757 HENDERSON HIGHWAY

WINNIPEG, MANITOBA

R2K 2K7

PLEASE CALL 982-2000 IF YOU HAVE ANY QUESTIONS - THANK-YOU

VISIT OUR LIFE LEASE PROJECTS FOR DETAILS ON BENEFITS, FINANCING AND ACCOMMODATION

	VILLA BELIVEAU	VIC WYATT HOUSE
	SOUTHWARD VILLA	ST. VITAL KNIGHTS VILLA
	ST. MICHAEL'S VILLA	WINNIPEG RIVER MANOR

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