Thank you for considering a grant from Homes Are Possible, Inc. (HAPI)!

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1 Thank you for considering a grant from Homes Are Possible, Inc. (HAPI)! Home rehabilitation work may include but is not limited to: Roof repairs/shingles Siding Windows/Door Plumbing Electrical Foundation Repairs Accessibility Issues The home, as well as the applicant, will need to meet criteria for this program. It is at the discretion of HAPI to cancel an application if the rehabilitation is not considered feasible. The applicant must be listed as an owner on the Warranty Deed for the home and it must be their primary and sole place of residence. The program is in the form of a forgivable loan. A deed restriction is placed on the home for five (5) years and is reduced by 1/60 th each month the home remains as the applicant s primary residence and is not sold, transferred, rented or refinanced with cash back. Repayment will be required if any of these residential criteria are no longer applicable. Grant Regulations consist of: The applicant must own the home-it can not be a rental unit. The deed must include the applicant s name as the owner of the property Mobile homes are not eligible The applicant and current household members must be income eligible The maximum allowable funds to be used on the home are dependent on funding. From this funding HAPI will charge a fee for general contracting management ($500) and for cost of filing the Deed Restriction ($30) Actual verification of income, copy of warranty deed, income tax return and most recent property tax receipt must be sent with the application Property taxes MUST be current on the residence If cost of project is over the eligible spendable grant amount ($5,470) it is the homeowner s responsibility to pay the overage to the contractor at the beginning of project Income limits may vary by household size and county. All grants are dependent on funding availability Income limits for the 2014 year are: Household Size County Maximum Income 1-2 Hughes $39, Hughes $45, Spink $32, Spink $37, All other counties $32, All other counties $37,145 Home Improvement Check List

2 In order to consider your application for home improvements, the following information will be required. A completed application. This must include all members of the household living in the home Income from ALL household members. Each wage earner must include: o Copies of the past two consecutive months pay stubs from all employers o Self-employment-if self-employed two (2) years of taxes returns (2012 & 2013) including all schedules o If unemployed (for less than a year) and not collecting unemployment, provide the name, address and phone number of the most recent employer o Workers Compensation, Social Security, SSI, Disability, Veterans Benefits Verification must be in the form of the annual benefits statement. o TANF, Child Support, Alimony: (court records are preferred documentation) o Rental Payments, Lease Payments, or Land Payments and all other income not listed on tax return o A copy of your 2013 tax return o A copy of current property tax receipt o A copy of the Warranty Deed to the property showing applicant ownership. A copy may be obtained through your county s Register of Deeds office for a small fee Homeowners Education Class must be completed prior to any work beginning on your project. This is a free class and held in Aberdeen and Sisseton once a month. Other arrangements can be made if necessary. Households will be served on a first come/first receive basis. There is a limited amount of funding available for this program. If you have any questions, please feel free to give me a call at (605) or or me at Sincerely, Colleen Jones Colleen Jones Housing Asst. enclosure

3 HOMES ARE POSSIBLE, INC. (HAPI) Application for HAPI Home Rehab Program ESTIMATED GRANT AMOUNT REQUEST $6,000_ (spendable amount of $5,470 after fees) Applicant Information: Name Address City Zip Code County Phone Number Cell Phone Work Phone Address Number in Household Married Single Unmarried Have you ever received a forgivable loan through another Affordable Housing Project such as: Grow South Dakota; Home Ownership Assistance Program (HOAP); Northeast South Dakota Community Action Program (NESDCAP); Opportunities for Independent Living (OIL); Sisseton-Wahpeton Oyate or HAPI? Yes No If yes, when and which agency? Co-Applicant Information: Name Address City Zip Code County Phone Number Cell Phone Work Phone Address HOMES MUST BE ON A PERMANENT FOUNDATION-NO MOBILE HOMES MUST BE OWNER/OCCUPIED HOMES NO RENTAL HOMES OR APARTMENTS Grant funds can not be used by a tenant or landlord for a rental unit. I/We hereby declare and state that my/our property is and will be maintained as an owner/occupied sole residence and any grant funds will only be used to rehabilitate said owner/occupied property. The need for assistance will be based on pre-inspection by HAPI. Improvements must be for applicant s primary residence. The project will be inspected on completion and HAPI will be provided with documentation of the fees for rehab (labor, materials, etc.). Assistance is NOT eligible for cosmetic purposes. All requests MUST be approved by HAPI and paperwork completed prior to work being done.

4 The type of work to be done: Plumbing Roofing Electrical Siding Heating Other Please List The homes has unhealthy conditions relating to: Lead based paint (home built before 1978) Mold/Mildew Sewage Fumes Asbestos Chemical/Smoke Fumes Not aware of unhealthy conditions Other: Eligibility Criteria Eligible homeowners must be below 50% of the area median income. Income limits vary by household size and county. PLEASE COMPLETE THE FOLLOWING: Please check the appropriate box(es). This information is used for statistical purposes only. Are you or anyone in your household: Disabled/Handicapped Recovering from Physical Abuse Age 62 or older Recovering from Alcohol or Drug Abuse Information For Government Monitoring Purposes The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the Lender s compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to provide it. However, if you choose not to provide it, under Federal regulations this LENDER is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.) Applicant Choose not to respond Hispanic or Latino American Indian/Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander Islander White Other Co-Applicant Choose not to respond Hispanic or Latino American Indian/Alaskan Native Asian Black or African American Native Hawaiian or other Pacific White Other Male Female Male Female

5 Please Read the Following Information Privacy Act Information: This information will be used to determine your eligibility for the program. Statements of home ownership, family size and income must be accurate, and-all other information must be given to the best of your knowledge. Information obtained from this and other forms may be used by Federal Home Loan Bank (FHLB) to monitor the effectiveness of this program. In addition, this information may be used for investigative or prosecutorial proceedings in the event of fraudulent claims or statements. If you refuse to provide the information requested on this application, your home will not be considered for assistance. No information on this application is made available to the general public. This authorization is given only in connection with its use by Homes Are Possible, Inc. (HAPI) in its administration of its programs and for no other purpose. It shall continue in effect until such time as I state, in writing, to Homes Are Possible, Inc. (HAPI). I declare that this home is not scheduled for acquisition or clearance under any government program. I will disclose to HAPI if and when this should ever occur. This is an equal opportunity program. Discrimination is prohibited by Federal Law. By my signature below I authorize the agency to make any necessary contacts to verify any aspect of eligibility. I authorize any person, agency or institution to supply information requested by Homes Are Possible, Inc. (HAPI) concerning me or my family and to allow reproduction of records in their possession pertaining to me or my family by a duly authorized representative of Homes Are Possible, Inc. (HAPI). I authorize employees of Homes Are Possible, Inc. (HAPI) to perform, monitor and inspect work. I understand that any false statement made in this application is legal grounds for prosecution by any agency of the government using this application as a basis for assistance and certify, under penalty of perjury, the truth of the information in this application. I have furnished this application information to the best of my knowledge and by this signature approve and verify it. Any misrepresentation regarding this information my lead to the recapture of the total amount of funds allocated to each project. Applicant Date Co-Applicant Date Homes Are Possible, Inc. (HAPI) is an Equal Housing Opportunity Agency. In accordance with Federal Law and US Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, religion, political beliefs, or disability (Not all prohibited bases apply to all programs). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Ave. SW Washington, DC or call (800) (voice) or (202) (TDD). USDA is an equal opportunity provider, employer and lender.

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