2015 Samaritan HouseEXHIBIT 10-B.3a
HOME Program Annual Certification for Rental Housing as of 111/2014
Grantee:
Project Name _
and Address: C'�ti � I �L 6� l a-tL H C? f=� S � I T 1'LC�
`1 ;
` - ' I- �`e. � �' �a l l pc l r
r S� `� 1--�- 5" f , � 1
Name of GRANTEE: r~ ----..
Name of OWNER (if not the J
Grantee) t't5
Name, Address, & Phone Number of
Property Management Company, if
applicable:
Check box if Property Management Company changed since last Annual Certification
Name, Phone Number & E-mail of
Person Completing Form: L r �� i G J _ - 1-.. �
clv—i
FACILITY INFORMATION
—1 ik ou Feume: Attach rent schedule(s) in effect during the time period covered by certification
a. Check the Rent Standard(s) used for the project, Attach the applicable rent schedule(s), if other
than HOME rents are used.
® HOME Rents HOMEILIHTC Blended Rents Project Based Section 8 Rents
Rural Development 515 Rural Development 538 Other (specify)
r NOTE: MDOC must approve all rent schedules. t;x.i;ib; ?� must be submitted to MDOC at least
' 30-45 days before expected tenant notification date_ Rent schedules may only be changed
once a year.
2. Unit Mix
a. # of HOME -assisted Units
b. # of Non -HOME -assisted units
0 BR 1 BR 2 BR 3 BR 4 BR S or more BR
c. For projects that are not 100% HOME -assisted, are the HOME units 0 Fixed or Floating
�JunLy rknuwances:
a. Does tenant pay any utilities? LK No El Yes
b. If YES, identify the source of the utility allowance
used (e.g., Section 8, Rural Development, etc.)
1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used
HOME Use Only
tches Onsite File:
❑ Yes ❑ No
etches Onsite File:
❑ Yes ❑ No
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
108.3-1 January 2014
Item
2) If Section 8 utility allowance used, circle the applicable Section 8 region and check the utilities the tenant pays for
below and identify fuel type for each utility tenant pays for
Specify Fuel Type Section 8 Re ions (Circ I 0
❑ Heating... ...........
IJ Natural Gas
❑ Bottled Gas
❑ Electric
❑ Oil
❑ Coal/Other
❑ CookingRegion
.............❑
Natural Gas
El Gas
El
El oil
El Coal/Other
1 Region 2 Region 2
❑ Water Heating ...
El Natural Gas
❑ Bottled Gas
❑ Electric
❑ Oil
❑ Coal/Other
Region 4 Region 5 Region 6
❑ Other Electric
Date(s) of Section 8 Utility Schedule Used:
Region 7
Region 8
Region 9
❑ water
fl i - j J1r� �! � 1G' - - - ZG'(
Region 1D
Region 11
Region 12
❑ Sewer
J
Region 13
Region 14
Region 15
❑ Trash Collection
Region 16
Region 17
Region 18
❑ Air Conditioning
4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units
a. Describe the term of the lease/rental
agreement
b. when (date) was your lease or rental agreement last updated?
If leaselrental agreement has changed during the last year, attach a current copy to this annual certification.
NOTE: If the property management company has changed since the last certification, attach a copy of the current
lease/rental agreement
HOME Use Only
Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes El No
Are there any prohibited lease terms? (See HOME Admin Manual, Chapter 7) ❑ Yes ❑ No
5. Identify where the Fair Housing posters are displayed.
6.
Have you updated your tenant selection criteria in the last 12 months? Yes L ! No
If yes, attach the updated selection criteria/ policy
NOTE: If the property management company has changed since the last certification, attach a copy of
the current tenant selection criteria
r. Now many:
a. Section 8 tenants are currently residing in the project?
b. Section 8 clients have applied for tenancy at the project in the last 12 months?
S. Projects with 5 or more HOME -assisted units are required to have an - - -
(AFHMP) in place.
a. If you have an AFHMP, what date was it last reviewed?
b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities
throughout the year?
0 Yes No
NOTE: If the property management company has changed since the last certification, attach a
copy of the new Affirmative Fair Housing Marketing Plan
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
9. Attach copies of the Project's Requirements met?
a. Financial statements for the past year, including a Statement of Financial Position,
Statement of Activities, and Statement of Cash Flows ❑ Yes ❑ Yes
b. Operating budget for the current year
HOME Investment Partnerships Program HOME Administration Manual
Montana Department of Commerce 108.3-2 January 2014
1
o C
rr
Q C
CD CD
Sll 3
r�r (D
3
m
�T
v
o�
7
a-
E3 2
3
(D
n T
m o
cn
m
0
co
w
a
Cy
FT
tQ
Unit Number
a
HOME -designated Unit (Y1N)
Low (L) or High (H) HOME
Rent Unit Designation
—f—
Tenant Last Name
Size of Household
Disabled Household, if
identified by tenant) (YIN)
Ca
E
Annual (Gross) Income **
c�
V
w.
_
Percent of Area Median Income
Code ***
4:
4:
-
Date of Initial Income
Certification
JO
s`
s
��
�� v,
��
c
Date of Last Income
—_-
Recertification
EJk
_
_
-
S1
n
Tenant Rent
C>
i
s
m
'
Subsidy Amount (if any)rk
—
S
(s
f
V-
�
S
Utility Allowance (for tenant -
paid utilities) i
c
I
0
t
Total Rent17-1 4
i
I
c-,
C�
Number of Bedrooms
Date of Last HQS or UPCS
Inspection
Z'
Date of Move -In
Date of Move -out (if applicable)
Project Based Unit (YIN)
EXHIBIT 10-13.3a
HOME Program Annual Certification for Rental Housing as of 1/1/2014
Grantee:
Project Name
L i �S C. 1q C
and Address: r
13 q*i,1 A-f'e- toes+ I tec-
Name of GRANTEE: +c �; , � i i"p"�. ( (
Name of OWNER (if not the
Grantee)
1-juie, Huaress, & rnone Number of
Property Management Company, if
applicable:
Name, Phone Number & E-mail of
Person Completing Form:
C.hr'(✓ ki c(cyer
(:neck hox if Property Management Company changed since last Annual Certification
0'r I . I'rq�j e r ice-
FACILITY INFORMATION
4C(°) 2Z- 7 "G !
1. Rent Schedule: Attach rent schedule(s) in effect during the time period covered by certification
a. Check the Rent Standard(s) used for the project. Attach the applicable rent schedule(s), if other
than HOME rents are used.
0 HOME Rents ❑ HOMEILIHTC Blended Rents Project Based Section 8 Rents
Rural Development 515 ❑ Rural Development 538 Other (specify)
NOTE: MDOC must approve all rent schedules_ Exribi 7-L must be submitted to MDOC at least
' 3p-45 days before expected tenant notification date_ Rent schedules may only be changed
once a year.
HOME Use Only
itches Onsite File:
❑ Yes ❑ No
2. Unit Mix 0 BR 1 BR 2 BR 3 BR 4 BR 5 or more BR Matches Onsite Fiile�
a. # of HOME -assisted Units ❑ Yes ❑ No
b. # of Non -HOME -assisted units
c. For projects that are not 100% HOME -assisted, are the HOME units ❑ Fixed or Floating
3. Utility Allowances:
a. Does tenant pay any utilities? = No ®Yes
b. If YES, identify the source of the utility allowance SeC+ic Fs'
used (e.g., Section 8, Rural Development, etc.)
1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
10B.3-1 January 2014
Item
2) If Section 8 utility allowance used, circle the applicable Section 8 region and check the utilities the tenant pays for
below and identify fuel type for each utility tenant pays for
Specify Fuel Type
Heatin g.......•......❑
Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil
❑ Coal/Other
Section 8 Regions (Circle One
Cooking ........ .....
❑ Natural Gas El Bottled Gas El Electric El Oil
❑ Coal/Other
Region 1 Region 2 Region 2
❑ Water Heating ...❑
Natural Gas El Bottled Gas ❑ Electric El oil
❑ Coal/Other
Region 4 Regions Region s
❑ Other Electric
Dates) of Section 8 Utility Schedule Used:
Region 7 Region 8 Region 9
® Water
®
�
egion 10 Region 11 Region 12
Sewer
❑ Trash Collection
❑ Air Conditioning
4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units
a. Describe the term of the lease/rental
agreement
Region 13 Region 14
Region 16 Region 17
Region 15
Region 18
b. When (date) was your lease or rental agreement last updated?
If leaselrental agreement has changed during the last year, attach a current copy to this annual certification.
NOTE: If the property management company has changed since the last certification, attach a copy of the current
lease/rental agreement
HOME Use Only
Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes
Are there any prohibited lease terms? (See HOME Admin Manual, Chapter 7) ❑ Yes 0 No
5.
�V1Rily vvhure the i-air dousing posters are displayed.
6. Have you updated your tenant selection criteria in the last 12 months? Yes
If yes, attach the updated selection criteria 1 policy 0 No
NOTE: If the property management company has changed since the last certification, attach a copy of
the current tenant selection criteria
7. How many:
a. Section 8 tenants are currently residing in the project?
b. Section 8 clients have applied for tenancy at the project in the last 12 months?
�. Pwiecfs with b or more HOME -assisted units are required to have an - --
(AFHMP) in place. -
a. If you have an AFHMP, what date was it last reviewed?
b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities
throughout the year?
Yes No
NOTE: If the property management company has changed since the last certification, attach a
copy of the new Affirmative Fair Housing Marketing Plan
Requirements met?
❑ Yes ❑ N o
Requirements met?
El Yes El No
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
k'Uj,1cs ui the vrotecrs
a. Financial statements for the past year, including a Statement of Financial Position, ,� Requirements met?
Statement of Activities, and Statement of Cash Flows ❑ Yes ❑ Yes
b. Operating budget for the current year
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
10B.3-2 January 2014
(NI,k) ;iun paseg IOGfOJd
(algieoildde jl);no-avow jo alea
UI-BnOA 10 ales
uoi;oadsul
sodn jo SOH Ise] 10 a;e❑
0
c�
4
swoolpag }o jagwnN
a
;uaN le;ol
t�
�n
p
E Q
C)
EE
o W
(sa!;l1!;n pied
�-
0
-;usua; Jo;) aouemouv Aimi l
s
c°
o
m +
(Aue;i);unowy Ap!sgnS
o
$
4 +
;usualt
r
L
.3
Z O
uogeoulljaoad awooul }spy 10 a;eclLU
U p
3
d �
r_ N
UO1WD4!)JGO aw03UI JEiMul1O a;eQ
a� -Y
K
o�
�
v
awoouJ
r
ueipaw e9.1y10;uaoiad
75
:2
a . waoui (ssojO) lenuuy
`x
,�
c�
c3
>
(ILIA) (;ueua;
_v
Co
Ag popuap! p `PloyasnOH palgeslQ
�
CA
.E w
PlogasnOH;a aziS
oom
v
aweN ;sel ;ueual
v
E
0
Uoi;eu6isaQ i!un
.0
;ua�i 3wOH (H) 461H Jo ('I) mo-i
o m
CL
(NIA) iiun pa;Eeu6isap-3WOH
-
L-
3 cz
]--
�-
o m
JagwnN;iunl
4A r
L9
cl1
0o
0
r
E
n a)
a..
a
a) ;_
E
m`U
a
d
C
E a
i.0 m
2 c4
0 a
_2i
EXHIBIT 10-13.3a
HOME Program Annual Certification for Rental Housing as of 1f112014
Grantee:
Project Name
and Address: Sayrl(L!_i civ� 1`�� .SE i 1atG
Iq:5- e)tlt 14tle-
Name of GRANTEE:
Name of OWNER (if not the
Grantee)
omu, nuoress, & F'none Number of
Property Management Company, if
applicable:
Name, Phone Number & E-mail of
Person Completing Form:
(:neck ,box it Property Management Company changed since last Annual Certification
FACILITY INFORMATION
i . vent 5cneaule: Attach rent schedule(s) in effect during the time period covered by certir ation
a. Check the Rent Standard(s) used for the project. Attach the applicable rent schedule(s), if other
than HOME rents are used.
1z HOME Rents HOME/LIHTC Blended Rents Project Based Section 8 Rents
❑ Rural Development 515 ❑ Rural Development 5381-1 Other (specify)
NOTE: MDOC must approve all rent schedules. Exh bit ,"-L must be submitted to MDOC at least
30-45 days before expected tenant notification date_ Rent schedules may only be changed
once a year.
2. Unit Mix D BR 1 BR 2 BR 3 BR 4 BR 5 or more BR
a. # of HOME -assisted Units
b. # of Nan -HOME -assisted units
c. For projects that are not 100% HOME -assisted, are the HOME units Fixed or Floating C
vunLy �-uiuwances:
a. Does tenant pay any utilities? No Yes
b. If YES, identify the source of the utility allowance 's e C' -Neel
used (e.g., Section 8, Rural Development, etc.)
1) If other than Section 8, ATTACH copy(ies) of applicable utility allowance schedule used
HOME Use Only
atches Onsite File,
❑ Yes ❑ No
atches Unsite File,
❑ Yes ❑ No
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
10B.3-1 January 2014
2) If Section 8 utility allowance used, circle the applicable Section 8 region and check
below and identify fuel type for each utility tenant pays for
Item I Specify Fuel Type
❑� Heating ..... ......... N Natural Gas ❑ Bottled Gas ❑ Electric ❑ Oil ❑ Coal/Other
the utilities the tenant pays for
Section 8 Regions (Circle One)
Cooking .............❑ Natural Gas ❑ Bottled Gas Q Electric ❑ Oil ❑ Coal/Other
Region 1 Region 2 Region 2
Water Heating ...❑ Natural Gas ❑ Bottled Gas IN Electric ❑ Oil ❑ Coal/Other
Region a Region 5 Region s
® Other Electric Date(s) of Section 8 Utility Schedule Used:
Region 7 Region 8 Region 9
19 Water
A_ 31 4611 51�
egion 1p `. Region 11 Region 12
Sewer O
❑ Trash Collection
Region 13 Region 14 Region 15
❑ Air Conditioning
Region 16 Region 17 Region 18
4. Lease/Rental Agreements (REQUIRED for ALL HOME -assisted units
a. Describe the term of the lease/rental
agreement
b. When (date) was your lease or rental agreement last updated?
S4-P �I-kL e�L Lc t C
If lease/rental agreement has changed during the last year, attach a current copy to this annual certification.
NOTE: If the property management company has changed since the last certification, attach a copy of the current
lease/rental agreement
HOME Use Only
Does termination of tenancy by owner stipulate a 30-day written notice be given? ❑ Yes
Are there any prohibited lease terms? (See HOME Admin Manual ter 7 Chapter ❑ No
p } I1 Yac n K1_
5.
iUenury wnere the Fair Housing posters are displayed.
L& V o" hc"C rcl i
6. Have you updated your tenant selection criteria in the last 12 months? `V
= Yes No
If yes, attach the updated selection criteria 1 policy
NOTE: If the property management company has changed since the last certification, attach a copy of
the current tenant selection criteria
rww iiiany.
a. Section 8 tenants are currently residing in the project?
b. Section 8 clients have applied for tenancy at the project in the last 12 months? E-1
ss. ►'rojects with 5 or more HOME -assisted units are required to have an
n (AFHMP) in place.
a. If you have an AFHMP, what date was it last reviewed?
b. Are you maintaining a file that documents your Affirmative Fair Housing Marketing activities
throughout the year?
EE]Yes No
NOTE: If the property management company has changed since the last certification, attach a
copy of the new Affirmative Fair Housing Marketing Plan
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
Requirements met?
❑ Yes ❑ No
u. ,Axtacn copies of the Project's
a. Financial statements for the past year, including a Statement of Financial Position, Requirements met?
Statement of Activities, and Statement of Cash Flows ❑ Yes ❑ Yes
b. Operating budget for the current year
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
1 [)B.3-2 January 2014
(N/A) PA pase8 loafoid
(algeolldde ;i);no-anon;o G12C]
I11-nAnlhi in
J
-•M S- -T-$J
\
=V
uopedsul
SOdn jo SOH Ise-1 10 a}eQ
t'
�
_2
swooJp9810 jagwnN
�
Q1
--yy
zy
Iua�{ lelol
rn
,-. a)
E ❑
U II
o` W
(saijggn pied
- p
-lueua} col) aouemolIV Apian
M
s[?
!4
c`
O
p +
m c
(Aue;l) junowV ApisgnS
�.-
4
�J
O
m 0
W
5A
V
0 -
}ua�l Jueual
',
N
N
N
z
o
m
�%.
Q
IJRJ DOM aw0oul;se-11 jo aileQ
`4-�l
Z
V a
>
c a
uolleoiillaO awooul ler;iul 10 aje❑
�w
E�
O O
�`
Q =
apo0
owoouI ue!paVV eaJy;o;uaa-lad
m
awooul (ssoa0) lenuuy
a -6
c °1
(NIA) (1ueual
_
a.-
Aq paUquapl jl 'plogesnoH palgeslQ
0 T
,s ui
plogasnoH 10 aziS
_
ooz
v
L
o
?WEN Ise-l;ueuaj-
%)
v O
aj
uolieu6lsaa im
"�
}ua�l 3WOH (H) ui5lH ao (-1) mol
c
CL .Q
(N/A) i!un Pa;eu6lsaP-3WOH
o
jagwnN }!un
ct
J
C
��t=
JJ
L
co
0
;
a�
QE
E
U) o
a� U
0
ca
CL �
m
c �
E cu
Ch a
a)
>p
c co
LU C
c�
O o
=2
Tenant Income must be re-examined annually. Owners/property managers must review full source documentation for all
tenants every sixth year of the affordability period of the project. Other years, each tenant's income may be verified
through self -certification by the tenant (signed and dated). HOME rent/income limits are at:
-`IVJ'�f.(LC1�G�L'i'Og�ICES'Cl3fC�
i
HOME Use Only
1. How many units are occupied by tenants whose incomes are:
Are Income targeting
0 to 30% of AMI? 31 to 50% of AMI? 51 to 60% of AMI? 61 to 80% of AMI? levels being met?
❑
2. Do rents meet the selected rent standard? El Yes No
❑ Yes ❑ No
3. For projects with 5 or more HOME units, do 20% of the tenants have incomes at or below
50% of AMI and rents not greater than the Low HOME Rent or 30% of monthly income? �EEIIY ❑ No
Call (406) 841-2820 with any questions regarding the referenced HOME requirements.
Grantee: C 14-'S- . , I, Spa(
Project Year: i G 9 '7
Project Name: 1-9, ,VVkLf-JLCL 1 }46,,CSe.
I certify that the information included in this report represents a true and complete statement of the facts.
SIGNATURE of Person Completing Report I r%—
Print/Type Nam --and
SIGNATURE of( x _
of the
cutive Director/ CEO 1 Chief Elected Official
ctor 1 CEO 1 Chief Elected Official
Form reviewed by HOME Program Officer:
Date:
Return completed, signed forms to.
HOUSING DIVISION — HOME PROGRAM
MT DEPARTMENT OF COMMERCE
P.O. BOX 200545
HELENA, MT 59620-0545
�-51
r:� /�;
Date
HOME Investment Partnerships Program
Montana Department of Commerce HOME Administration Manual
10B.3-6 January 2014
124-9" Ave. YY .
Kalispell, MT 59901.
406-257-5801
Thank you for your interest in renting an apartment at The Samaritan Houser
INC. Enclosed you will find a rental application and price list.
All apartments require a security deposit equal to the amount charged for rent.
The deposit is payable at move -in. rental prices are as follows.
124 9t' Ave. west:
Studio transitional apartments $190month
(Without bathroom)
Studio transitional apartments $210month
(With bathroom)
135 Vh Ave. west:
1 bedroom loft apartment $325month
(Utilities not included in rent)
Has electric heat
140 9th Ave. west:
1 bedroom apartment $360month
Studio apartment $305month
(Utilities included)
145 9"' Ave. west:
1 bedroom loft apartment $325month
(Utilities not included)
Has gas heat
All apartments are non-smoking! All rentals are required to sign a
rental agreement.
Please attach pmof of incomeff identification (picture ID and social
security cards). We cannot process any application without these
items.