Please Note: Admission requirements state that mobile home must be 1980 or newer.

NOTE: This application will not be processed until all information requested has been completed and/or submitted.

I/We hereby affirm that the foregoing information is true and complete to the best of my/our knowledge, and authorize the Landlord to make inquiries to verify the statements herein. I/we further understand that any intentional misrepresentation in this application might result in default in the rental agreement and/or eviction of this household.

If any of the aforementioned information changes, I/we agree to notify landlord immediately.

All household members age 18 or older sign below:

I/We have applied or are currently residing in a unit under the management of the Salish & Kootenai Housing Authority (hereinafter SKHA) Low Income Housing Tax Credit and Rural Development 515 housing programs. As part of the certification process SKHA may need to verify information contained in my/our rental application or file update and in other documents that are required.

I/We authorize you to provide SKHA, all information and documentation that they request. Such information includes, BUT IS NOT LIMITED TO, employment history, any source of income; bank, money markets, and similar account balances, credit history, copies of income tax returns, criminal background checks, student status, educational costs and financial aid.

This authorization also includes any minor children of the above named individuals.

Please print your full legal name and list your Social Security Number:

Your prompt reply to SKHA is appreciated. Furthermore I/We grant SKHA permission to release information necessary in assisting me in obtaining other services for which I/We may be eligible.