RELEASE of INFORMATION /

APPENDIX 21

Sample Form

HUD

AUTHORIZATION

| for the

RELEASE of INFORMATION /

PRIVACT ACT NOTICE

Authorization for the Release of Information/ U.S. Department of Housing

. <i and Urban Development

Privacy Act Notice Office of Public and Indian Housing

> the U.S. Department of Housing and Urban Development (HUD)

and the Housing Agency/Authority (HA)

PHA requesting release of information; (Cross out space if none)

(Full address, name of contact person, and date)

IHA requesting release of information: (Cross out space if none)

(Full address, name of contact person, and date)

Authority: Section 904 of the Stewart B. McKinney Homeless Persons who apply for or receive assistance under the following

Assistance Amendments Act of 1988, as amended by Section 903 programs are required to sign this consent form:

of the Housing and Community Development Act of 1992 and , . .

Section 3003 of the Omnibus Budget Reconciliation Act of 1993. PHA-owned rental public pouuing .

Turnkey 11] Homeownership Opportunities

This law is found at 42 U.S.C. 3544.

This law requires that you sign a consent form authorizing: (1) Muraal Help Homeownership on ponnyyy

HUD and the Housing Agency/Authority (HA) to request verifi- Section 23 and 19(c) leased housing

cation of salary and wages from current or previous employers; (2) Section 23 Housing Assistance Payments

nu and the einer wage ane te eee rempensible fos HA-owned rental Indian housing

ion claim information from the state agency responsible for . .

keeping that information; (3) HUD to request certain tax return Sernon 8 Rental Cerificate

information from the U.S. Social Security Administration and the Section 8 Rental Voucher

U.S. Internal Revenue Service. The law also requires independent Section 8 Moderate Rehabilitation

verification of income information. Therefore, HUD or the HA . . . .

: ; wpe ae ge . Failure to Sign Consent Form: Your failure to sign the consent

may request information from financial institutions to verify your . ; eg oe 3

ligibility and level of benefits form may result in the denial of eligibility or termination of

eligibility : . assisted housing benefits, or both. Denial of eligibility or termi-

Purpose: In signing this consent form, you are authorizing HUD nation of benefits is subject to the HA’s grievance procedures and

and the above-named HA to request income information from the Section 8 informal hearing procedures.

sources listed on the form. HUD and the HA need this information . ‘

Sources of Information To Be Obtained

to verify your household’s income, in order to ensure that you are

eligible for assisted housing benefits and that these benefits are set

at the correct level. HUD and the HA may participate in computer

matching programs with these sources in order to verify your ; ; ’

eligibility and level of benefits. received assisted housing benefits.)

Uses of Information to be Obtained: HUD is required to protect U.S. Social Security Administration (HUD only) (This consent is

the income information it obtains in accordance with the Privacy limited to the wage and self employment tnformation Ave Pay.

Act of 1974, 5 U.S.C. 552a. HUD may disclose information ments of retirement income as referenced at Section 6103(1)(7

(other than tax return information) for certain routine uses, such as of the Internal Revenue Code.)

to other government agencies for law enforcement purposes, to U.S. Internal Revenue Service (HUD only) (This consent is

Federal agencies for employment suitability purposes and to HAs limited to unearned income [i.e., interest and dividends].)

for the purpose of determining housing assistance. The HA is also

required to protect the income information it obtains in accordance

with any applicable State privacy law. HUD and HA employees

may be subject to penalties for unauthorized disclosures or improper uses of the income information that is obtained based on the

consent form. Private owners may not request or. receive

information authorized by this form.

State Wage Information Collection Agencies. (This consent is

limited to wages and unemployment compensation | have received during period(s) within the last 5 years when I have

Information may also be obtained directly from: (a) current and

former employers concerning salary and wages and (b) financial

institutions concerning unearned income (i.e., interest and dividends). | understand that income information obtained from these

sources will be used to verify information that 1 provide in

determining eligibility forassisted housing programs and the level

of benefits. Therefore, this consent form only authorizes release

Who Must Sign the Consent Form: Each member of your directly from employers and financial institutions of information

household who is 18 years of age or older must sign the consent regarding any period(s) within the last 5 years when 1 have

‘orm. Additional signatures must be obtained from new adult received assisted housing benefits.

members joining the household or whenever members of the

household become 18 years of age.

Original is retained by the requesting organization. ref. Handbooks 7420.7, 7420.8, & 7465.1 form HUD-9886 (7/94)

Consent: 1 consent to allow HUD or the HA to request and obtain income information from the sources listed on this form for

the purpose of verifying my eligibility and level of benefits under HUD’s assisted housing programs, 1 understand that HAsthat

-eceive income information under this consent form cannot use it to deny, reduce or terminate assistance without first

independently verifying what the amount was, whether | actually had access to the funds and when the funds were received. In

addition, 1 must be given an opportunity to contest those determinations,

This consent form expires 15 months after signed.

Signatures:

Head of Household Date

Social Security Number (if any) of Head of Household Other Family Member over age 18 Date

Spouse Date Other Family Member over age 18 Date

Other Family Member over age 18 Date Other Family Member over age 18 Date

Date Other Family Member over age 18 Date

Other Family Member over age 18

Privacy Act Notice. Authority: The Department of Housing and Urban Development (HUD) is authorized to collect this information

by the U.S. Housing Act of 1937 (42 U.S.C. 1437 et. seq.), Title V1 of the Civil Rights Act of 1964 (42 U.S.C. 2000d), and by the Fair

Housing Act (42 U.S.C. 3601-19). The Housing and Community Development Act of 1987 (42 U.S.C. 3543) requires applicants and

participants to submit the Social Security Number of each household member who is six years old or older. Purpose: Your income and

other information are being collected by HUD to determine your eligibility, the appropriate bedroom size, and the amount your family

will pay toward rent and utilities. Other Uses: HUD uses your family income and other information to assist in managing and monitoring

HUD-assisted housing programs, to protect the Government’s financial interest, and to verify the accuracy of the information you provide.

This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory

investigators and prosecutors. However, the information will not be otherwise disclosed or released outside of HUD, except as permitted

or required by law. Penalty: You must provide all of the information requested by the HA, including all Social Security Numbers you,

and all other household members age six years and older, have and use. Giving the Social Security Numbers of all household members

six years of age and older is mandatory, and not providing the Social Security Numbers will affect your eligibility. Failure to provide

any of the requested information may result in a delay or rejection of your eligibility approval.

Penalties for Misusing this Consent:

HUD, the HA and any owner (or any employee of HUD, the HA or the owner) may be subject to penalties for unauthorized disclosures or improper uses of

information collected based on the consent form.

Use of the information collected based on the form HUD 9886 is restricted to the purposes cited on the form HUD 9886. Any person who knowingly or willfully

‘equests, obtains or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more

chan $5,000.

Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as may be appropriate, against

the officer or employee of HUD, the HA or the owner responsible for the unauthorized disclosure or improper use.

ref. Handbooks 7420.7, 7420.8, & 7465.1 form HUD-9886 (7/94)

Original is retained by the requesting organization.

APPENDIX 22

Sample Letter

HOUSING DEPARTMENT

DIRECTOR RESPONSE TO

REQUEST TO ADD INDIVIDUAL

TO HOUSEHOLD COMPOSITION

Grand Traverse Band

of Ottawa and Chippewa Indians

Housing, Department Ix

2605 N. West Bay Shore Dr.

Peshawbestown, MI 49682

Office: (231) 534-7800 Fax: (231) 534-7025

2

Aaaannd®

Maddii\2

'¢,

taa

Ls

Ss

(Date)

(Client Name)

(Address)

(City, State, ZIP)

RE: REVIEW OF REQUEST TO ADD INDIVIDUALS TO THE HOUSEHOLD

Dear

This letter serves to acknowledge receipt of your letter (received. by Housing on

,20 _) requesting that individuals be added to your household.

Those individuals have been identified, by you, as:

? f]

)

My initial review indicates that your request may be possible, however, before a

FINAL determination can be made, the following actions are required:

You will need to complete a new “Household Composition’ form indicating the

full names,ages, SSN’s, and relationship of those individuals to you.

You will need to complete a new “Household Income’ form indicating the

employers / sources of income for those individuals.

Those individuals, listed above, who are over eighteen (18) years of age, will

need to complete (and sign) a “State of Michigan Criminal History

Background Check’ form.

Note: There is a $5.00 processing fee (that goes to the State) associated with

that check. This is must be paid at time of submission.

Those individuals, listed above, who are over eighteen (18) years of age, will

need to complete (and sign) “Release of Information” forms.

GRAND TRAVERSE CHARLEVOIX LEELANAU BENZIE MANISTEE ANTRIM

The information requested here should be compiled, signed, and returned to the

Housing Department office NO LATER THAN , 20!

Upon receipt, the information will be reviewed by the . . Staff, in

accordance with the Housing Departments Admissions Policy. If the individuals are

found to be in compliance with that policy and eligible for Housing Assistance your

request shall be given favorable consideration.

You will, however, be advised of a FINAL decision, regarding your request, within

thirty (30) calendar days of your returning the above noted documents (provided they

are complete and accurate) to the Housing Department office.

questions regarding this matter, please feel free to call yOur Occupancy

If you have any

‘at (231) 534-7800

Specialist

Sincerely,

JAmes Thompson Manager

Housing Deparkrnent ...-

atch: Household Composition Form

Housing Income Form

State Criminal Background Check

Release of Information Forms

CC:

Client File

GWTHD Form Letter # 58

04/01/01

APPENDIX 23

Sample Form

INSPECTION

REPORT

estas

Ottaw,

baad

Ry SS

Li

1980

Grand Traverse Band

of Ottawa and Chippewa Indians

Housing, Department IX .

2605 N. West Bayshore Dr.

Peshawbestown, MI 49682

axes Depart

CTE

Unit Inspection Form

Move In

Move Out

Other Inspection

Unit Condition/Work Needed

G = Good

F = Fair

P = Poor

Office: 231/271-4473 Fax: 231/271-2025

Development Name: Unit Number:

Development Number: Inspection Date:

Address: Keys: Issued: Returned:

Resident Name:

Bedroom Size: Electric Reading: LP Gas Reading:

Unit Inspection

1 = Clean

2 = Repair

3 = Replace

4 = General Maintenance

Items

_| Unit

Resident

Damage

Work

Condition | Needed

Remarks /

Describe

KITCHEN & DINING AREA

1. Sink & Faucet

2. Range Hood

A. Light

-"'B. Shield

3. Range

Model#.__

Serial #

D. Oven

EB Elements

F. Handles:

ay

GRAND T

G. Broiler Pan / Grill

“4, “Refridgerator

Model #

Serial #

A. Gasket

B. Freezer Door

“C. Main Door

D. Shelves

| A. Doors

“B. Shelves

6. Fire Extinguisher #

7, Countertops

8. Floors

LEELANAU

BENZIE MANISTEE

ANTRIM

ri

aiacnsi ese

Items

| 10. Windows

A ‘Screens

1. Rods

A. Curtains

B. Drapery

12. E Heat Diffuser

| 13. Co'd Air Return Vent |

14, Light Fixture / Glass

15. "Electric C Outlet Covers

16. Ceiling

‘17. Doors

A. Locks

B. Door Jambs

18. Closet

A. Closet Hardware

Living Room

19. Floor

20. Walls

21. Ceiling

22. _Light Fixtures / Glass

23. Windows

AL Curtain Rods

B, “Hecke :

24, Screens

27. Electric Outlets

28. Heat Diffuser .

29. Retum ‘Air Vent

30. Entry Doors

A. Door Locks _

B. Jamb / Trim

31. Closet

A. Closet Hardware

[Bathroom # 1

32. Floors

34, Calling

}35. Doors

36. Locks

| 37. Door Jambs

38. Faucet

39. ‘Shower / Rod / Bielacare

40. Wash Basin

A. Faucet

B ‘Handles

41. Tub / Stopper / Grab Bars

Items

Unit

Condition

Work

Needed

Resident

Damage

Wear &

Tear

Remarks /

Describe

42. Cabinets

43, “Commode

& Seals _

45. Medicine Cabinet

46, Electric Outlet Cover

‘47. Test GFI Outlet

48, "Heat Diffuser

49." Towel Bars

50. Tissue Holder r Roller _

51, Exhaust Fan

52, Emergency | Alarm Cord

53. Handicap E Bars

54. Window

| A. Screen

Bathroom # 2

55. Floors

60. Door Jambs

61. ‘Faucet

63 - Wash B Basin

A. Faucet

“B. Handles

C. Stopper

62. Shower / Rod / Enclosure _

' 65. Cabinets

66. ‘Commode

cor Seals _

67, Light Fixture

68. Medicine Cabinet

69. “Electric Outlet Cover

71. ‘Heat Diffuser

_ Towel Bars

B. Tissue Holder / Roller

70, Test GFI Outlet 1

64, Tub / Stopper / Grab Bars -

74, Exhaust Fan

Unit Work Resident Wear & Remarks /

Items

a Condition} Needed Damage Tear Describe

| |

753 Emergency Alarm Cord |

16, Handicap Bz Bars ; a ae

77. Window . eo re :

"A. Screen. po fe

General Interior

TB. Stairways

79, Hallways

81. Cold Air Vent

82. ‘Heat Diffuser :

83. ‘Storage Closet / She ‘Ives | - i]

84, Vestibules

A. Doors

F. Walls

G. Ceiling

H. Lights

85. Door Bells

: ‘B. Pus sh Buttons

86. Smoke Alarms . _—

7 Benne en ae a ae Se ee

A. Stairway

~B. Handrail

mo ‘Treads . . . .

> Flog . nd a on re |. ; -

E. Walls

F, Ceiling

H. Door Locks—

~Etambs

J. Windows

K Screens

E, ~ Outlets / Covers | a] .

M. _Storm Window / Screen F N,

Bes : a

88. _ Laundry Tub- a _ : .

C. Stopper - -

89, Washer / Dryer Hook Up

90. O.S. Dryer Vent ae =

91. Floor Drains . 2

92. Sump Pump a :

Major Equipment a

93. Fresh Air Vent ( Intake )

Ttems

Unit

Condition

Work

Needed

Resident

Damage

Wear &

Tear

Remarks /

Describe

94, Water Pump

95 ; Water Filters

96. ‘TV Amplifier

97, Furnace Drain Pipe

98. E Electrical Panel

99. W Wiring ( General )

‘101. | Ge 8 Lines

‘102. Thermostats

103. _Heating

A Lp ’ Gas Fi Furnace _

B. Wood Stove

© Chiemneys |

104. Water Heater

A. Vent Pipe

General | Housekeeping

r105. Ir Interior Trash

106. Exterior Trash

‘leanliness

A. Floors

B. Walls

C, Windows

109. “Crawl SE Space

110. Attic

Unit Exterior

111. Light Fixtures G Pole ).

112. Walkways

113. Driveway

114. Steps: Front / Rear

100. Plumbing ( General )

D. Vent Pipes . _

108. Extermination Status

1 15. Storm Daors

evens theme AMT I

| A. Glass

B. Screens

GC, Hardware

117. Os S. GFI Receptacle

118. O.S. Walls / Siding

‘11. Roofing

120. Gutters / Downspouts

121, Grass Cutting

(122. Yard Clean-up

‘124. ‘Roof V Vents

126. Metal Soffit

‘127. Area Wells

128. "Fresh ‘Air Vents

‘116. OS. Light ‘Front/Rear .

123.1 House Numbers oy

125. Exhaust Vents oe

NL meee

yy

oer

Items Unit Work Resident Wear & Remarks /

Condition} Needed Damage Tear Describe

129. Fencing — :

130. Check ext. of chimney

Bedroom# 1

131. Floors .

132. Walls

133. Ceiling i 7 :

‘isa Door ee eae Senn a |

A Hardware :

B. -Jambs

135, Cold Air Retum Vent

136. Heat Diffuser 7 ; . : |

a7. Light Fixe ee a meee eee Cees . , «woes

138. Electrical C Outlets - . :

139. Curtain Rods ~

140. Windows rs ‘a

| A. Glass \

7 B. Screens: - | -

141. Closet

142. Closet

Bedroom #2. rn Oe Senn Scene

143, Floors

144. Walls -_ [ 7

‘145. Ceiling = | CT

146. Doors ——

A. Hardware —

“B. Jambs ee ee

"147, ColdAirRetum Vent | | |

148. Heat Diffuser

149, Light Fixture

150. Electrical Outlets

151, CurtainRods | eee

/152. Windows 7 ; ;

: A Glass

Be ‘Screens

uaa cee eee eee ee _

} 154. Closet — :

Bedroom #3

155. Floors | ;

"156. Walls

“157. Ceiling 7

(158. Doors i fo

A. Hardware

BR. Jambs i fp

159. ColdAirRetumVent | | |

160. Heat Diffuser

161. Light Fixture | | _—

162, Blectical Outlets = | | |

163. CurainRods tid opp

Items

Unit Work

Condition] Needed

Resident

Damage

Remarks /

Describe

164. Windows

A. Glass

B. Screens

165. Closet

‘166. Closet

Bedroom #4

167. Floors

168. Walls

‘69. Ceiling

170. Doors

B. Jambs

176. Windows

B. Screens

1178. Closet

Miscellaneous

172. Heat Diffuser

173. Light Fixture

174. Electrical Outlets

175. Curtain Rods

A. Hardware.

F171. Cold Air Return Vent

. 1 71. Closet

Miscellaneous

Remarks:

Signature of Resident Counselor

Signature of Tenant or Authorized Representitive and Date

Inspected by

Date

Date

Sample Letter

TENANTS RIGHTS

DURING ©

INSPECTIONS |

TENANT RIGHTS

DURING

INSPECTIONS

(ANNUAL, INTERIM, MOVE-IN, & MOVE-OUT)

| hereby acknowledge that the purpose of the Grand Traverse Band Housing

Department’s INSPECTION (Move-in Move-Out, Annual & Interim) are to document

the current condition of the home / apartment (both inside and out).

| understand that | have the right to comment (in writing, on the inspection form) as to

the condition of the home/apartment that | am about to move in to, vacate, or reside in.

| also understand that the Housing Department staff has the right to videotape these

inspections and that those tape(s) will be used to help resolve any future disputes

between the Housing Department and the tenant.

House/Apartment Number:

Location:

y =. FY 4.

Inspection Date:

(Printed Name of Lease Holder) (Signature) (Date)

(Printed Name of Spouse/Significant Other) (Signature) (Date)

Housing Department Staff Signature (Date)

DISTRIBUTION: — Original to Client File (Attach to Inspection Sheet)

Copy to Client and Inspector

GTBHD Form # 36

04/01/02

APPENDIX 25

Sample Lease

LOW INCOME

GRAND TRAVERSE BAND HOUSING DEPARTMENT

Project No.

Project Name. House No.

DWELLING LEASE

Tenant File No.

1. DESCRIPTION OF THE PARTIES AND PREMISES.

A.

B.

The Housing Department, relying upon the representation of Tenant as to Tenant’s family

income and family composition, does hereby rent to:

(Tenant)

the dwelling unit described below, under the terms and conditions stated herein.

Address of Rented Premises:

Occupancy Date:

2. AMOUNT AND DUE DATE OF RENTAL PAYMENTS.

A.

Term_of Lease. This lease creates a month-to-month tenancy beginning on the occupancy

date to be the 1° day of the month following the occupancy date, and thereafter from month-to-

month on the 1° of each month.

Tenant (s) Initials

Date

Rent. Monthly rent under this lease is determined by the Tenant's income in accordance with

the current approved rent schedule, which is attached hereto and incorporated herein. Rent

shall be due any payable in advance on the 1% day of each month. Rent shall be re-determined

by the Housing Department in accordance with Section 5 of this lease. Written notice of re- .

determination shall take effect in accordance with Section 5.

Pro-ration. The monthly rent amount shall be pro-rated for any term of less than one (1)

month.

Renewal _of Term. The term of this lease shall be renewable from month-to-month unless

adjusted or terminated according to the terms and conditions hereinafter set forth.

WELLING

LEASE GRAND TRAVERSE BAND HOUSING DEPARTMENT

3. SECURITY DEPOSIT

A.

A.

Payment of Security Deposit. Tenant agrees to pay the sum of $ asa

Security Deposit. The Security Deposit is based on the greater of “one month’s rent’ or

“$250”.

Use_of Security Deposit. The security deposit shall be applied by the Housing Department,

at the termination of the lease, toward reimbursement of the cost of repairing any damages to

the dwelling unit caused by the Tenant, his family, or dependents, or towards rent, cleaning,

unpaid utilities, costs, and legal expenses incurred in the termination of the lease.

Refund of Security Deposit. Any unused portion of the Security Deposit, together with a

written itemization of any deductions therefrom, will be refunded and provided to the Tenant at

Tenant’s last known address within forty-five (45) days after the Tenant has actually vacated the

unit to Housing Department.

Joint Tenants. |n the event that joint Tenants or more than one Tenant occupy one rental unit,

the Security Deposit shall not be refunded as long as one of the tenants continues to occupy the

dwelling unit and the unit is not vacated by all Tenants.

UTILITIES and OTHER SERVICES.

FURNINSHING OF UTILITIES. If any of the following are checked, the Housing Department

agrees to furnish the following utilities in accordance with current the Schedule of Utilities on file

at the Housing Department:

[] Gas CL] Electricity C] Water [] Sewer _] Garbage

INTERRUPTION OF UTILTHES. The Housing Department will not be responsible for

interruption of utilities by reason of any cause beyond its control.

OTHER UTILTIES. The Tenant shall be solely responsible for utilities, which are not provided

by the Housing Depariment.

HEAT AND ELECTRICAL SERVICE. lf LP gas or electricity is not to be furnished by the

Housing Department, it is the responsibility of the Tenant to provide LP gas (see NOTE) and

electricity to the dwelling unit. Tenant agrees to maintain sufficient heat and electrical service to

Tenant (s) Initials:

Date:

prevent freezing of piped water and any other damages to the dwelling unit caused by failure to

furnish such LP gas heat or electricity. If for any reason Tenant is unable to maintain sufficient

heat or electricity, Tenant shall immediately notify the Housing Department.

NOTE: Each unit has been equipped with a large capacity LP gas tank for use by the Tenant.

LP_CYLUNDER TANKS ARE NOT ACCCEPTABLE FOR FUEL STORAGE, Tenant agrees NOT to install (or contract to

have installed) LP cylinder tanks.

TELEPHONE SERVICE. Tenant shall be responsible for his / her own telephone service.

Billing should be set up to go directly to the Tenants address - NOT HOUSING.

CABLE T.V. SERVICE. Tenant shall be responsible for his / her own Cable T.V. service

(where available). Billing should be set up to go directly to the Tenants address - NOT

HOUSING.

LIWELLING LEASE

GRAND TRAVERSE BAND HOUSING DEPARTMENT

A.

RE-DETERMINATION OF RENT, DWELLING SIZE, AND ELIGIBILITY.

RE-DETERMINATION. At least once each year, the Tenant shall furnish accurate information

to the Housing Department for use in determining whether the rent should be increased or

decreased, whether the dwelling size is still appropriate for Tenant’s family size, and whether

Tenant is still eligible for Low Income Rental Housing Assistance. This determination will be

made in accordance with the approved rent schedule and occupancy polices on file at the

Housing Department.

CUSTODY OF CHILDREN. Tenant must have legal and physical custody of any children

listed as members of the family unit.

SPOUSE VACATING. If Tenant claims a change in family composition due to a spouse

vacating the premises, Tenant shall verify the change by providing the Housing Department

with evidence of the change. The Housing Department will accept as sufficient evidence the

complete absence of a spouse from the rental premises an the filing of a separation petition in

court, or a restraining order restraining the spouse from entering the premises.

CHANGE _IN_ INCOME. Any change in income throughout the year must be reported to the

Housing Department immediately in writing. Change in income may result in re-determining of

rent, which will become effective in accordance with paragraph 5.G. of this Lease Agreement.

This re-determination of rent may occur at any time during the course of the lease.

MISREPRESENTATION. If, in the event it is determined that Tenant has misrepresented to

the Housing Department facts upon which the amount of rent is determined, any increase in

the amount of rent shall be retroactive to the date of the misrepresentation. Failure to notify the

Housing Department of any change shall be considered misrepresentation.

TRANSFER DUE TO CHANGE _IN_ SIZE OF FAMILY. If the Housing Department

determines that the size of the dwelling unit is no longer appropriate to Tenant’s family size, the

Housing Department shall provide notice of MANDAORY Transfer to the Tenant to move on or

before a date of fourteen (14) days from the date of notice.

NOTE: See Housing Department Transfer Policy for additional details.

INCREASES AND DECREASES _IN_RENT.

INCREASES in rent payments resulting from rent reviews or re-examination are to be

Tenant (s) Initials:

Date:

(1)

effective the first day of the second month following the income change.

(2) DECREASES in rent payments are to be effective the first day of the month following the

reported income change, only if notice of the decrease in income is received in writing

on or before the 25™ day of that month in awhich the income decrease is experienced by

Tenant. If notice is given after the 25" day of the month, then the rent payment

decrease will become effective the first day of the second month following the income

change.

SWELLING LEASE GRAND TRAVERSE BAND FOCUSING DEPARTMENT

6. OCCUPANCY OF THE UNIT FOR NON-DWELLING PURPOSES.

A. USE OF THE UNIT. The premises herein are leased to the Tenant for use as a private family

residence and uses normally incident thereto and for no other purpose. Tenant shall not assign

this Agreement, nor sublet or transfer possession of the premises, nor give accommodations to

boarders or lodgers without the prior written consent of the Housing Department.

Tenant further agrees not to use or permit the use of the dwelling unit for any illegal or immoral

purpose or for any purpose other than as a a private dwelling solely for the Tenant and his / her

family.

The following persons are declared legal occupants of the residence:

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name - First, Last, Ml)

(Relationship to Tenant) .

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name — First, Last, Ml)

(Relationship to Tenant)

(Name — First, Last, Ml)

(Relationship to Tenant)

B. | OVERNIGHT GUESTS. Tenant shall not permit any overnight guests or visitors to occupy the

premises for more than three (3) calendar days i in any one (1) month without written permission

of the Housing Department.

C. TEMPORARY GUESTS. In the event Tenant desires guests or visitors to occupy the premises

for more than three (3) calendar days, they must request permission from the Housing

Department, in writing. Temporary stays, approved by the Housing Department, will NOT

exceed thirty (30) calendar days.

Tenant (s) Initials:

Date:

GRAND TRAVERSE BAND HOUSING DEPARTMENT

DWELUDNG LEASE ae

D. ADDING INDIVIDUALS PERMANENTLY TO THE LEASE. In the event Tenant desires to

add individuals “permanenitly’ to the lease, he / she must submit a written request to the

Housing Department.

(1) If, said individuals meet the admissions criteria, as outlined in the Housing Department

Admissions Policy, they will be granted “permanenf status on the lease.

(2) If, said Individuals do not meet the admissions criteria they will be asked to vacate

immediately. Failure of Tenant to have said individuals vacate the unit shall result in

termination of the lease agreement.

E, COMPLIANCE WITH REGULATIONS. The Housing Department and Tenant are obligated

te maintain the project in a decent, safe, and sanitary condition. Tenant agrees to abide by the

necessary and reasonable regulations as may be adopted by the Housing Department for the

benefit and well-being of the housing project and Tenants, which regulations are posted in the.

Housing Department Office and in the Tenant Handbook and Rules of Occupancy and which

regulations are made a part hereof by reference.

F. CRIMINAL_ ACTIVITY.

(1) Tenant, any member of the Tenant’s household, or any guest or other person under

Tenant's control shall not engage in criminal activity, included drug-related criminal

activity, on or near the premises while the Tenant resides in Housing Department

property, and such criminal activity shall be cause for termination of tenancy.

(2) For purposes of this paragraph, “drug-related criminal activity’ means the illegal

manufacture, sale, distribution, use, or possession with intent to sell, distribute, or use,

of a controlled substance as defined in section 102 of the Coritrolled Substances Act

(21 U.S.C. 802).

(3) If the Housing Department has substantial relevant and admissible evidence that a

Tennant, Tenant’s Guest, or person under Tenant’s control was in possession of a

controlled substance in the Leased unit or on / near the Leased premises, shall be

grounds for Termination of the Lease. Arrest for such activity, and confiscation of drugs

(that field test - POSITIVE) and / or drug related paraphernalia is deemed sufficient

grounds for Termination of Lease. A Criminal Conviction, in a Court of Law, does not

have to take place prior to Termination of Lease.

(4) Criminal activity also includes the harboring of fugitives.

G. DAMAGES.

(2) Tenant shall refrain from, and cause Tenant’s family and guests to refrain from

deliberately or negligently destroying, defacing, damaging or removing any part of the

dwelling premises or project.

(3) Tenant shall refrain from, and cause Tenant’s family and guests to refrain from

deliberately causing any part of the dwelling premises or project to become unsafe or

unsanitary. ,

(4) Tenant’s family and guests shall conduct themselves in a manner, which will not disturb

the neighbors’ peaceful enjoyment of their accommodations and will be conducive to

maintaining the project in a safe and sanitary condition.

Tenant (s) Initials:

Date:

GRAND TRAVERSE BAND HOUSING DEPARTMENT

DYWELLING LEASE

(5) Repairs necessitated by damages caused by the Tenant or Tenant’s family or guests,

beyond reasonable wear and tear, or repairs necessitated by damages resulting from

failure to maintain the dwelling unit in a safe or sanitary condition, shall be the sole

responsibility of the Tenant.

The cost of repairs shall be paid by the Tenant, within sixty (60) calendar days, of the

damages being repaired and the Tenant billed for said damages.

(6) Tenant shall pay for any damages caused to the premises or to the development of

which the premises are a part, caused by the Tenant, by his immediate family

occupying the premises, or by the Tenant’s guests or invitees.

(7) Tenant shall pay for parts, materials, fixtures, or replacements and the labor services of

person or persons engaged to repair or replace the damage.

(8) The Housing Department agrees to maintain the buildings and common areas and

grounds of the project in a decent, safe, and sanitary condition in conformity with the

requirements of adopted housing codes and applicable regulations or guidelines. The

Housing Department shall make all necessary repairs, alterations, and improvements

to the dwelling unit necessitated by normal wear and tear.

(9) It shall be presumed that any damage to the premises were caused by Tenant, his / her

family or guests unless Tenant provides evidence to the contrary. Evidence shall be

presented by third party verification. For example, an “incident report from local law

enforcement.

(10) IMPACT ON FUTURE OCCUPANCY. Failure of the Tenant to correct or pay for such

repairs shall result in the Tenant not being eligible for future occupancy of any housing

or housing related programs offered by the Housing Department. This restriction will

remain in effect until such time as the total cost of such repairs / maintenance have

been PAID IN FULL.

G. NOTIFICATION OF DAMAGES.

(1) Tenant shall notify the Housing Department within two (2) calendar days, in writing, by

furnishing an incident report of any damage to the premises. If damages were not

caused by the Tenant, Tenant’s Family or Guests, then a supporting “incidenf report

from local law enforcement should accompany the written notice.

(2) Tenant shall immediately notify the Housing Department in the event that the

premises are damaged to an extent that renders the premises uninhabitable.

(3) Tenant shall immediately notify the Housing Department whenever damage to the

premises may cause further damage or deterioration to the dwelling unit or surrounding.

buildings or property.

H. HEALTH, SAFETY, PEACEFUL ENJOYMENT.

(1) Tenant, Tenant’s family and Tenant’s guests shall refrain from purposely or negligently

engaging in any activity which threatens the health or safety of other residents, or

employees of the Housing Department, or persons residing in the vicinity of the

premises.

Tenant (s) Initials:

Date:

{YWELLING LEASE GRAND TRAVERSE BAND HOUSING DEPARTMENT

(2) Tenant, Tenant’s family and Tenant's guests shall refrain from purposely or negligently

threatening the peaceful enjoyment of any other Tenant. Activities which threaten the

peaceful enjoyment of other Tenant's include, but are not limited to, the following:

(a) Causing loud noises, which may disturb other Tenant’s between 10:00 p.m. and

6 a.m. Such loud noises can come from any source, including, but not limited

to: Stereos, motor vehicles, voices, pets, fireworks, weapons, etc.

(b) Congregating in groups of three (3) or more (excluding legal occupants of the

residence where the congregation takes place) outside Housing units after

10:00 p.m.

(3) TERMINATING THE LEASE. A single violation of either of the activities noted above -

shall result in a WARNING being issued to the Tenant. That waming will state that any

further violation within one (4) year of the date of the warning shall result in Termination

of Tenant's Lease. A second violation within one (1) year of the date of the warring

shall result in Termination of the Tenant’s Lease.

I. SURRENDER OF PREMISES.

(1) ~ Tenant shall surrender the premises at the termination of this lease in good order and

repair, reasonable wear and tear excepted.

(2) Tenant shall remove all personal property, belongings, and furnishings from the

premises at the termination of the lease.

(a) Failure by the Tenant to remove all personal property, belongings and

fumishings shall result in the removal of the items by the Housing

Depariment.

(b) Tenant:-shall be fully responsible for the reasonable costs of removal and shall

not be eligible for occupancy of any future housing offered by the Housing

Department until the costs of removal have been paid in full.

7. PROJECT REGULATIONS

A. Tenant agrees to follow all rules and regulations prescribed by the Housing Department, which

are included in the Tenant Handbook and Rules of Occupancy and in bulletins issued by the

Housing Department from time to time, including all amendments made to such regulations.

B. The Tenant Handbook and Rules of Occupancy are made part of this lease and a violation of

said rule, in either document, is a violation of this lease.

8. ABANDONMENT

A. EFFECT OF ABANDONMENT.

(1) The premises shall be deemed abandoned and this lease shall be terminated at the

option of the Housing Department if Tenant is absent from the premises for fourteen

(14) calendar days without notifying the Housing Department or essential utilities have

been disconnected making the premises untenable.

Tenant (s) Initials:

Date:

DWELLING LEASE GRAND TRAVERSE BAND HOUSING DEPARTMENT

(2) Tenant shall remain subject to the obligations of this lease, including the obligation to

make monthly payments until the Housing Department provides Notice of Termination

to Tenant.

(3) Such notice shall be communicated by the Housing Department to the Tenant at the

Tenant’s last known address and the Termination shall be effective ten (10) calendar

days from the date of the Notice.

(4) In the event Tenant(s) cannot be located, notice shall be deemed given if mailed by

certified mail to Tenant’s last known address.

B. RE-ENTRY AND PERSONAL PROPERTY.

(1) Upon giving the Notice, the Housing Department shall have the right to re-enter the

premises, and remove all persons and personal property therefrom.

(2) The Housing Department may sell or dispose of any personal property, if any, and

apply the proceeds to any charges due the Housing Department after the Termination

date set forth in the notice.

C. SECURING THE PREMISES. In the event of abandonment, the Housing Department may,

at its discretion, secure the premises to prevent the Tenant from re-entering the premises and to

protect the unit against damage (vandalism).

D. PERSONAL PROPERTY UPON TERMINATION. Any personal property remaining in the

premises, after the lease has been terminated and the Tenant removed, shall be subject to sale

or disposal by the Housing Department. The costs associated with such sale or disposal shall

be the responsibility of the Tenant.

a. INSPECTIONS

A, INSPECTION. Tenant agrees to permit the Housing Department or its representative(s) to

enter the premises during all reasonable hours to inspect the unit or to make such repairs,

additions, or alterations as may be deemed necessary. Such entry may be made only during

reasonable hours after reasonable advance notice in writing or by telephone.

B. UNSAFE OR UNSANITARY CONDITION.

(1) If, during the course of inspection by the Housing Department, the dwelling unit is

found to be in an unsafe or unsanitary condition caused by Tenant, or damaged beyond

normal wear and tear, the Tenant shall be given fourteen (14) calendar days to repair or

correct the condition.

(2) The Housing Department may, at its discretion, have an Indian Health Service

representative inspect the dwelling unit.

(3) The Housing Department will conduct re-inspection to verify compliance.

(4) Failure by the Tenant to repair or correct the condition or damage shall result in

termination of the lease.

Tenant (s) Initials:

Date:

IDPWELLUING LEASE

GRAND TRAVERSE BAND HOUSING DEPARTMENT

C. ENTRY UPON EMERGENCY OR TO PREVENT WASTE.

(1) The Housing Departrnent shall have the right to immediately re-enter the premises in

the event of emergency or to prevent substantial damage or waste to the premises

without prior written or telephone notice to the Tenant if the Housing Department

reasonably believes that an emergency situation exits which requires such entrance.

(2) The Housing Department must thereafter promptly notify the Tenant of the date, time

and intended purpose of entry, and of the emergency, which necessitated it.

D. PRE-OCCUPANCY INSPECTION.

(1) Prior to occupancy, the Tenant and the Housing Department shall jointly inspect the

dwelling unit.

(2) The Housing Department reserves the right to videotape the inspection.

(3) The Tenant and a Housing Department representative shall (jointly) sign a statement

describing the condition of the dwelling unit and the equipment in the unit. A copy of

that statement shall be provided to the Tenant while the Housing Department will

retain the original.

E. INSPECTION UPON VACATION OF PREMISES.

(1) When the Tenant vacates the dwelling unit, the Tenant and the Housing Department

shall jointly inspect the dwelling unit.

(2) The Housing Department reserves the right to videotape the inspection.

(3) The Tenant and a Housing Department representative shall (jointly) sign a statement

describing the condition of the dwelling unit and the equipment in the unit. The

Housing Department will provide a copy of the inspection to the Tenant. Additionally,

the Housing Department will provide the Tenant with a written statement detailing any

deductions from the security deposit within forty-five (45) calendar days of the date the

Housing Department is notified that the Tenant has vacated the premises. Both will

be sent to the Tenant’s last known address.

EF. TENANT’s DUTIES UPON VACATING PREMISES. Prior to vacating the premises, the

Tenant shall:

(1) Notify the Housing Department, in writing. Telephone notifications will NOT be

accepted.

(2) Make all necessary arrangements with utility and other service providers to terminate

service.

(3) Request a MOVE-OUT Inspection.

(4) Return the keys to the premises to the Housing Department.

Tenant (s) Initials:

Date:

KNWELLING LEASE

GRAND TRAVERSE BAND HOUSING DEPARTMENT

10. TERMINATION OF THE RENTAL AGREEMENT

A.

REASONS _ FOR TERMINATION. The Housing Department will not terminate a tenancy

except for serious or repeated violations of the terms or conditions of the lease or for other good

cause.

SERIOUS VIOLATIONS. The following violations shall be considered “serious” violations and

shall result in the termination of the lease:

(1)

(2)

(3)

(4)

(5)

6)

)

(8)

(9)

(10)

(11)

Failure to pay Rent when due.

Failure to repair damage to sremises in accordance with the terms of the lease.

Misrepresentation of facts regarding income and members of the household.

Failure to properly maintain utilities.

Engagement in Criminal activities.

Failure to notify the Housing Department of damage to the premises.

Failure to maintain the premises and grounds in a safe and sanitary condition.

Engaging in conduct, which threatens the health, safety, or peaceful enjoyment of any

person in accordance with Section 6.H. of this lease.

Intentionally causing damage to premises.

Failure to pay money owed to the Housing Department pursuant to this lease.

Possession of a firearm in violation of the Housing Departments published rules.

REPEATED VIOLATIONS. Repeated violations shall mean two (2) or more violations of any

provisions of this lease or the attached Tenant Handbook and Rules of Occupancy.

TERMINATION NOTICE. The lease shall be terminated fourteen (14) calendar days from

receipt of Notice of Termination by the Tenant pursuant to this section.

11. LEGAL NOTICES

A.

Tenant (s) Initials:

Date:

SUFFICIENCY OF NOTICE TO TENANT. Any notice to Tenant required hereunder will be

sufficient if:

(1)

(2)

Delivered in writing to the Tenant personally, or —

To an adult member of Tenant’s family residing in the dwelling unit

10

DWELLING LEASE GRAND TRAVERSE BAND HOUSING DEPARTMENT

(3) If the notice cannot be given under 11.A.(1) or 11.A.(2) with reasonable diligence, then

the Housing Department or its designated representative will:

(a) Deliver the notice by mail to the Tenant by certified mail, return receipt

requested, or;

(b) Affix a copy of the notice in a conspicuous place on the rental premises where it

can be conveniently read and by mailing a copy by regular or other mail to the

Tenant’s last known address.

SUFFICIENCY OF NOTICE TO THE HOUSING DEPARTMENT. Notices to the Housing

Department are to be given to the Housing Department in writing and shall be delivered to a

Housing Department employee at the Housing Department Office or delivered by mail to the

Housing Department by certified mail, return receipt requested.

12. GRIEVANCE PROCEDURE

All grievances or appeals arising under this Dwelling Lease shall be processed and resolved pursuant to

the Grievance Procedure of the Housing Department which is in effect at the time such grievance or

appeal arises, which procedure on file at the Housing Department office and incorporated herein by

reference.

13. ENTIRE AGREEMENT

This Lease, consisting of twelve (12) pages and incorporating by reference the Tenant Handbook and

Rules of Occupancy together with any adjustments of rent or dwelling unit, which evidences the entire

agreement between the Housing Department and Tenant.

14. TENANT HANDBOOK AND RULES OF OCCUPANCY

Tenant has received a copy of the Tenant Handbook and Rules of Occupancy reviewed the same with a

Housing Department representative and understands the provisions thereof.

Tenant (s) Initials:

Date:

11

GRAND TRAVERSE BAND HOUSING DEPARTMENT

DiWELLING LEASE

IN WITNESS WHEREOF, the parties have executed this lease agreement this

day of

, 2002, at Peshawbestown, MI.

(Signature of Head of Household) (Date)

(Signature of Tenant’s Spouse) (Date)

(Signature of Co-Lease Holder - Other than Spouse) (Date)

(Signature of Resident Services Representative) (Date)

(Signature of Housing Department Director) (Date)

Distribution: Copy to Tenant

Original to Tenant File

Tenant (s) Initials:

Date:

12

APPENDIX 26

Sample Lease

TAX CREDIT

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