Common use of YES NO Clause in Contracts

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ................................................................................ ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... ................................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have Has any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. ............................ From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ........................................................................................................................................................................................ If NO, include additional adult household’s current address and contact information on a separate sheet piece of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ .................................................. From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?? ............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ................................................................................ ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... ................................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have Has any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC 59/RD rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ................................................................................ ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... ................................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have Has any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. ............................ From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ........................................................................................................................................................................................ If NO, include additional adult household’s current address and contact information on a separate sheet piece of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ .................................................. From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?? ............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? .................. If YES, please explain: ☐ YES ☐ NO 8. Do you expect the following change(s) to your household? ………………………………………………… ☐ Baby due on: (date) ☐ Expected adoption/custody change on: (date) ☐ Additional adult household member expected on: (date) ☐ YES ☐ NO 9. Do you have a live-in care attendant? …………………………………………………………………………. ☐ YES ☐ NO 10. Do you wish to have priority for a handicap accessible unit with special design features? ...................... ☐ YES ☐ NO 11. Are ANY members of your household, including minor dependents, currently or expected to be a student within the next year? If YES, list all household members who are/will be students: ☐ YES ☐ NO Student Name(s) Age School Name & Address Full or Part Time Enrollment ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ INCOME Do ANY household members, including minor dependents, currently receive or expect to receive income from the following source(s)? 12. Employment/Wages ……………………………………………………………………………………………... If YES, complete the following AND include 4 to 6 current, consecutive paystubs for each place of employment ☐ YES ☐ NO 13. Unemployment Benefits or Severance Pay …………………………………………………………………… If YES, household member name(s): Include a copy of the past 12 months of benefit payments ☐ YES ☐ NO 14. Social Security Benefits, Disability or Death Benefits ………………………………………………………... If YES, household member name(s): (Include a copy of current award letter(s) less than 120 days old dated by the Social Security Administration) ☐ YES ☐ NO 15. Cash Assistance Benefits (DWP, GA, MFIP, MSA, TANF – Do NOT include Food Support or Medical Assistance) .... If YES, household member name(s): ☐ YES ☐ NO County are you currently receiving benefits in: 16. Court Ordered Child Support or Alimony (answer YES even if it is NOT being received)…………… If YES, household member name(s): Include a copy of the past 12 months of child support payments received. This CANNOT be a ReliaCard or bank account statement. ☐ YES ☐ NO 17. Non-Court Ordered Child Support or Alimony……………………………………………………………… (Paid directly from the other parent(s)/spouse, not through the county or state child support system) If YES, Name of Payor: Address: ☐ YES ☐ NO Phone: Email: 18. Regular Contributions from someone outside the household……………………………………………... (Monetary contributions including payments made on your behalf such as rent, utilities, phone bill, etc.) If YES, Name of Contributor: Address: ☐ YES ☐ NO Phone: Email: _ _ 19. Self-Employment/Independent Contractor/Business Income……………………………………………... (Uber/Lyft, truck driver, delivery services such as InstaCart/Door Dash, Online Content Creation, Etsy Shop, etc.) ☐ YES ☐ NO If YES, household member name(s): Date Started/Business Open: 20. Regular payments from a pension or retirement plan (PERA, Railroad, etc.)……………………………. If YES, household member name(s): ☐ YES ☐ NO 21. Regular payments from an annuity, trust or insurance policy……………………………………………… If YES, household member name(s): ☐ YES ☐ NO 22. Veteran’s Administration Benefits………………...…………………………………………………………… If YES, household member name(s): (Include a copy of current award letter less than 120 days old dated by the Veteran’s Administration) ☐ YES ☐ NO email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ INCOME CONTINUED 23. Military Pay (including allowances)……………………………………………………………………………. If YES, household member name(s): (Include 4 to 6 current, consecutive paystubs or pay statements) ☐ YES ☐ NO

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? .................. If YES, please explain: ☐ YES ☐ NO 8. Do you expect the following change(s) to your household? ………………………………………………… ☐ Baby due on: (date) ☐ Expected adoption/custody change on: (date) ☐ Additional adult household member expected on: (date) ☐ YES ☐ NO 9. Do you have a live-in care attendant? …………………………………………………………………………. ☐ YES ☐ NO 10. Do you wish to have priority for a handicap accessible unit with special design features? ...................... ☐ YES ☐ NO 11. Are ANY members of your household, including minor dependents, currently or expected to be a student within the next year? If YES, list all household members who are/will be students: ☐ YES ☐ NO Student Name(s) Age School Name & Location Full or Part Time Enrollment ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time ☐ Full Time ☐ Part Time HTC rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ INCOME Do ANY household members, including minor dependents, currently receive or expect to receive income from the following source(s)? 12. Employment/Wages ……………………………………………………………………………………………... If YES, complete the following AND include 4 to 6 current, consecutive paystubs for each place of employment ☐ YES ☐ NO 13. Unemployment Benefits or Severance Pay …………………………………………………………………… If YES, household member name(s): Include a copy of the past 12 months of benefit payments ☐ YES ☐ NO 14. Social Security Benefits, Disability or Death Benefits ………………………………………………………... If YES, household member name(s): (Include a copy of current award letter(s) less than 120 days old dated by the Social Security Administration) ☐ YES ☐ NO 15. Cash Assistance Benefits (DWP, GA, MFIP, MSA, TANF – Do NOT include Food Support or Medical Assistance) .... If YES, household member name(s): ☐ YES ☐ NO County are you currently receiving benefits in: 16. Court Ordered Child Support or Alimony (answer YES even if it is NOT being received)…………… If YES, household member name(s): Include a copy of the past 12 months of child support payments received. This CANNOT be a ReliaCard or bank account statement. ☐ YES ☐ NO 17. Non-Court Ordered Child Support or Alimony……………………………………………………………… (Paid directly from the other parent(s)/spouse, not through the county or state child support system) If YES, Name of Payor: Address: ☐ YES ☐ NO Phone: Email: 18. Regular Contributions from someone outside the household……………………………………………... (Monetary contributions including payments made on your behalf such as rent, utilities, phone bill, etc.) If YES, Name of Contributor: Address: ☐ YES ☐ NO Phone: Email: _ _ 19. Self-Employment/Independent Contractor/Business Income……………………………………………... (Uber/Lyft, truck driver, delivery services such as InstaCart/Door Dash, Online Content Creation, Etsy Shop, etc.) ☐ YES ☐ NO If YES, household member name(s): Date Started/Business Open: 20. Regular payments from a pension or retirement plan (PERA, Railroad, etc.)……………………………. If YES, household member name(s): ☐ YES ☐ NO 21. Regular payments from an annuity, trust or insurance policy……………………………………………… If YES, household member name(s): ☐ YES ☐ NO 22. Veteran’s Administration Benefits………………...…………………………………………………………… If YES, household member name(s): (Include a copy of current award letter less than 120 days old dated by the Veteran’s Administration) ☐ YES ☐ NO email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ INCOME CONTINUED 23. Military Pay (including allowances)……………………………………………………………………………. If YES, household member name(s): (Include 4 to 6 current, consecutive paystubs or pay statements) ☐ YES ☐ NO

YES NO. 2. Do you certify this will be your only place of residence? ................................................................................... ................................................................................ ☐ YES ☐ NO 3. Are you or any member of your household currently receiving Rental Assistance? ...................... ................................... (i.e., Section 8 Housing Assistance Payments, Rural Development Rental Assistance, Housing Choice Voucher, etc.) If YES, I understand that, according to my current lease, I must provide the required written notice to the agent currently managing the property where I live. ☐ YES ☐ NO 4. Have Has any household member(s) (check that apply): ☐ Been Homeless ☐ Fled Housing Due to Violence ☐ Lived in Public Housing ☐ None None 5. How did you hear about this housing? ☐ Online ☐ Newspaper ☐ Drive By ☐ Local Agency ☐ Resident Referral ☐ Other HTC 59/RD rev 01.2025 email: ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ Current address: Street Address City State Zip Code How long have you lived at your current address? ............................. From: To: Owner/Manager: Name/Company Phone # Email Is this a family member/friend? ................................................................................................................................... ☐ YES ☐ NO Do all adult household members live at this address? ............................................................................................If NO, include additional adult household’s current address and contact information on a separate sheet of paper ☐ YES ☐ NO Previous address: Street Address City State Zip Code How long did you live at this address? ................................................ From: To: Owner/Manager: Name/Company Phone # Email Was this a family member/friend?............................................................................................................................... ☐ YES ☐ NO 6. Primary Language: Do you require an interpreter? ☐ YES ☐ NO 7. Is there someone NOT listed on this packet who would normally be living in the household? ....