Mon-Thur: 9a - 12p / 1p - 3:30p

Office Location

121 E 1st St Cortez, CO 81321 BLDG A

Mailing Address

PO BOX 1776 Cortez, CO 81321

Affordable Housing Application

Properties Calkins All Others
Family of 1 $46,080 $39,480
Family of 2 $52,640 $44,400
Family of 3 $65,760
Family of 4 $49,300
Family of 5 $59,200 $71,040
Family of 6 $76,320
Managing Agent requires COPIES of the following documentation for ALL HOUSEHOLD MEMBERS and Application Fee
  • Social Security Cards
  • Certified Birth Certificates (Certified copies, not complimentary copies from the hospital) or CIBs for Native Americans.
  • Valid State-Issued IDs (for 18 years of age or older). Must be Colorado IDs at time of Lease signing.
  • $40.00 Application fee for each adult- Cashiers Check or Money Order (NO CASH)


Once your completed Application is received, you will be placed on the waiting list by the date and time the Application is received. Submitting an application does not guarantee housing.

Complete the Application and answer all questions. If the questions do not apply to you, state either NO, NONE or N/A. Every blank must be complete. Incomplete Applications Will Be Withdrawn.

Federal Law preempts State Laws when it comes to the use of Medical Mari juana, Initial e, Medical Mari juana users are prohibited into the Public Housing and the Housing Choice v vu\.ucr (Section 8) Programs, as well as any wtlts owned or managed by the Housing Authority of the County of Montezuma.
A. Federal Drug Laws Marijuana is categorized as a Schedule I substance under the Controlled Substances Act (CSA). See 21 US. C. 801 et seq. The Manufacture, distribution, or possession of mari juana is a federal criminal offense, and it may not be legally prescribed by a physician for any reason. See 21 USC. 841 (a)(]); 812(b)(l)(A)-(C)

By signing below, I/We acknowledge and understand that the use of controlled substances for recreational use or medicinal use is prohibited on all Housing Authority of the County of Montezuma property and the use, possession and distribution of a controlled substance will be a deciding factor in the decision to provide housing assistance to you or anyone in your household.
"The information regarding race, ethnicity and sex designation solicited on this application is requested in order to assure the Federal Government that Federal Laws prohibiting discrimination against tenant Applications on the basis of race, color, national origin, religion, sex, familial status, gender identity (including gender expression), sexual orientation, age and disability are complied with. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your Application or to discriminate against you in any way. However, if you choose not to furnish it, the owner is required to note the race, ethnicity, and sex of the individual applicants on the basis of visual observation or surname."

Submitting an application does not guarantee housing
In accordance with the regulations at 24 CFR 5.856 and 5.905, O/As and PHAs must Initial perfonn necessary criminal history background checks to determine if any applicant, or member of an applicant's household, is subject to a lifetime registration requirement under a State or Federal sex offender registration program. This check must be carried out with respect to the State in which the housing is located and with respect to States where applicant and members of the applicant's household are known to have resided.
Please be advised that it is your responsibility to notify the Housing Authority in writing, of any CHANGE OF MAILING ADDRESS. We must be able to contact you by your current mailing address at which time a Nationwide Criminal Background Check and Credit Report will be conducted on all applicants over the age of 18.

By qualifying and accepting a unit, you agree to pay a Security Deposit set forth for said unit. The managing Agent has the right to keep said deposit (tenant would forfeit deposit) if prospective Tenant does not give a minimum of a 30-day notice that they will not be moving into said unit.

if the proper notice is given to the Managing Agent, Managing Agent has 30 calendar day to return the Security Deposit, less any administrative fees, to the address provided.

I certify that the information present on this form is true and accurate to the best of my/our knowledge. The undersigned further understands that providing false presentations herein constitutes an act of fraud. False, misleading or incomplete information will result in the denial of Application.

Move-in Application

The information on this form is needed to certify your household. Please complete this entire form and leave no blanks. If there are any questions that you do not understand, please call the apartment manager. Thank you for your cooperation.

part 1 household composition

hh mbr 1
hh mbr 2
hh mbr 3
hh mbr 4
hh mbr 5
hh mbr 6

part 2 current/previous residency

part 3 household income

does your household have income, assistance, or benefits from the sources listed below?

part 4 current employment information (please attach a separate form for additional employment, if needed)

part 5 previous employment information (not required for retired persons)

part 6 student status certification

Students include individuals attending public or private elementary schools, middle or junior high schools, senior high schools, colleges, universities, technical, trade or mechanical schools. Students do not include individuals participating in on-the-job training or correspondence courses

please choose one option below that best describes your household

part 7 household asset information


Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my/our knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading, or incomplete information will result in the denial of application or termination of the lease agreement.
All household members ages 18 or over must sign and date.
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