COUNTY OF STETTLER HOUSING AUTHORITY
“Seniors And Community Housing”
www.stettlerhousing.com
Central Office
Willow Creek Lodge
Heart Haven Lodge
6020 - 47 Avenue, Stettler, AB T0C 2L1
Phone: 403-742-2953 Fax: 403-742-3199
6011- 50 Avenue, Stettler, AB T0C 2L1
Phone: 403-742-9220 Fax: 403-742-9221
Stettler Community Housing
Paragon Place Lodge
5011- 55 Street, Stettler, AB T0C 2L2
Phone: 403-742-6195 Fax: 403-742-6198
403-740-9224
Big Valley - Valley Villa Apts.
403-741-8605
Stettler Affordable Housing Program Guidelines
This program is open to low and moderate income families who meet the following criteria:
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Currently reside within the County of Stettler boundaries; including all municipalities within these
boundaries
Gross annual family income (reviewed annually)
o between $25,000 to $40,500 for 3 bedroom townhouses
o between $25,000 to $36,500 for 2 bedroom apartment units
o between $23,000 to $31,000 for 1 bedroom apartment units
Three bedroom units must have two or more dependent children
Good rental references
Preferences
Preferences will be given to families that have steady employment income
All applicants will be interviewed
Rent and Utilities
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Rent, which includes heat, water, sewer and garbage pickup, is as follows:
o Three bedroom townhouses (Meadowlands and Emerson) in Stettler will be $527/month
o Three bedroom townhouse in Donalda will be $527/month
o Three bedroom townhouse in Big Valley will be $527/month
o Two bedroom apartment units (Rosedale Apartments) in Stettler will be $417/month
o One bedroom apartment units (Rosedale Apartments) in Stettler will be $375/month
These are reduced rents based on the average market rents for the area. The market rents are reviewed
annually.
Damage deposit is one month’s rent payable in advance.
Tenant will pay power, phone, cable and contents insurance
Tenant Responsibilities
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Tenants are expected to pay rent each month on the first of each month
Tenants are expected to look after their unit and their own yard maintenance (townhouses), as well as
snow shoveling (townhouses).
Tenants are expected to use this time of subsidized rent to improve and strengthen their financial
situation, with a long-term goal of being able to pay market rent in the community or move on to home
ownership.
All units are NO PETS and NO SMOKING
Page 1 of 8
COUNTY OF STETTLER HOUSING AUTHORITY
“Seniors and Community Housing”
www.stettlerhousing.com
Affordable Housing – Application for Accommodation
(CONFIDENTIAL)
Please Read Instructions for Application Carefully
Complete ALL questions supplying ALL of the requested information. If a question does not apply to your situation, mark
N/A in the section. Space is provided for any other information you would like us to be aware of.
You will be required to provide the following:
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A signed letter from the employer of EACH working member in your family stating the rate of pay, number of
hours worked per week, total earnings, and commencement date of current employment.
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If you or any member of your family is receiving Unemployment Insurance, Workers’ Compensation or Social
Assistance, a letter from the appropriate official must be attached verifying the amount of the benefit. (Form
letters can be obtained from the Housing Authority Office.)
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Documentation to verify all other sources of income: i.e. child support, oil royalties, etc. (NOT Family Allowance)
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A copy of your most recent pay cheque, benefit cheque, pension cheques, etc., or a stub from these for each
member of your family receiving income from any source.
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A copy of your valid Alberta Health Care card. Copies of any child custody arrangements, if applicable.
We will contact present and past landlords with regards to your rental history.
Your completed application must be signed in the presence of a Commissioner of Oaths in and for the Province of
Alberta. This service is provided at our office without charge.
In order for you to obtain the information we require, your application will be held for two (2) weeks. After two
weeks, if the required information is not received, your application will be cancelled, however, it can be reactivated
at any time in the following 12 months. It is not necessary to complete another application form.
THIS APPLICATION WILL NOT BE PROCESSED UNLESS
ALL QUESTIONS ARE FULLY ANSWERED.
If a translator was required to complete this application, please provide their name and telephone number.
________________________________________________
(Translator’s Name)
______________________________________________
(Translator’s Telephone Number)
Please return all applications to: Willow Creek Lodge, 6020 – 47th Ave. Stettler, AB T0C 2L1
Housing Administrator: Judith Hunt Telephone: 740-9224 or 742-2953 Fax: 742-3199
COUNTY OF STETTLER HOUSING AUTHORITY USE ONLY
Name: ____________________________________ Date Received: ________________________________
Page 2 of 8
APPLICATION FOR ACCOMMODATION – AFFORDABLE HOUSING
(CONFIDENTIAL)
Please Print
Note: Please answer ALL questions.
1. Applicant’s Name __________________________________
(Last)
_____________________________________
(First)
Home Telephone: ____________________________ Business Telephone: ___________________________
Alberta Health Care NO. _____________________________________________________________________
2. Spouse’s Name ______________________________________
(Last)
____________________________________
(First)
Alberta Health Care NO. ______________________________________________________________________
3. MARITAL STATUS: Married _____
Separated ______
Widowed _____
Single _____
Divorced ________
How long? _______ Common-law _________ How Long? _______
4. List all persons, including yourself, who will be living with you should your application be approved.
Last Name:
First Name:
Relationship to
Applicant:
Birth Date
Day/Month/Year
Occupation/School
Grade
Is a baby expected? Yes _______ No ________
If yes, give estimated due date: _________________________________
5. Are all members listed above Canadian Citizens? Yes _______ No ______
If no, provide copies of immigration papers for members who are not Canadian Citizens.
6. Present Address: _________________________________________________________________________
(P.O. Box/Apartment No./Street)
_________________________________________________________________________
(Town/Village)
(Postal Code)
When did you move to your present address? ___________________________________________________
7. Do you own or rent your present accommodation? Own ________ Rent _______
If renting, name of present Landlord: ___________________________________________________________
Address: ___________________________________________________________
Telephone Number: ____________________________________________________
Present rent or house payment is $ ___________________ per month
Utility Costs per month: Heat $ _________________ per month Lighting $ ______________per month
Water and Sewer $ _______________ per month
Page 3 of 8
8. Is your present accommodation a: House ______ Townhouse ______
Rooming House ______ Hotel or Motel ______ Other ______
Apartment _______
9. Rooms in your present accommodation: Kitchen ______ Living Room ______
Number of Bathrooms ______ Number of Bedrooms ______
10. Do you share any part of the accommodation with person(s) other than those listed in question #3?
Yes ______ No ______ If yes, how many? Number of Adults ______ Number of Children ______
What part of the accommodation is shared? _________________________________________________
If you do not pay rent, do you contribute financially? Yes _______ No ______
If yes, please specify ____________________________________________________________________
11. Is any member of your family physically handicapped? Yes ______ No ______
If yes, please specify ____________________________________________________________________
Do you require a handicapped unit? Yes ______ No ______
12. Previous Residential History (beginning with most recent)
Address:
Date moved
In
Out
Landlord Name & Phone #
Monthly Rent
Reason for leaving
COUNTY OF STETTLER HOUSING AUTHORITY HAS A STRICT NO PET POLICY.
13. Reasons for wanting to move: _________________________________________________________________
If you have been given a “NOTICE TO VACATE”, please submit a copy of the notice stating the reason for
eviction.
14. STATEMENT OF INCOME
NOTE: All information regarding your family’s income must be complete and accurate, provide details of current
employment held in the last twelve (12) months (begin with the most recent employer).
Applicant Name: ________________________________
Company Address:
Employed
From
To
When did your spouse last work?
Social Insurance Number: _____________________
Rate of Pay Gross
Monthly
Month __________
Hourly
Hours Per Week
Year___________
Page 4 of 8
Co-Applicant Name: ______________________________Social Insurance Number: _____________________________
Company Address:
Employed
From
To
Rate of Pay Gross
Monthly
Hourly
Hours Per Week
Other Household Member: _____________________________ Social Insurance Number: _____________________
Company Address:
Employed
From
To
Rate of Pay Gross
Monthly
Hourly
Hours Per Week
Other Household Member: _____________________________ Social Insurance Number: _____________________
Company Address:
Employed
From
To
Rate of Pay Gross
Monthly
Hourly
Hours Per Week
Have you received any other sources of income in the past twelve (12) months?
(Please indicate if not applicable – N/A)
SOURCE OF INCOME
NAME OF FAMILY
MEMBER IN
RECEIPT
DATE FROM/TO
GROSS MONTHLY
INCOME
A. Student
Grants/Allowance
B. Unemployment
Insurance
Page 5 of 8
C. Workers'
Compensation
D. Social Assistance
(Not Family Allowance)
E. Child
Support/Alimony
(Voluntary or Court
Award)
F. Other Income (Tips,
Interest, Royalties,
Etc)
G. Pensions:
1. Canada Pension
(Retirement, Widow &
Orphan Benefits)
SOURCE OF INCOME
NAME OF FAMILY
MEMBER IN
RECEIPT
DATE FROM/TO
GROSS MONTHLY
INCOME
G. Pensions:
2. Old age security
G. Pensions:
3. Department of
Veteran Affairs
G. Pensions:
4. Guaranteed Income
Supplement
G. Pensions:
5. Alberta Income
Supplement
G. Pensions:
6. Company or Group
Pension
H. Income From Self
Employment:
Details of self-employment must be outlined by the submission of a financial statement subject to review by the Housing
Authority.
15. ASSETS
Cash on Hand $ ______________ Bank Account $__________________
Stocks, Bonds, Mutual Funds, etc. $ __________________
Real Estate $__________________ Mortgage(s) $_____________________ Other Assets $ _____________
NOTE: Essential personal and household effects such as clothes, furniture, vehicles, etc. are not included in
assets.
16. DRIVER’S LICENCE NUMBER ____________________________________________________________________
Car – Year/Make/Model: ______________________________________________________________________
Car – Color/Licence No: _______________________________________________________________________
Page 6 of 8
17. Please feel free to describe your present accommodation and any information you would like the Tenant
Selection Committee to be aware of. This space is provided for you to explain your reasons for applying for
Affordable Housing, and will assist us in the approval of your application.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Page 7 of 8
I understand that this application does not constitute an agreement on the part of the COUNTY OF STETTLER HOUSING
AUTHORITY, or its agents, to provide me with rental accommodation.
I further acknowledge the right of the COUNTY OF STETTLER HOUSING AUTHORITY, or its agents, at any time prior to the
execution and delivery to me of a lease hereby applied for, to withdraw, revoke, or cancel, without penalty or liability for
damages or otherwise, any acceptance or approval of this application previously made or given.
I hereby authorize the COUNTY OF STETTLER HOUSING AUTHORITY, or its agents, in writing, to investigate any or all of
the statements made herein, being fully aware that discovery of any false statement shall cancel any further
consideration of my application.
I further agree that I am obligated to advise the COUNTY OF STETTLER HOUSING AUTHORITY, or its agents, in writing, of
any changes in family composition, gross family income, assets, employments or change of address, should they occur.
I ALSO AGREE THAT THE INFORMATION PROVIDED BY ME PERTAINS TO ALL PERSONS NAMED WITHIN THIS
APPLICATION.
________________________________________________
Witness
________________________________________
Applicant
________________________________________________
Witness
_______________________________________
Applicant
DOMINION OF CANADA)
IN THE MATTER OF THIS APPLICATION FOR DWELLING
PROVINCE OF ALBERTA)
ACCOMMODATION IN THE HOUSING PROJECT.
TO WIT:
)
I/we ____________________________________, of the ___________________________________________________
of ________________________________________, in the Province of Alberta, do solemnly declare as follows:
1. That I/we am/are the applicant(s) named in the said application;
2. That the statements made by me/us in the said application are to the best of my/our knowledge, information
and belief, full and true in all respects;
3. That I/we have resided in the Province of Alberta _____________ years of my/our life/lives and in the district for
_________________ years;
And I/we make this solemn Declaration conscientiously believing it to be true and knowing that it is of the same
force and effect as if made under oath and by virtue of the “Canada Evidence Act.”
Declared before me
at the _____________ of
in the Province of Alberta,
this __________day of ________________, 20____
)___________________________________________
Signature of Applicant
)___________________________________________
Signature of Applicant
___________________________________________
A Commissioner of Oaths in the Province of Alberta
____________________________________________
Printed Name of Commissioner for Oaths
My appointment expires on ______________________
Day/Month/Year
Page 8 of 8