The Salt & Light Company, Inc. I ALLY, Inc. I People First! I Home Start I Delta Real Estate

APPLICATION

FORM

1841 Burlington-Mt. Holly Road (Co. Rt. 541) Tel: (609) 261-4571

Westampton, NJ 08060 Fax: (609) 261-2147

Please fill in each form field completely. ALL FIELDS ARE MANDATORY! If any field is not applicable please indicate by "N/A"

Affordable Rental Housing Available for Victims of Domestic Violence

The Salt and Light Company has affordable 1 & 2-bedroom apartment units available to very-low income homeless persons who have been displaced due to domestic violence. Occupancy is limited to a single parent with up to two children. A third party Domestic Violence Services Provider Agency must verify the cause of an applicant’s homelessness.

Applications will be received from 05/4/2026 to 05/15/2026. Applications are available from Delta Real Estate, managing agent at: 1841 Burlington-Mt. Holly Road Westampton, NJ 08060 from 9 a.m. - 4:30 p.m., or can be mailed upon request, or completed on the website at www.affordablehomesgroup.com, under the application tab. Office phone number (609) 261-7244.

Completed applications along with supporting documents are due in the Delta Real Estate office by 4:30 p.m. on 05/15/2026. Qualified applications will be selected based on a first come, first qualified basis. All applications will be dated by the date and time of the receipt of the application. Incomplete applications will not be reviewed.

Rental Application for Victims of Domestic Violence

LIST OF SUPPORTING DOCUMENTS

Form Name

Today's Date

Applicant Name

Applicant Birthday

Month

Day

Year

Applicant Marital Status

Applicant Phone Number

Applicant Email

Applicant Current Street Address

Years at Present Address

Present Rent

Landlord

Landlord's Phone Number

Section 8, Do you receive a subsidy or have a valid Section 8 voucher?

Are you living alone?, If no, who are you living with? (Adults)

Child 1 Name / Age / Date of Birth

Child 2 Name / Age / Date of Birth

Child 3 Name / Age / Date of Birth

Applicant's Employer

Name of Supervisor

Supervisor's Phone No.

Work Address

Length of Employment (years/months)

Gross Wages

Full Time or Part Time

Total 2025 Household Income (From IRS 1040 Form)

Present Annual Earned Income for 2026 Year-to-Date

Additional Income 1: (unemployment compensation, SSI/SSD, child support / public assstance, (state type) / Alimony / pension / disability, etc.

Additional Income 1 Amount Per Month

Additional Income 2: (unemployment compensation, SSI/SSD, child support / public assstance, (state type) / Alimony / pension / disability, etc.

Additional Income 2 Amount Per Month

Additional Income 3: (unemployment compensation, SSI/SSD, child support / public assstance, (state type) / Alimony / pension / disability, etc.

Additional Income 3 Amount Per Month

Applicant Signature

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The Affordable HOMES Group

A Family of Companies

APPLICATION

FORM

Rental Application for Victims of Domestic Violence