application for housing · 2013-09-08 · application for housing ... 3. information will not be...

11
Application for Housing DISTRICT OF COCHRANE SOCIAL SERVICES ADMINISTRATION BOARD HOUSING SERVICES ACCESS For Office Use Only: Primary Provider: _____________________________________________________________________ Date application Received: _______________ Time: __________ Received By: ____________________ Please indicate if you are interested in: a) Rent Geared to Income (Subsidized Rent) b) Market Rent (Non-subsidized Rent) c) Number of Bedrooms required ___________ Yes ________ No ________ Yes ________ No ________ This copy will serve to acknowledge receipt of your application by the District of Cochrane Social Services Administration Board, Housing Services Access, and to acknowledge that your application is: Complete or Incomplete. If “Incomplete” is circled, please fill in the highlighted areas on the application and / or provide the missing information, as requested. If “Complete” is circled, retain this for your records. If you have any questions, please call the Housing Services nearest you. PLEASE READ THE FOLLOWING, COMPLETE THE NAME AND ADDRESS BELOW THEN YOUR SIGNATURE IS REQUIRED COLLECTION OF PERSONAL INFORMATION CLAUSE Personal information contained on this form or in attachments, including form 1, is collected by the District of Cochrane Social Services Administration Board pursuant to Sections 162, 163, 164, 165 and 166 of the Social Housing Reform Act, 2000, and will be used to determine suitability and eligibility for housing applied for, continuation of housing and the appropriate rent scale and rent-geared-to-income charge. Personal information may be released to the housing provider, the government of Canada, including Canada Customs & Revenue Agency, other municipal/provincial and federal departments and agencies who assist in the provision of affordable housing and to social agencies and government agencies providing social assistance to the tenant. The tenant consents to the verification, disclosure, and transfer of information given on this form and attachments by or to any of the above entities and will provide any required supporting material. Questions about this collection should be directed to the Housing Services of the District of Cochrane Social Services Administration Board. Freedom of Information Contact Person: Barb Millions, Ontario Works Supervisor, Suite 120, 38 Pine St. N., Timmins, ON P4N 6K6 Declaration I/we make the above, the following and all other, whether verbal or written, representations, to the District of Cochrane Social Services Administration Board Housing Services, knowing that they will be relied upon by the District of Cochrane Social Services Administration Board Housing Services and its member-housing providers, to assess by qualifications for rental subsidy accommodation and to establish rent. 1. I have read the definition of Income and Gross Family Income on the following page and I fully understand them. 2. The information given on this form is accurate and complete as requested. 3. I understand that if rental subsidized accommodation is provided to me, that accommodation is to be occupied only by myself and “those persons listed in the STATEMENT OF HOUSEHOLD COMPOSITION” subject to approval. I give consent and authorization to the District of Cochrane Social Services Administration Board Housing Services to: 1. Make any inquiries that it deems necessary to verify the information given in this form (including a credit or landlord check, if applicable) and I authorize any person or Social Agency having knowledge of any such information to release the information to the District of Cochrane Social Services Administration Board Services. 2. Disclose the information given by me to the District of Cochrane Social Services Administration Board Housing Services, to any Social Agency providing any form of service to me or to any housing provider associated with the District of Cochrane Social services Administration Board Housing Services. 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA, PHIPA, PIPEDA. 4. For the purposes of PHIPA, I give consent for the collection of health information to District of Cochrane Social Services Administration Board Housing Services for the purpose of assessing eligibility. The consent is valid until all matters relating to eligibility are resolved to the satisfaction of the District of Cochrane Social Services Administration Board Housing Services. 5. The District of Cochrane Social Services Administration Board Housing Services voluntarily complies with the Federal Privacy Information Protection and Electronics Documents Act 2000 (PIPEDA), which applies to the standards for personal information with respect to commercial activity. Applicant Signature Date Witness Signature Co-Applicant Signature Date Witness Signature Co-Applicant Signature Date Witness Signature Name: ________________________________________________ Address: _____________________________________________________________________________ MINUTEMANPRESS50200-2Z55 Page 1 of 11

Upload: others

Post on 24-Jun-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

Application for Housing DISTRICT OF COCHRANE SOCIAL SERVICES ADMINISTRATION BOARD

HOUSING SERVICES ACCESS

For Office Use Only:

Primary Provider: _____________________________________________________________________

Date application Received: _______________ Time: __________ Received By: ____________________

Please indicate if you are interested in:

a) Rent Geared to Income (Subsidized Rent)

b) Market Rent (Non-subsidized Rent)

c) Number of Bedrooms required ___________

Yes ________ No ________

Yes ________ No ________

This copy will serve to acknowledge receipt of your application by the District of Cochrane Social Services Administration Board, Housing Services Access, and to acknowledge that your application is:

Complete or Incomplete.

If “Incomplete” is circled, please fill in the highlighted areas on the application and / or provide the missing information, as requested. If “Complete” is circled, retain this for your records. If you have any questions, please call the Housing Services nearest you.

PLEASE READ THE FOLLOWING, COMPLETE THE NAME AND ADDRESS BELOW THEN YOUR SIGNATURE IS REQUIRED

COLLECTION OF PERSONAL INFORMATION CLAUSE Personal information contained on this form or in attachments, including form 1, is collected by the District of Cochrane Social Services Administration Board pursuant to Sections 162, 163, 164, 165 and 166 of the Social Housing Reform Act, 2000, and will be used to determine suitability and eligibility for housing applied for, continuation of housing and the appropriate rent scale and rent-geared-to-income charge. Personal information may be released to the housing provider, the government of Canada, including Canada Customs & Revenue Agency, other municipal/provincial and federal departments and agencies who assist in the provision of affordable housing and to social agencies and government agencies providing social assistance to the tenant. The tenant consents to the verification, disclosure, and transfer of information given on this form and attachments by or to any of the above entities and will provide any required supporting material. Questions about this collection should be directed to the Housing Services of the District of Cochrane Social Services Administration Board.

Freedom of Information Contact Person: Barb Millions, Ontario Works Supervisor, Suite 120, 38 Pine St. N., Timmins, ON P4N 6K6

Declaration

I/we make the above, the following and all other, whether verbal or written, representations, to the District of Cochrane Social Services Administration Board Housing Services, knowing that they will be relied upon by the District of Cochrane Social Services Administration Board Housing Services and its member-housing providers, to assess by qualifications for rental subsidy accommodation and to establish rent.

1. I have read the definition of Income and Gross Family Income on the following page and I fully understand them. 2. The information given on this form is accurate and complete as requested. 3. I understand that if rental subsidized accommodation is provided to me, that accommodation is to be occupied only by myself

and “those persons listed in the STATEMENT OF HOUSEHOLD COMPOSITION” subject to approval. I give consent and authorization to the District of Cochrane Social Services Administration Board Housing Services to:

1. Make any inquiries that it deems necessary to verify the information given in this form (including a credit or landlord check, if applicable) and I authorize any person or Social Agency having knowledge of any such information to release the information to the District of Cochrane Social Services Administration Board Services.

2. Disclose the information given by me to the District of Cochrane Social Services Administration Board Housing Services, to any Social Agency providing any form of service to me or to any housing provider associated with the District of Cochrane Social services Administration Board Housing Services.

3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA, PHIPA, PIPEDA.

4. For the purposes of PHIPA, I give consent for the collection of health information to District of Cochrane Social Services Administration Board Housing Services for the purpose of assessing eligibility. The consent is valid until all matters relating to eligibility are resolved to the satisfaction of the District of Cochrane Social Services Administration Board Housing Services.

5. The District of Cochrane Social Services Administration Board Housing Services voluntarily complies with the Federal Privacy Information Protection and Electronics Documents Act 2000 (PIPEDA), which applies to the standards for personal information with respect to commercial activity.

Applicant Signature

Date

Witness Signature

Co-Applicant Signature

Date

Witness Signature

Co-Applicant Signature

Date

Witness Signature

Name: ________________________________________________ Address: _____________________________________________________________________________

MINUTEMANPRESS50200-2Z55 Page 1 of 11

Page 2: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

Definition of Income “Income” means all income, benefits and gains, of every kind and from every source including, but not limited to the following: a) gross salaries, wages, overtime payments,

commissions, bonuses, tips, gratuities; b) grants, scholarships or bursary payments; c) the greater of the net income from the business or

the total withdrawals from the business as personal salary or other benefits of anyone who is self-employed in a business;

d) the gross amount of unemployment insurance benefits;

e) the gross amount of workers’ compensation payments or other industrial accident insurance payments made because of illness or disability;

f) the gross amount of any old age security, federal guaranteed income supplement and spouse’s allowance and financial assistance under the Ontario Guaranteed Annual Income System (GAINS);

g) the gross amount of every kind of pension, allowance, benefit and annuity whether from a federal, provincial or municipal government of Canada or any level of government of any other country or state or from any other source;

h) the gross amount of alimony, separation, maintenance or support payments;

i) the gross amount of gains from investments including interest on dividends, stocks, shares other securities, and where the actual income can not be

determined, an imputed rate of return set by the Ministry of Housing from time to time;

j) the gross interest income from savings or chequing accounts in a bank, trust company or a credit union;

k) the gross amount of interest earned or payable from bonds, debentures, term deposits or investments, certificates, mortgages, capital gains or lump sum payments or other assets;

l) an imputed income equal to the total appraised value of all assets which do not produce interest income multiplied by a rate of return set by the landlord from time to time.

“Gross Family Income” means the aggregate income of: 1) the tenant and every person residing in the leased

premises; 2) every tenant on the lease temporarily resident

elsewhere. “Spouse” means: 1) a couple who are married to one another or who

represent that they are married to one another; 2) a couple who not being married to one another,

evidence an intention to cohabit in a relationship of permanence or represent to the landlord that they intend to do so.

Examples of Possible Sources of Income

Employment

• Full-time

• Part-time

• Irregular

• Casual

• Seasonal

• Odd Jobs

• Shift Bonuses

• Yearly/Seasonal Bonuses

• Disability Pay

• Overtime Earnings

• Commissions

• Tips and Gratuities

• Cost of Living Bonuses

• Sickness Pay

• Long Term Income Protection

Payments

• Separation / Vacation Pay

Self-Employment

• Tutoring

• Music Teaching

• Child Care

• Babysitting

• Taxi

• Business

Pensions and Allowances

• Old Age Security (OAS)

• Guaranteed Income Supplement (GIS)

• Ontario Disability Support Plan (ODSP)

• Canada Pension Plan (CPP)

• Quebec Pension Plan

• Social Security (other countries)

• Widow’s Pension

• Company Pension

• Private Pension

• Public Service Pension

• Civilian War Pension

• Disability Pension

• War Veteran’s Allowance (D.V.A.)

• War Veteran’s Allowance (other countries)

• Military or Militia or Civil Defense Allowances

• Canada Manpower Retraining Allowance

• Training Allowances

• Retraining Allowances

Other

• Payments from Official Guardian or Public Trustee

• WSIB

• Insurance Payments

• Provincial or Municipal Payments (O.W.)

• Unemployment Insurance Commission Payments

• Payments under Compensation for Victims of Crime Act

• Payments from Children’s Aid Society or Catholic

Children’s Aid

• Separation Payments

• Alimony Payments

• Support Payments (for spouse or child)

• Support from relatives or other sources

• One-time lump-sum payments (inheritances, court and

out of court settlement)

• Mortgage Income

• Student Grants

Income Producing Assets Non-Income Producing Assets

• Farm property which produces income • Life Insurance (with a cash surrender value)

• Registered Retirement Savings Plan • Real Estate (residential, commercial, farmland, cottage,

mobile home) which produces rental income • Real Estate (house, condominium, summer cottages,

farmland, commercial or vacant land)

• Savings Accounts (bank, trust company, credit union),

annuities, Guaranteed Investment Certificates, stocks or

shares, bonds, debentures, mortgages, loans, notes,

term deposits

• Collection of, or investments in other valuable non-

income producing assets

• Licence which produces income (e.g. Taxi Licence) • Business interest which does not produce income

• Business interest which produces income

Page 2 of 11

Page 3: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

COCHRANE DISTRICT SOCIAL SERVICES ADMINISTRATION BOARD HOUSING SERVICES ACCESS

A. Statement of Household Composition (Make a complete list of the persons who will be living in the home for which you are applying) APPLICANT

Last Name: _________________________________ First Name: ________________________________ YR MTH DY M F Social Insurance Number: ________________________ Birth Date: _____|____|____ Sex _____ _____

Street & Number: ________________________ Apt. No: __________ City: ________________________

Mailing Address (if different from above): _____________________________________________________

Province: _______________ Postal Code: ____________ Home Telephone: ________________________

Are you a: Canadian Citizen “ Landed Immigrant “ Refugee/Applicant “ Status Indian/Metis “ Other “

Present Marital Status: Married “ Single “ Widowed “ Divorced “ Separated “ Common-law “ Other “

Employer: ______________________ Address: ______________________ Phone: (_____) ____ _______

Date Employment Started: ________________________________________________________________

CO-APPLICANT

Last Name: _________________________________ First Name: ________________________________ YR MTH DY M F Social Insurance Number: ________________________ Birth Date: _____|____|____ Sex _____ _____

Street & Number: ________________________ Apt. No: __________ City: ________________________

Mailing Address (if different from above): _____________________________________________________

Province: _______________ Postal Code: ____________ Home Telephone: ________________________

Are you a: Canadian Citizen “ Landed Immigrant “ Refugee/Applicant “ Status Indian/Metis “ Other “

Present Marital Status: Married “ Single “ Widowed “ Divorced “ Separated “ Common-law “ Other “

Employer: ______________________ Address: ______________________ Phone: (_____) ____ _______

Relationship to Applicant: _________________________________________________________________

B. Other Household Members to Live in Home for Which you Are Applying

(If any of your children do not live with you all the time, place an X in the box next to their name(s).)

Birthdate Sex Last Name First Name X

Year Month Day M F Relationship

Person to contact in case of emergency, (next of kin, sponsor, doctor).

1. Name:_________________ Relationship: __________________ Phone No.: (_____) _____-_________

2. Name:_________________ Relationship: __________________ Phone No.: (_____) _____-_________

3. Doctor:____________________________ Phone No.: (_____) _____-_________

Page 3 of 11

Page 4: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

C.

Present Housing Circumstances Number of bedrooms required: ______ Do you have a physical/medical condition that is aggravated by your current living situation? Yes ___ No ___ If yes, please explain: ________________________________________________ Do you require or anticipate a modified/wheelchair accessible unit for a disability? Yes ___ No ___ If yes, please explain ________________________________________________ Do you require supportive housing or life skills? Yes ___ No ___ Are you homeless? Yes ___ No ___ Are you a victim of domestic abuse? Yes ___ No ___ Is your family separated due to lack of affordable housing? Yes ___ No ___ Parking Required? Yes ___ No ___ Problem with stairs? Yes ___ No ___ Problem with elevator? Yes ___ No ___

Are you under notice to vacate your home now? Yes ___ No ___ If yes, please explain: ______________________________________________

______________________________________________

______________________________________________

Are you living with family or friends, or in a motel or hotel or emergency shelter? Yes ___ No ___ Other, please specify:

______________________________________________

If yes, please explain: ______________________________________________

______________________________________________

Do you anticipate a change in the number of people in your household? Yes ___ No ___

D. Present and Previous Accommodations

Present Landlord: ___________________________

Landlord’s Phone Number: (_____) _____________

How long have you lived at this address? _________

Your former Landlord: ________________________

Former Landlord’s phone: (_____) ______________

Your Former Address: ________________________

__________________________________________

Dates From: _______________ to ______________

Did you or the co-applicant ever own a home? If yes,

when did you stop owning it?

__________________________________________

Have you or the co-applicant ever lived in a co-op, non-

profit, or government housing in Ontario? Yes ___ No ___

If yes, provide the following:

Name of Provider: _______________________________

Address: _______________________________________

Phone Number: _________________________________

What Date? ____________________________________

E. TOTAL MONTHLY HOUSEHOLD INCOME (Gross monthly income before deductions.) Please note: You must state all sources of income of those in your household and provide

proof of each if you are applying for Social Housing. Name:

Source Proof Applicant Co-Applicant Other: Other:

Employment (Most recent cheque stubs)

Hourly Rate:____ Average Hrs Per Week: ____

Social Assistance (Attach stub and drug card)

Specify:

Ontario Works (O.W.)

Ontario Disability Support Plan (ODSP)

Ontario Student Assistance Program (OSAP)

Employment Insurance (EI) (Most recent cheque)

Canada Pension Plan (Bank record or last cheque)

Old Age Security (OAS) (Bank record or last cheque)

Support/Alimony (Supporting legal documents)

WSIB (Most recent cheque)

Assets (Attach description)

Other Pensions (Bank record or last cheque)

Other Income (Bank record or last cheque)

Page 4 of 11

Page 5: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

If you are applying for market rent, disregard F. and G.

F. ASSETS Bank account ____________________ _____________________________________ ________________________ Bank Name Branch Address Account Number

Bank Accounts Amount Monthly Income (Interest)

Savings

Chequing

Other Accounts (Trust Companies, Credit Unions)

Bonds/Savings Certificates

Annuities, Shares, Securities, Stocks, Debentures

Rent Revenue

Other (Specify e.g. Mortgage)

Total Monthly Income $ $

Are you a property owner? Yes ____ No ____ If yes, give type, value and location:

Do you own a business? Yes ____ No ____ If yes, give details:

G. Statement of Non-Income Producing Assets Value Value

Applicant Co-Applicant

a) House $ $

b) Cottage

c) Other Real Estate

Sub-Total For Office Use Only

Less: Amount Of Mortgage Outstanding

Imputed Return

Net Assets - Real Estate Applicant Co-Applicant

Business Assets (Partnership, etc.)

Monies Owed To You (Amounts over $500.00)

Paid-Up Life Insurance

Other (Specify)

Total $ $ $ $ $

If any assets have been transferred, indicate:

Date of transfer: ______________________ Transferred To: ____________________________

Comments and/or additional information you feel would be pertinent to this application:

Page 5 of 11

Page 6: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available

Some wheelchair accessible A Parking spots available at a cost

U Located onsite B Limited parking spots available

* Walkup - Low rise building with no elevator C Parking available at no charge

Note: Most apartment buildings/townhouses have a party room

CDSSAB, HOUSING SERVICES TIMMINS AREA

FAMILY / SINGLES

Page 6 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of

Units

1 B

edro

om

2 B

edro

om

3 B

edro

om

4 B

edro

om

5 B

edro

om

Park

ing

Gar

age

Frid

ge/

Sto

ve

Sele

ctio

n

Timmins - Family / Singles Genesis Housing Co-op 1065 Bailey Street

T.House + Apts.

36 C U

Goldridge Co-operative 150 Kelly Ann Drive T.House + Apts.

44 C U

Kaleidoscope Co-operative 1115 McLean Drive Unit 96 T.House + Apts.

95 C U

Pins Gris co-operative 400 Shirley St. Unit 100 T.House 40 C U

Tisdale Whitney Co-operative 900 Government Rd Porcupine

T.House 40 C U Timmins Rent Suppl. Units Landlord : Riverside Acres

Riverpark Road T.House + Apts.

27 C Timmins Rent Suppl. Units Cedar Apts.

641 Cedar St. North Apt. 14 C U Timmins Rent Suppl. Units Harrower Properties

101 Kelly Ann Apt. 18 C U Timmins Rent Suppl. Units 680958 Ontario Ltd.

520-540 Lonergan T.House 6 C U Timmins Rent Suppl. Units Pheonix Investments

111 Clifford Apt. 1 C U Timmins Rent Suppl. Units McLean Courts

691 McLean Drive Apt. 12 C U Timmins Rent Suppl. Units Landlord : Timcor Leasing

525 Westmount T.House 11 C U Timmins Rent Suppl. Units Landlord : 487171 Ontario Inc.

Chartrand Apts. 19 Preston Street

Apt. 11 A U Timmins Rent Suppl. Units Landlord : Martin Lambert

443-445 Pine St. North Four- Plex

8 C U CDSSAB, Housing Dept. Vanier Street Semi 5 C CDSSAB, Housing Dept.

Denise, Martin and Delia Street

Semi 6 C CDSSAB, Housing Dept. Lemoyne Street Semi 12 C CDSSAB, Housing Dept.

Suzanne, Randall, Graham, Mountjoy St.

Semi 12 C

CDSSAB, Housing Dept. McClinton, Spooner, Louise Streets

House Semi

6 C

CDSSAB, Housing Dept. Randall Street House Semi

12 C CDSSAB, Housing Dept. Lamminen Ave. & Emilie St. T.House 24 C CDSSAB, Housing Dept. Brousseau & Maple St. Semi 16 C CDSSAB, Housing Dept.

Sterling Ave, Cedar & Birch St. S.

T.House 65 C

Kenneth Crescent Non Profit Kenneth Crescent & Collins House Semi

50 C U City of Timmins Non Profit Country Vila

450 Shirley Street T.House 40 C U

Page 7: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available Some wheelchair accessible A Parking spots available at a cost

U Located onsite B Limited parking spots available * Walkup - Low rise building with no elevator C Parking available at no charge Note: Most apartment buildings/townhouses have a party room

CDSSAB, HOUSING SERVICES COCHRANE HEARST IROQUOIS FALLS KAPUSKASING MOOSONEE VAL GAGNE

FAMILY / SINGLES Page 7 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of

Units

1 B

edro

om

2 B

edro

om

3 B

edro

om

4 B

edro

om

5 B

edro

om

Park

ing

Gar

age

Frid

ge/

Sto

ve

Sele

ctio

n

Cochrane - Family / Singles

CDSSAB - Project OH-1 6 & 7th Street

14 & 15th Avenue Semi 30 C

CDSSAB - Project OH-3 15th Avenue Semi 16 C CDSSAB - Project OH-5 Sybil / Victoria Semi 8 C Cochrane District Housing 381 & 383 8th Street Apt. 22 C U Hearst - Family / Singles

Hearst Families Houle & McManus

Boucher & 70-15th Sts. House 9 C

Landlord: Cler-Vican Ltd. 429 Alexandra Street Apt. 3 B

Landlord: Eddy Denommee 401, 409, 411 & 417 Prince

Street Apt. 11 B

Brisson Boulevard 406 & 408 Brisson Boulevard Apt. 8 A Place Lambert Berville Street T.House 25 A Place Charbonneau Berville Street T.House 14 A Iroquois Falls - Family / Singles CDSSAB - Project OH-1 Union Street Row 12 C CDSSAB - Project OH-6 O’Mara Drive House 6 C CDSSAB - Project OH-101 Campion Street Semi 16 C CDSSAB - Project OH-102 Campion Street Semi 12 C Kapuskasing - Family / Singles Winnipeg Winnipeg Street Semi 16 C Brunetville Ontario St. / Cabot St. Semi 20 C Singles Ontario, Brock & Wolfe Apt. 20 A U Family Handicap Accessible Winnipeg Street Apt. 2 A U Val Albert Vanier, Mill & Downs Streets Semi 18 C Landlord: 862233 Ont. Inc. Richmond Street *Walkup 4 B Landlord: M. Lamontagne 9 Ash Street Apt. 2 B Drury St. Non-Profit Housing 10 Drury Street Apt. 46 A U Moosonee - Family / Singles

Moosonee Non Profit Scattered Apt.

House 126 C U

CDSSAB, Moosonee Wabun, Wavey, Bay, Moose Semi &

House 72 C

Mocreebec, Mosse Factory Trapper, Jolly, Visitor, Clarke House 20 C U Val Gagne - Family / Singles

CDSSAB - Project OH-3 Lessard Street Row 10 C

Page 8: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available A Parking spots available at a cost B Limited parking spots available

Some wheelchair accessible C Parking available at no charge Note: Most apartment buildings / U Located onsite * Walkup - Low rise building with no elevator townhouses have a party room

CDSSAB, HOUSING SERVICES-COCHRANE FAUQUIER HEARST IROQUOIS FALLS KAPUSKASING MATHESON MATTICE MOONBEAM MOOSONEE RAMORE SMOOTH ROCK FALLS TIMMINS VAL GAGNE VAL RITA

SENIOR / SINGLE Page 8 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of U

nits

1 B

edro

om

2 B

edro

om

Laundry

Par

king

Ele

vato

r

Frid

ge/

Sto

ve

Bal

cony

Sele

ctio

n

Cochrane - Senior (60 Years +) CDSSAB - Project OH-1 Villa Genier Apt. 10 U A U CDSSAB - Project OH-2 235 13th Avenue *Walkup 15 U A U CDSSAB - Project OH-4 436 11th Avenue *Walkup 37 U A U U CDSSAB - Project OH-6 437 11th Avenue *Walkup 31 U A U U Fauquier - Senior (60 Years +) Domaine du Bel Age 1210 Doyon Street *Walkup 16 U A U U Hearst - Senior (60 Years +) Villa Beau-Sejour 54-8th Street *Walkup 24 U A U U Villa Belle-Rivière 47-13th Street *Walkup 24 U A U U Place St. Paul 1015 Edward Street Apt. 24 U A U U U Iroquois Falls - Senior (60 Years +) CDSSAB - Project OH-2 471 DeTroys *Walkup 14 U A U U CDSSAB - Project OH-4 156 Picadilly *Walkup 25 U A U U CDSSAB - Project OH-103 628 Majestic *Walkup 10 U A U U Iroquois Falls Seniors Apt. IFSAC Non-Profit

250 Cambridge Ave. Apt. 23 U A U U Kapuskasing - Senior (60 Years +) Grandvue 32 McPherson Ave. Apt. 31 U A U U U Bayview Apartments 12 McPherson Ave. Apt. 49 U A U U U Cedar Grove 55 Cedar Street Apt. 51 U A U U U Matheson - Senior (60 Years +) Matheson Seniors 414-6th Avenue Apt. 23 U A U U U Mattice - Senior (60 Years +) Villa Missinaibi 160 Melrose Street *Walkup 15 U A U U Moonbeam - Senior (60 Years +) Residence des Pionniers 1 Pelletier Street Apt. 19 U A U Moosonee - Senior / Singles CDSSAB, Moosonee Niska Apt. 28 C U Ramore - Senior (60 Years +) / Singles CDSSAB - Project OH-1 374 McIntyre Street Apt. 10 U A U CDSSAB - Project OH-5 375 McIntyre Street Apt. 15 U A U Smooth Rock Falls - Senior (60 Years +) Villa du Rocher 92 Ross Road Apt. 24 U A U U U Timmins - Senior / Singles CDSSAB - Bartleman Apts. 646 Bartleman Street

*Walkup Apt.

51 U B U U CDSSAB – Sterling Seniors 33 Sterling Avenue E. Apt. 61 U B U U U CDSSAB – Melrose Apts. 491 Melrose Blvd. *Walkup 42 U B U U City of Timmins Non Profit 77 Mountjoy Street N.

*Walkup Apt.

32 U B U U City of Timmins Non Profit 67 Mountjoy Street N. Apt. 61 U C U U U CDSSAB-Pine Street N. Apts. 217 Pine Street North Apt. 102 U B U U U Le Mirage, foyer des aînés 44 Borden Avenue Apt. 50 U A U U Timmins Finnish Seniors 231 Huot St., So. Porc. Apt. 30 U C U U U CDSSAB - Park Ave. Apts. 620 Park Avenue

*Walkup Apt.

12 B U U CDSSAB – Lakeview Apts. 58 Lakeview, So. Porc. Apt. 60 B U U CDSSAB – Lee Apts. 255 Lee Avenue Apt. 15 B U CDSSAB – College Apts. 615 College Street

*Walkup Apt.

51 C U Val Gagne – Senior (60 Years +) CDSSAB – Project OH4 Lessard Street *Walkup 11 U A U U

Val Rita – Senior (60 Years +) Villa Rita 24 Deschenaux St. Apt. 10 U A U

Page 9: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available

Some wheelchair accessible A Parking spots available at a cost

U Located onsite B Limited parking spots available

* Walkup - Low rise building with no elevator C Parking available at no charge

Note: Most apartment buildings/townhouses have a party room

CDSSAB, HOUSING SERVICES HEARST KAPUSKASING TIMMINS

Page 9 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of

Units

1 B

edro

om

2 B

edro

om

Laundry

Park

ing

Sec

uri

ty

Frid

ge/

Sto

ve

Support

ive

Ser

vice

s

Sele

ctio

n

Hearst - Supportive Housing/Accessible Units Maison Renaissance Drug Abuse & Rehabilitation

924 Halle Street Res. 16 C U

Maison Georgienne Hearst Counselling Services

417 George Street *Walkup 7 U A U U U

Appartement Gamelin Mentally Handicapped

44-46 13th Street Apt. 4 U U

Supported Ind. Living Mentally Handicapped

1114 Edward Street Apt. 5 U

Kapuskasing - Supportive Housing/Accessible Units

Kapuskasing Counselling 24 Ontario Street 7 Nelson

Apt. 8 U A U U U

Timmins - Supportive Housing/Accessible Units

Access Better Living Inc. 506 Lonergan Blvd. Apt. 15 U C U U U

Canadian Mental Health Assn. 239 Wilson Ave. House 3

Community Living Timmins 166-A Brousseau Ave. House 5

Page 10: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available

Some wheelchair accessible A Parking spots available at a cost

U Located onsite B Limited parking spots available

* Walkup - Low rise building with no elevator C Parking available at no charge

Note: Most apartment buildings/townhouses have a party room

CDSSAB, HOUSING SERVICES COCHRANE KAPUSKASING HEARST

Page 10 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of

Units

1 B

edro

om

2 B

edro

om

3 B

edro

om

Park

ing

Shee

lchai

r Ac

Frid

ge/

Sto

ve

Gar

age

Sele

ctio

n

Cochrane Phase I - Urban Native Housing

Family / Singles 5th St. 5th Ave. Rural Hough, 11th Ave. 7th St. 14th Ave. 15th Ave.

House / Duplex /Semi

10 C U

Cochrane Phase II - Urban Native Housing

Family / Singles 15th Ave. Semi 2 C U

Cochrane Phase III - Urban Native Housing

Family / Singles Victoria St. / 15th Ave. Semi 8 C U

Kapuskasing Phase II - Urban Native Housing

Family / Singles Lawrence / Hazel / Borden/ Frontenac / Thompson / Egerton

House / Row / Duplex

7 C U U

Hearst Phase II - Urban Native Housing

Family / Singles Prince St. Semi 4 C U

Kapuskasing Phase III - Urban Native Housing

Family / Singles Mill St. / Borden / Egerton/ Frontenac / Winnipeg / Brunetville

Semi 12 C U U

Page 11: Application for Housing · 2013-09-08 · Application for Housing ... 3. Information will not be disclosed to any other party, except in accordance with provisions of the FIPPA, MFIPPA,

CDSSAB Housing Services

BUILDING SELECTION SHEET

Unit size available A Parking spots available at a cost

Some wheelchair accessible B Limited parking spots available

U Located onsite C Parking available at no charge

CDSSAB, HOUSING SERVICES COCHRANE SMOOTH ROCK FALLS VAL RITA RAMORE HOLTYRE MATHESON

FAUQUIER FREDERICK HOUSE MATTICE MOONBEAM OPASATIKA

Page 11 of 11

Please Mark With (X) All of your Selections

Building Street Address

Build

ing T

ype

No.

of

Units

1 B

edro

om

2 B

edro

om

3 B

edro

om

Park

ing

Whee

lchai

r Ac

Frid

ge/

Sto

ve

Gar

age

Sele

ctio

n

Smooth Rock Falls - Rural & Native Housing

Family / Singles Ross St. / Hollywood St. House 2 C U U

Val Rita - Rural & Native Housing

Family / Singles De La Coupe St. House 7 C U

Ramore - Rural & Native Housing

Family / Singles Timmins / Ferguson Bastien Streets

House 5 C U

Holtyre - Rural & Native Housing

Family / Singles Euclid / Edwards / Gleason Streets

House 4 C U

Matheson - Rural & Native Housing

Family / Singles Quinn St. House 2 C U

Cochrane - Rural & Native Housing

Family / Singles Rural area (*2 units with garage)

House 7 C U U

Fauquier - Rural & Native Housing

Family / Singles Belanger / Gauthier St. House 3 C U

Frederick House - Rural & Native Housing

Family / Singles Rural area House 1 C U

Mattice - Rural & Native Housing

Family / Singles Chabot / Aagnas Streets / Rural area

House 15 C U

Moonbeam - Rural & Native Housing

Family / Singles Brunelle St. / Joseph St. House 4 C U

Opasatika - Rural & Native Housing

Family / Singles Notre Dame / Govern’t / St. Anne / St. Joseph

House 5 C U