APPLICATION FOR B'NAI B'RITH PARKVIEW APARTMENTS
A PROJECT OF GIDEON LODGE NO. 140, B'NAI B'RITH HOUSING DEVELOPMENT FUND COMPANY, INC.
Name_________________________________________________________
Address________________________________________________________
City: _______________________ State: _________ Zip: ________________
Telephone number: _____________________________
Male [ ] Female: [ ]
Birth Date: _______________________
Social Security Number: _________________________________________
Are you:
Single: [ ] Married [ ] Widowed [ ] Divorced [ ] Separated [ ]
Do you own an automobile? Yes [ ] No [ ]
License number: ______________________________________
IF APPLICATION IS FOR TWO PEOPLE - SECOND APPLICANT INFORMATION
Name_________________________________________________________
Address________________________________________________________
City: _______________________ State: _________ Zip: ________________
Telephone number: _____________________________
Male [ ] Female: [ ]
Birth Date: _______________________
Social Security Number: _________________________________________
Are you:
Single: [ ] Married [ ] Widowed [ ] Divorced [ ] Separated [ ]
Relationship to first applicant: _____________________________________
Do you own an automobile? Yes [ ] No [ ]
License number: ______________________________________
List Sources of Income in Annual Amounts
Applicant 1
Social Security
Savings Interest
Checking Interest
Pension
Dividend Interest
Employment
Other(specify)
Applicant 2
Social Security
Savings Interest
Checking Interest
Pension
Dividend Interest
Employment
Other(specify)
Names and Addresses of Responsible Relatives or Friends
Name:
Address:
Phone:
Relationship:
Name:
Address:
Phone:
Relationship:
Name:
Address:
Phone:
Relationship:
Check Apartment Preference (Check both if you would consider either):
Studio [ ] One Bedroom [ ] Large One Bedroom, two baths [ ]
Please indicate if you are handicapped and the nature of your handicap:________________________________________________________________
I (WE) UNDERSTAND THAN UPON FILING OF THIS APPLICATI0N, IT WILL BE ACTED UPON THE ADMISSIONS COMMITTEE, WHOSE DECISION SHALL BE FINAL AND BINDING. THE APPLICANT(S) WILL UPON REQUEST FURNISH SUBSTANTIATION OF ANY INFORMATION SET FORTH HEREIN, AND WILL, UPON REQUEST, BE AVAILABLE ANY INFORMATION ESSENTIAL HEREIN.
I (WE) UNDERSTAND THAT GIDEON LODGE NO. 140, BíNAI BíRITH HOUSING DEVELOPMENT FUND COMPANY, INC. INCURS NO OBLIGATION IN CONNECTION WITH THIS APPLICATION
_____________________________________________
Signature of applicant 1
_____________________________________________
Signature of applicant 2
Date:________________________________
MAIL APPLICATION TO:
KEN HARRIS
EXECUTIVE DIRECTOR
B'NAI B'RITH PARKVIEW APARTMENTS
400 HUDSON AVENUE
ALBANY, NEW YORK 12203
(518) 465-2293