Dear Applicant, please be advised that any incomplete application

ATTENTION APPLICANT

PLEASE CONSIDER THE FOLLOWING ITEMS BEFORE SUBMITTING YOUR

APPLICATION.

ORDER OF PREFERENCE

1) Preference given to TAT enrolled members, veteran preference DD14 required.

2) Preference given to homeless persons.

3) Preference given to families with children or individuals living in multi-family

home establishments.

4) Preference given to Elders 55 and older.

5) Preference given to individuals residing in North Segment

Preference shall not be given to a family who already owns a home.

OCCUPANCY LIMITS MAX OCCUPANCY

1) 1 Bedroom 4 occupants

2) 2 Bedroom 6 occupants

3) 3 Bedroom 8 occupants

Children who are over the age of 6 and differ in sex cannot share a bedroom, this

will be a factor in consideration.

FOR TRANSFERRING TO A MOBILE HOME

• Preference to people who have previously rented with us.

Dear Applicant, please be advised that any incomplete

application will not be considered. All applicants will receive

one courtesy call to inform them of missing items. If you are

not responsive you will not be considered at the time approvals

take place. Furthermore, all criminal findings on the

background check will be considered on a case by case basis.

Sex and drug related offenses will automatically disqualify your

consideration.

North Segment Property Management

1250 3

rd

Ave E

PO Box 579

New Town, ND 58763

Office: 701-627-3270 Fax: 701-627-3240

North Segment Property Management Housing is for families who can

financially afford housing and keep up with monthly payments.

Which Housing Project are you applying for?

________ Hawks Estates

________ Wooden Bowl

________ North Segment Housing (Elbowoods)

________ River View Trailer Park – Lot Only

________ Golden Age Trailer Park – Lot Only

________ Cottonwood Trailer Park – Lot Only

________ Van Hook Units - Lease

________ Commercial Property

** RED HAWK HOUSING UNITS ARE PET FREE AND ALL HOUSING IS DRUG FREE.

** $40.00 application fee is required before application is processed.

Money order or check only.

This is a non-refundable application fee!

Make sure to fill out the whole application otherwise it’s

going to be considered incomplete!

North Segment Property Management

350 East Ave Lot A-21

New Town, ND 58763

Office: 701-627-3270 Fax: 701-627-3240

INTAKE APPLICATION

Name:_______________________________________________________________________

(First) (MI) (Last)

Current Address_____________________________________________________________

________________________________________________________P.O. Box Number____

City State Zip

Segment currently residing in?_______________________________________________

Telephone/Cell number:_____________________________________________________

Social Security Number______________________________________________________

Tribal Affiliation_______________________________ Enrollment No._______________

Marital Status: Married______ Single_____ Divorced_______ Other_________

Information of Co-Applicant

Name:_______________________________________________________________________

(First) (MI) (Last)

Address______________________________________________________________________

______________________________________________________________________________

Telephone/Cell number______________________________________________________

Social Security number_______________________________________________________

Tribal Affiliation________________________________Enrollment No._______________

Marital Status: Married______ Single_____ Divorced_____ Other___________

North Segment Property Management

350 East Ave Lot A-21

PO Box 579

New Town, ND 58763

Office: 701-627-3270 Fax: 701-627-3240

EMPLOYMENT INFORMATION

Are you employed_______ Where?_____________________________________________

Employer Phone number_____________________________________________________

Please provide information of all income for family members who will be

residing the home. (ie. Last two pay stubs, Social Security benefits)

______________________________________________________________________________

Total annual household income_______________________________________________

HOUSEHOLD INFORMATION

Applying for:

One (1) Bedroom_______ Two (2) Bedroom ________ Three (3) Bedroom_______

Note: A background Check for all individuals over the age of 18 will be conducted. A

background form must be filled out for every household member age 18 and over.

Please list all members of your household including yourself in the space below:

NAME

DATE OF BIRTH

RELATIONSHIP

SOCIAL

SECURITY NO.

Have you applied for other housing assistance from either Fort Berthold

Housing Authority, other Segment Housing, FEMA Housing or the Tribal Credit

Program?

______________________________________________________________________________

Do you own any other home not occupied by your family? ___________________

Where?______________________________________________________________________

______________________________________________________________________________

Is anyone in your household handicapped____________________________________

_____________________________________________________________________________

Does anyone in your household have a Felony charge_______ Explain__________

______________________________________________________________________________

Are you a Veteran_______________________ Attach DD214_____________________

Required Documents

• Photo ID’s of all Adults residing in the household

• Copy of Social Security cards of all members in the household

• Tribal enrollment copies of household members

• Copy of last two pay stubs from employment of all working household

members

• Last landlord’s information so we can contact for reference

______________________________________________________________________________

Please read the application over carefully, make sure all information to the best

of your knowledge is true and accurate. This information is being used to

verify your eligibility to receive housing.

I understand that false or misleading information will affect my eligibility for

housing consideration.

Applicants signature____________________________________ Date________________

Co-Applicants signature_________________________________ Date________________

Emergency contact person____________________________________________________

Authorization for Criminal Background/Credit Check

I hereby authorize the release of information for my criminal convictions and credit record to

the North Segment Property Management. This includes, but is no limited to Local, Tribal,

State and Federal Agencies

OTHER APPLICANT OVER THE AGE OF 18

Name (first, middle, last):

Other names used:

(i.e., maiden first or last names,

nicknames etc.)

Social Security Number:

Birth Date:

Present Address:

Previous Address:

The records identified above will be used for screening purposes in the applicant

process for the rental of a lot space at all trailer courts and estates owned by North

Segment Property Management.

By signing this form, I hereby agree that I will not file any claim or lawsuit against the

North Segment Property Management relating to the use of any criminal and credit

records regarding me for screen purposes.

________________ ______________________________

Date: Signature of Household Member

Three Affiliated Tribes: Mandan, Hidatsa, & Arikara

North Segment Property Management

Councilwoman Monica Mayer, M.D.

350 East Ave A-21

New Town, ND 58763

Office: 701-627-3270 Fax: 701-627-3240

mmayer@mhanation.com