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194 Rumford
Mansfield, MA
Information Package and Lottery Application
Attached is the information regarding the affordable rental units at 194 Rumford in Mansfield, Massachusetts.
Potential Tenants will not be discriminated against on the basis of race, color, national origin, disability, age, ancestry,
children, familial status, genetic information, marital status, public assistance recipiency, religion, sex, sexual orientation,
gender identity, veteran/military status, or any other basis prohibited by law.
194 Rumford is a new 8-unit rental row house townhome development offering 1 affordable two-bedroom unit,
by lottery, for an eligible applicant. The two-bedroom unit includes 2 bathrooms in approximately 1,500 sq. ft. of living
space. Washer and Dryer hook-ups in the unit. One covered parking space is available at no charge. All kitchen
appliances included. This is a pet free and smoke free property. Service animals will be allowed with appropriate
documentation.
The monthly rent is: $1,922. Tenants are responsible for all electric utilities and water, except sewer. A utility
allowance has been deducted from the rents. All affordable units will be distributed by lottery as outlined in the
attached package.
These rents are NOT income based. Applicants are responsible for the full rent as stated above. Section 8 or
other housing vouchers will be accepted, and it is up to you to talk with your voucher holder to determine if they will
approve the project and accept the rents. Generally, the minimum income needed to lease a unit, without a Section 8
or other housing voucher, is: $57,660. Income and assets may be used in determining minimum income eligibility, if
needed.
PLEASE NOTE: All applicants must include complete financial documentation with the application. An
application will be considered incomplete and will not be included in the lottery if all financial documentation is not
received on or before the application deadline.
Applicants who submitted an incomplete application will be notified after the application deadline and will
NOT be included in the lottery. Applicants that submit an incomplete application will be notified via email, if
available, or by letter. The email or letter will include the list of missing documentation. If you submit the missing
documentation and your application is determined complete you would be added to the waiting list. If unfilled units
remain after the lottery, the available units would then be offered to you based on the date you were added to the
waiting list, subject to applicable preferences and eligibility.
KEY DATES
Public Information Meeting via Zoom
6:30 p.m., Wednesday, June 5, 2024
Go to Zoom.com, click Join Meeting and provide the following when prompted:
Meeting ID: 827 0189 5234
Passcode: 023680
Application Deadline, Postmarked on or before
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July 1, 2024
Lottery via Zoom
3:00 p.m., Wednesday, July 31, 2024
Go to Zoom.com, click Join Meeting and provide the following when prompted:
Meeting ID: 886 5478 8374
Passcode: 671474
For those applicants who are unable to attend the live Zoom or otherwise want to review, the meeting will be
recorded, with those portions not containing unauthorized sensitive personal information, and will be available for
viewing up to the application deadline, upon request.
Thank you for your interest in affordable housing at 194 Rumford. We wish you the best of luck. Please contact
MCO Housing Services at 978-456-8388 or email us at [email protected]m
if you have any questions.
We encourage you to advise other people or organizations that may be interested in this program and make copies of
the relevant information as needed.
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194 Rumford
Question & Answer
The units will be leased in accordance with policies and guidelines established by the Commonwealth of Massachusetts
Executive Office of Housing and Livable Communities (EOHLC) through its LAU program.
What are the qualifications required for Prospective Tenants?
• Qualify based on the following maximum income table, which is adjusted for household size:
Household Size
1
2
3
4
Max Gross Allowable Income
$68,500
$78,250
$88,050
$97,800
LOTTERY APPLICANT QUALIFICATIONS:
1. Household income cannot exceed the above maximum gross allowable income limits. Income for adults 18 or older
is required.
2. When assets total $5,000 or less, the actual interest/dividend income earned is included in the annual income OR
when assets exceed $5,000, annual income includes the greater of actual income from assets or a .06% imputed income
calculation. Assets divested at less than full market value within two years of application will be counted at full market
value when determining eligibility. Asset statements for adults 18 or older are required.
3. In addition to income and asset eligibility you will also be subject to a screening by the project and determined
eligible based on that basis.
4. Applicants may not own a home and lease an affordable unit, including homes in a trust.
5. Persons with disabilities will be given first preference for such units regardless of what pool they are in based on the
requested bedroom size. Where a person with a disability is awaiting an accessible unit and a unit with adaptive
features becomes available, the owner/management agent must offer to adapt the unit.
Are there units available for Local Preferences?
No, the available unit will be distributed through the Open Pool.
Are there Group 2 units?
All the units are adaptable. There are no Group 1 or 2 units. Persons with disabilities are entitled to request a
reasonable accommodation in rules, policies, practices, or services, or to request a reasonable modification in the
housing, when such accommodations or modifications may be necessary to afford persons with disabilities an equal
opportunity to use and enjoy the housing. Such reasonable accommodation in not limited to Group 2 units. The request
for reasonable accommodation must be made at time of initial lottery application with the required documentation, i.e.
letter from doctor.
Are there preferences for Household Size?
Preference for the two bedrooms will be for households requiring two bedrooms.
Household Size Preferences are based on the following:
1. There is at least one occupant per bedroom.
2. A husband and wife, or those in a similar living arrangement, shall be required to share a bedroom. Other
household members may share but shall not be required to share a bedroom.
3. A person described in the first sentence of (2) shall not be required to share a bedroom if a consequence of
sharing would be a severe adverse impact on his or her mental or physical health and the lottery agent receives
reliable medical documentation as to such impact of sharing.
4. A household may count an unborn child as a household member. The household must submit proof of pregnancy
with the application.
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What happens if my household income exceeds the income limit?
Annually you will be recertified for eligibility. Once your household income exceeds 140% of the maximum allowable
income adjusted for household size, then after the end of your current lease you will have the option of staying in your
unit and paying the market rent or not renewing your lease.
Lottery Process
Due to the nature of the affordable units’ availability, it is important for everyone to understand the procedure. Please
understand the allowable income guidelines are adjusted based upon your household size. Also be advised that the
program and its requirements are subject to changes in state or federal regulations.
Lottery Pools
One two-bedroom affordable unit is available by lottery at 194 Rumford through the Open Pool.
All applicants determined eligible will be provided with a lottery code which will be announced during the lottery.
All of the applicants will be pulled at the time of the lottery. This will establish the rankings for the distribution of the
unit. The highest ranked applicant requiring a two-bedroom unit will have the initial opportunity to lease.
Please note: Household size shall not exceed, nor may the maximum allowable household size be more restrictive than,
State Sanitary Code requirements for occupancy of a unit (See 105 CMR 400). Applicants will not be approved for units
larger than their household size allows.
Once the lottery rankings have been determined your information will be forwarded to the Leasing Office for credit and
background checks to the extent permitted by EOHLC guidance in effect at the time of your application. If the Leasing
Office determines you are eligible then you will be offered a unit. At lease signing you will be required to pay the first
month’s rent and security deposit which is TBD.
You need to be determined eligible by MCO Housing Services, the Leasing Office, and if you have a Section 8 or other
housing voucher, your Public Housing Authority (PHA). If the PHA determines you or the project do not meet the
eligibility criteria, then you will not be able to lease a unit.
If there are lottery applicants remaining once the affordable unit is leased then, based on the order in which such
applicant was drawn from the Open Pool and subject to any applicable preferences for accessible units and household
size, MCO Housing Services will establish a waiting list for future vacancies.
Time Frames
If you are selected and have the opportunity to lease a unit you will speak or meet with a representative to review your
application to verify all information. Please be advised that the official income verification will be done at the time you
have an opportunity to lease. Also understand you need to be income and asset eligible but will also, at minimum, be
subject to a credit screening, landlord screening, employment verification, criminal background and CORI checks by the
project and determined eligible or ineligible on that basis to the extent consistent with EOHLC guidance in effect at the
time of such determination.
Acceptance of Units
Post lottery each applicant will need to meet with the Leasing Office and complete their screening by the deadline
provided. If you miss the deadline, we will move to the next applicant waiting for a unit and you may lose the
opportunity to lease.
Summary
We hope this helps explain the process by which the units will be distributed. It can be a lengthy and sometimes
complicated process. We greatly appreciate your participation and wish you the best of luck in the lottery process.
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THE AFFORDABLE UNIT IS #6
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PERSONAL INFORMATION:
Date: ___________________
Name: ____________________________________________________________________________________________
Address: __________________________________________Town: ______________________ Zip: ________________
Home Telephone: __________________ Work Telephone: _____________________ Cell: _________________________
Email: ____________________________________________________________________________________________
Have you ever owned a home? _______ If so, when did you sell it? _______
Do you have a Section 8 or other housing voucher (the units are NOT subsidized, or income based): ____ Yes ____ No
Do you require any adaptations or special accommodation? _____ Yes _____ No
If Yes, Please explain:________________________________________
The total household size is _________
Household Composition - complete for everyone that will be living in the unit.
Name ________________________________________________Relationship______________________ Age_____
Name ________________________________________________Relationship______________________ Age_____
Name ________________________________________________Relationship_____________ _________Age_____
Name ________________________________________________Relationship_____________ _________Age_____
FINANCIAL WORKSHEET: (Include all Household Income, which includes gross wages, retirement income (if drawing on
it for income), business income, veterans’ benefits, alimony/child support, unemployment compensation, social security,
pension/disability income, supplemental second income and dividend income.)
Applicants Monthly Base Income (Gross) _______________________
Other Income, specify __________________ _______________________
Co-Applicants Monthly Base Income (Gross) _______________________
Other Income, specify _________________ _______________________
TOTAL MONTHLY INCOME: _______________________
Household Assets: (This is a partial list of required assets. Complete all that apply with current account balances)
Checking ________________________
Savings ________________________
Debit Card ________________________
For Office Use Only:
Date Appl. Rcvd: _____________
Household Size: ____________
Lottery Code: _______________
Application Deadline: July 1, 2024
194 Rumford
LOTTERY APPLICATION
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Stocks, Bonds, Treasury Bills, CD or
Money Market Accounts and Mutual Funds ________________________
Individual Retirement, 401K and Keogh accounts ________________________
Retirement or Pension Funds (amt you can w/d w/o penalty) ________________________
Revocable trusts ________________________
Equity in rental property or other capital investments ________________________
Cash value of whole life or universal life insurance policies ________________________
TOTAL ASSETS _______________________
EMPLOYMENT STATUS: (include for all working household members. Attach separate sheet, if necessary.)
Employer: ______________________________________________________________
Street Address: _____________________________________________________________
City/State/Zip: ______________________________________________________________
Date of Hire (Approximate): ____________________________________________________
Annual Wage - Base: __________________________
Additional: ______________________ (Bonus, Commission, Overtime, etc.)
ABOUT YOUR HOUSEHOLD: (OPTIONAL)
You are requested to fill out the following section in order to assist us in fulfilling affirmative action requirements.
Please be advised that you should fill this out based upon family members that will be living in the apartment/unit.
Please check the appropriate categories:
Applicant Co-Applicant (#) of Dependents
Black or African American _________ _________ _________
Hispanic or Latino _________ _________ _________
Asian _________ _________ _________
Native American or Alaskan Native _________ _________ _________
Native Hawaiian or Pacific Islander _________ _________ _________
Not White _________ _________ _________
SIGNATURES:
The undersigned warrants and represents that all statements herein are true. It is understood that the sole use of this
application is to establish the preliminary requirements for placement into a lottery to have an opportunity to lease an
affordable unit at 194 Rumford. I (we) understand if selected all information provided shall be verified for accuracy at
the time of lease.
Signature ________________________________ Date: _________________________
Applicant(s)
Signature ________________________________ Date: _________________________
Co-Applicant(s)
Refer to page 17 for submission information
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194 Rumford
Affidavit & Disclosure Form
I/We understand and agree to the following conditions and guidelines regarding the distribution of the affordable units
at 194 Rumford in Mansfield, MA through the Mass Executive Office of Housing and Livable Communities:
1. The gross annual household income for my family does not exceed the allowable limits as follows:
Household Size
1
2
3
4
Max Gross Allowable Income
$68,500
$78,250
$88,050
$97,800
Income from all family members, over the age of 18, must be included.
2. I/We understand the calculation of income will include the higher of actual income from assets (if over $5,000) or an
imputation of .06% of the value of total household assets which is added to a household’s income in determining
eligibility.
3. The household size listed on the application form includes only the people that will be living in the residence.
4. I/We certify all data supplied on the application is true and accurate to the best of my/our knowledge and belief
under full penalty of perjury. I/We understand that providing false information will result in disqualification from
further consideration.
5. I/We understand that being selected in the lottery does not guarantee that I/we will be able to lease a unit. I/We
understand that all application data will be verified, and additional financial information may be required, verified
and reviewed in detail prior to leasing a unit. I/We also understand that the Project’s Owner will also perform its own
screening to determine our eligibility to lease.
6. I/We understand that if selected I/we will be offered a specific unit. I/We will have the option to accept the available
unit, or to reject the available unit. If I/we reject the available unit I/we will move to the bottom of the waiting list
and will likely not have another opportunity to lease an affordable unit at 194 Rumford.
7. Program requirements are established by EOHLC and are enforced by EOHLC. I/We agree to be bound by whatever
program changes may be imposed at any time throughout the process. If any program conflicts arise, I/we agree that
any determination made by EOHLC is final.
8. Affordable units may not be leased to individuals who have a financial interest* in the development or to a Related
Party,** or to their families. I/we certify that no member of our household has a financial interest in this Project, is
a Related Party, or is a family member of someone who has a financial interest or is a Related Party.
*“Financial interest” means anything that has a monetary value, the amount of which is or will be determined by
the outcome of the Project, including but not limited to ownership and equity interests in the Developer or in the
subject real estate, and contingent or percentage fee arrangements; but shall not include third party vendors and
contractors.
**Related Party means:
1. any person that, directly or indirectly, through one or more intermediaries, controls or is controlled by or is under
common control with the Developer, as well as any spouse of such person or “significant other” cohabiting with
such person, and any parent, grandparent, sibling, child or grandchild (natural, step, half or in-law) of such person;
2. any person that is an officer of, member in, or trustee of, or serves in a similar capacity with respect to the
Developer or of which the Developer is an officer, member, or trustee, or with respect to which the Developer
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serves in a similar capacity, as well as any spouse of such person or “significant other” cohabiting with such person,
and any parent, grandparent, sibling, child or grandchild (natural, step, half or in-law) of such person;
3. any person that, directly or indirectly, is the beneficial owner of, or controls, 10% or more of any class of equity
securities of, or otherwise has a substantial beneficial interest (10% or more) in, the Developer, or of which the
Developer is directly or indirectly the owner of 10% or more of any class of equity securities, or in which the
Developer has a substantial beneficial interest (10% or more) , as well as any spouse of such person or “significant
other” cohabiting with such person, and any parent, grandparent, sibling, child or grandchild (natural, step, half or
in-law) of such person;
4. any employee of the Developer; and
5. any spouse, parent, grandparent, sibling, child or grandchild (natural, step, half or inlaw) of an employee of the
Developer or “significant other” cohabiting with an employee of the Developer.
9. I/We understand there may be differences between the market and affordable units and accept those differences.
10. I/We understand if my/our total income exceeds 140% of the maximum allowable income at the time of annual
eligibility determination, after the end of my then current lease term I will no longer be eligible for the affordable rent.
I/We have completed an application and have reviewed and understand the process that will be utilized to distribute the
available units at 194 Rumford. I/We am qualified based upon the program guidelines and agree to comply with
applicable regulations.
_______________________ ____________________________ _____________________
Applicant Co-Applicant Date
Refer to page 17 for submission information
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APPLICATION TIPS INFORMATION
1. More than 70% of applications submitted to MCO Housing Services for lotteries are incomplete and
not included in lotteries. Please take the time to read the application and submit all required
documentation. It is your responsibility to provide the correct documentation. It does not matter if
you were the first application or the last application received, we will NOT review applications until
AFTER the posted deadline.
2. Read the NOTES on the Required Personal Identification and Income Verification Documents. Failure
to do so could mean the difference between a complete and incomplete application as well as
eligibility for a unit.
3. All financial documentation, income, assets and tax returns, are required from all household adults
aged 18 or older. No exceptions.
4. All Asset statements must include your name, account number and Institution name. Do not take
photos or copy a statement from your phone. If you provide any asset statements without the
above information your application is an automatic incomplete.
5. DO NOT ASSUME you do not need to provide a certain document. When in question call or email
BEFORE you submit your application.
6. We will not use the amount listed on your paystubs or W2’s regarding your retirement account i.e.
401K, 403B, IRA, Roth IRA etc. Your paycheck and W2’s tell us you have a retirement account only.
You must provide the last statement from whoever is managing the account for MCO to determine
the account’s value.
7. Do NOT forget to include statements from Robinhood or any other online investment accounts.
They are considered part of your assets. If you have an open account, you must provide a statement
whether there are any funds in the account or not.
8. If you are unable to provide specific information, then submit a note with your application
explaining the circumstances. This will not guarantee your application will be included in the lottery,
but depending on the circumstances, we may be able to work with you.
9. Do not take photos with your cellphone of any documentation and email it to us. The photos are not
legible, and we will not accept them.
10. You can fax your information, but it is not recommended. If all pages are not received your
application would be considered incomplete.
I/We have read the above information.
___________________________________________ _______________________________________
Print Name Signature Date
____________________________________________ ________________________________________
Print Name Signature Date
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Required Personal Identification and Income Verification Documents
TO BE RETURNED WITH APPLICATION
Provide all applicable information. Complete financial documentation is required and must be sent
with your application to participate in the lottery. Incomplete applications will not be included in the lottery
and the applicant will be notified after the application deadline. If you have any questions contact MCO
Housing Services at 978-456-8388.
Initial each that are applicable, and provide the documents, or write N/A if not applicable and return this
sheet with your application.
1. _____ If you have a Section 8 Voucher or other Housing Voucher, you MUST provide a valid copy with
your application.
2. _____ One form of identification for all household members, i.e. birth certificates, driver’s license, etc.
3. _____ If you require Special Accommodation you must request as part of your application and if
documentation is required, i.e. doctors letter, it MUST be included with the application.
4. _____ The most recent last five (5) consecutive pay stubs for all jobs (check/direct deposit stubs). This
also jobs include per diem, seasonal or sporadic employment. For unemployment, DOR verification
stating benefits received and payment history. Same for disability compensation, worker’s
compensation and/or severance pay.
• NOTE: If you have obtained a new job within the last 12 months you must provide a copy of the
Employment Offer Letter.
• NOTE: If you are no longer working for an employer you worked for in the last 12 months, you must
provide a letter from the employer with your separation date.
• NOTE: You need to provide 5 pay stubs whether you are paid weekly, bi-weekly, semi-weekly, or
monthly.
5. _____ Benefit letter providing full amount of periodic amounts received from Social Security, annuities,
insurance policies, retirement funds, pensions, disability or death benefits and other similar types of
periodic receipts.
6. _____ Child support and alimony: court document indicating the payment amount, DOR statement or
copy of divorce papers. If you do not receive child support provide a letter stating that you are not
receiving child support or complete the attached form.
7. _____ If you are self-employed you MUST provide a detailed Profit and Loss statement for the last 12
months and three months of business checking and savings accounts along with the last three Federal
Income Tax Returns. Uber, Lyft, Grubhub, etc. are considered self-employment.
8. _____ Federal Tax Returns – 2023 (NO STATE TAX RETURNS)
• NOTE: Provide all pages that are submitted to the IRS. For example, if a Schedule 1 is submitted to
the IRS and not part of your application, your application will be considered incomplete.
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• NOTE: If you have not filed tax returns, in the required years, you must submit a letter from the IRS
verifying you have not filed. To obtain the letter submit form 4506-T, located at irs.gov, to the IRS
and they will mail you the letter or create an account at irs.gov and print out the Verification of Non-
filing letter for the tax year needed.
• NOTE: If you are unable to locate your tax returns you can submit a Tax Transcript of your tax return.
To obtain a Tax Transcript complete Form 4506-T, located at irs.gov, and submit to the IRS or create
an account at irs.gov and print out the Tax Transcripts for the year needed.
9. _____ W2 and/or 1099-R Forms: 2023
NOTE: If you are unable to locate your W2/1099’s you can submit a Wage Transcript of your
W2/1099’s. To obtain a transcript complete Form 4506-T, located at irs.gov, and submit to the IRS or
create an account at irs.gov and print out the required Wage Transcripts.
10. _____ Interest, dividends and other net income of any kind from real or personal property.
11. Asset Statement(s): provide current statements of all that apply, unless otherwise noted:
GENERAL NOTE: ALL ASSETS STATEMENTS MUST INCLUDED YOUR NAME, ACCOUNT NUMBER AND
INSTITUTION NAME FOR ALL CHECKING, SAVINGS, INVESTMENT ACCOUNTS AND RETIREMENT
ACCOUNTS. ANY ACCOUNTS PROVIDED WITHOUT THIS INFORMATION IS AN AUTOMATIC INCOMPLETE
APPLICATION.
• _____Checking accounts – Last three (3) months of statements – EVERY PAGE – FRONT AND BACK.
NOTE: Direct deposits from Payroll, SS, tax refund, transfers between your accounts, DOR, DTA
etc. we can identify. If you have cash deposits, payroll or non payroll or other income deposits you
MUST identify where the funds have come from. For example only, VENMO, EBAY, POSHMARK,
PAYPAL, CASH APP, ATM and MOBILE deposits, ZELLE and other transfers between any accounts
but your accounts, etc. There is no way we can list all sources. If you fail to explain these deposits
they will be counted as income, which may put you over the income limit.
NOTE: Do NOT provide a running transaction list of activity. You must provide individual
statements, every page front and back..
• _____Pre-paid debit card statements – current month.
NOTE: This is NOT your ATM/Debit card. This is usually a separate debit card statement showing
income deposited directly onto the debit card, i.e. Social Security or other regular income.
NOTE: If Social Security payments are deposited on a Direct Express card it is your responsibility to
provide proof. You can print a statement from the Direct Express website at
https://www.usdirectexpress.com/.
• _____Saving accounts – last three months of full statements
NOTES: Direct deposits from Payroll, SS, tax refund, transfers between your accounts, DOR, DTA
etc. we can identify. If you have cash deposits, payroll or non payroll or other income deposits you
MUST identify where the funds have come from. For example only, VENMO, EBAY, POSHMARK,
PAYPAL, CASH APP, ATM and MOBILE deposits, ZELLE and other transfers between any accounts
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but your accounts, etc. There is no way we can list all sources. If you fail to explain they will be
counted as income, which may put you over the income limit.
• _____Revocable trusts
• _____Equity in rental property or other capital investments
• _____Investment accounts, including stocks, bonds, Treasury Bills, Certificates of Deposit, Mutual
Funds, Money Market, Robinhood and all online accounts, etc.
• _____ Retirement accounts, IRA, Roth IRA, 401K, 403B, etc for all current and past jobs
• _____Cash value of Whole Life or Universal Life Insurance Policy.
• _____Personal Property held as an investment
• _____Lump-sum receipts or one-time receipts
NOTE: 401K, 403B or whatever your retirement account is called are required for Current and Past Jobs. If
you have rolled over an old account you need to let us know and provide the documentation.
12. _____Proof of student status for dependent household members over age of 18 and full-time students.
Letter from High School or College providing student status, full time or part time for current or next
semester.
13. _____A household may count an unborn child as a household member. The household must submit
proof of pregnancy with the application, i.e. letter from doctor.
14._____If the applicant is in the process of a divorce or separation, the applicant must provide legal
documentation the divorce or separation has begun or has been finalized. Information must be provided
regarding the distribution of family assets. If not provide then the all household income and assets will be
counted even if one adult will not be living in the unit.
15._____If you receive money to assist with your monthly expenses that is considered a gift and will count
towards your income eligibility. If you receive monies then you need to provide a letter documenting
amount and who the funds are from. If you have the opportunity to lease a form will be sent to be
completed by the gift giver.
We understand if we do not provide all applicable financial documentation we will not be included in the
lottery. We also understand that in such an event we will be notified after the application deadline that our
application is incomplete. We also acknowledge that MCO Housing Services will not make any changes to
our application before the deadline date.
Print Applicants Name(s): ______________________________________________________
_________________________________________ ______________________________________
Applicants Signature DATE Co-Applicants Signature DATE
Refer to page 17 for submission information
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194 Rumford
Mansfield, MA
Release of Information Authorization Form
Date: ________________
I/We hereby authorize MCO Housing Services, 194 Rumford Leasing Office, 194 Rumford, LLC, or any of its assignees to
verify any and all income, assets and other financial information, to verify any and all household, resident location and
workplace information and directs any employer, landlord or financial institution to release any information to MCO
Housing Services, 194 Rumford Leasing Office, 194 Rumford, LLC, or any of its assignees and consequently the Projects
Administrator, for the purpose of determining income eligibility for 194 Rumford.
A photocopy of this authorization with my signature may be deemed to be used as a duplicate original.
_____________________________________________________________________
Applicant Name (Please Print)
_____________________________________________________________________
Applicant Name (Please Print)
______________________________________
Applicant Signature
______________________________________
Applicant Signature
Mailing Address
__________________________________
__________________________________
__________________________________
__________________________________
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Return the following to MCO Housing Services:
1. Completed, signed and dated application
2. Signed and dated Affidavit and Disclosure Form
3. Signed and dated Application Tips Information
4. Completed, signed and dated Required Personal Identification and Income Verification
Documents Form
5. All required financial documentation
6. Complete, signed and dated Release of Information Authorization Form
7. Special Accommodation Income, if needed
8. Completed, signed and dated Custody & Child Support Affidavit, if applicable.
Application deadline on or before the July 1, 2024. You may submit
documentation via email, fax or mail.
MCO Housing Services, LLC
P.O. Box 372
Harvard, MA 01451
Overnight mailing address: 206 Ayer Road, Harvard, MA 01451
Phone: 978-456-8388
FAX: 978-456-8986
Email: lotteryinfo@mcohousingservices.com
TTY: 711, when asked 978-456-8388
NOTE: If you are mailing your application close to the application deadline, make sure you go into the Post Office and
have them date stamp and mail. As I understand, mail that is sent to the central sorting facility may use bar codes so we
would have no idea when the application was mailed and it can take longer for MCO to receive. If we receive an
application after the deadline that has a barcode it will be counted as a late application and will not be included in the
lottery.
