Rural Housing Service Pre-Qualification Worksheet County You Wish To Live In:

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1 USDA United States Department of Agriculture Rural Housing Service Pre-Qualification Worksheet County You Wish To Live In: APPLICANT INFORMATION CO-APPLICANT INFORMATION Name: Name: Address: Address: City, State, Zip: City, State, Zip: Phone: Phone: Address: Address: DOB: Sex: Marital Status: DOB: Sex: Marital Status: Social Security Number: Social Security Number: Race: Indian/Alaskan Asian Black Hawaiian White N/A Race: Indian/Alaskan Asian Black Hawaiian White N/A US Citizen Y N Ethnicity Hisp/Latino Not Hisp/Latino N/A US Citizen Y N Ethnicity Hisp/Latino Not Hisp/Latino N/A Employer: State Date: Employer: State Date: Gross MONTHLY Income: Gross MONTHLY Income: Wages: Wages SS/SSI: SS/SSI: Pension: Pension: Child Support: Child Support: Maintenance: Maintenance: Workers Compensation: Workers Compensation: Unemployment (seasonally rec d) Unemployment (seasonally rec d) Other: Other: Other Household Member Who Will Live in the House NOT Listed Above: Name Relationship Age FT Student? Income Source Type of Payment Creditor Name Monthly Payment Balance Type of Asset Balance/Value Vehicle Payment Cash Vehicle Payment Checking Acct Credit Card Checking Acct Credit Card Saving Acct Credit Card Saving Acct Student Loans CDs Child Support IRA/401k Owed Medical Debts Real Estate Owned Other Other How did you find out about this program? Please be sure to have each Applicant sign and return (1) Form , Authorization to Release Information along with this worksheet to: USDA Rural Development is an Equal Opportunity Lender, Provider and Employer

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3 Form RD Form Approved (Rev.4-02) OMB No TO: RE: Account or Other Identifying Number Name of Customer United States Department of Agriculture Rural Development Rural Housing Service AUTHORIZATION TO RELEASE INFORMATION I have applied for or obtained a loan or grant from the Rural Housing Service (RHS), part of the Rural Development mission area of the United States Department of Agriculture. As part of this process or in considering me for the interest credit, payment assistance, or other servicing assistance on such a loan, RHS may verify information contained in my request for assistance and in other documents required in connection with the request. I authorize you to provide to RHS for verification purposes the following applicable information: Past and present employment or income records. Bank account, stock holdings, and any other asset balances. Past and present landlord references. Other consumer credit references. If the request is for a new loan or grant, I further authorize RHS to order a consumer credit report and verify other credit information. I understand that under the Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., RHS is authorized to access my financial records held by financial institutions in connection with the consideration or administration of assistance to me. I also understand that financial records involving my loan and loan application will be available to RHS without further notice or authorization, but will not be disclosed or released by RHS to another Government agency or department or used for another purpose without my consent except as required or permitted by law. This authorization is valid for the life of the loan. The recipient of this form may rely on the Government s representation that the loan is still in existence. The information RHS obtains is only to be used to process my request for a loan or grant, interest credit, payment assistance, or other servicing assistance. I acknowledge that I have received a copy of the Notice to Applicant Regarding Privacy Act Information. I understand that if I requested interest credit or payment assistance, this authorization to release information will cover any future requests for such assistance and that I will not be renotified of the Privacy Act information unless the Privacy Information has changed concerning use of such information. A copy of this authorization may be accepted as an original. Your prompt reply is appreciated. Signature Date Signature Date Signature Date Signature Date According to the paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless as displays a valid OMB control number. The valid OMB control number for this information collection is The time to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the date needed, and completing and reviewing the collection of information. RHS Is An Equal Opportunity Lender SEE ATTACHED PRIVACY ACT NOTICE

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6 Northeast Colorado Housing, Inc. 801 South West #25, Fort Morgan CO Phone (970) Fax (970) LENDER DISCLOSURE This is to give you notice that Northeast Colorado Housing Inc. operates and administers other programs that provide down payment assistance loans and rehabilitation loans. Northeast Colorado Inc. does not have any exclusive, financial or other relationships with any other industry partners that may be relevant to a client. You, the client, are not obligated to receive, purchase or utilize any other services offered by the organization, or its exclusive partners, in order to receive housing counseling services. I/We have read and understand this disclosure form. Signature NAME (CLIENT) Signature NAME (CLIENT) NORTHEAST COLORADO HOUSING INC. DATE NORTHEAST COLORADO IS AN EQUAL HOUSING LENDER Exhibit 1

7 BORROWER S CERTIFICATION AND VERIFICATION AUTHORIZATION NORTHEAST COLORADO HOUSING, INC. 801 S. WEST STREET #25 FORT MORGAN, CO PHONE: CERTIFICATION The undersigned certify the following: I have applied for assistance from Northeast Colorado Housing, Inc.; in applying for the assistance I completed a loan application containing various information on the purpose of the loan, employment and income information, and assets and liabilities. I certify that all of the information is true and complete. I made no misrepresentation in the loan application or other documents, nor did I omit pertinent information. I understand and agree that the Lender reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with the employer and/or the financial institution. I fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this mortgage, as applicable under the provisions of Title 18, United States Code, Section To Whom It May Concern: VERIFICATION AUTHORIZATION I have applied for assistance from Northeast Colorado Housing, Inc., and as a part of the application, NECHI and the mortgage guaranty insurer (if any), may verify information in my loan application and in other documents required in connection with the loan, either before the loan is closed or as a part of its quality control program. I authorize you to provide to Northeast Colorado Housing, Inc., and to the mortgage guaranty insurer, any and all information and documentation that they may request. Such information includes, but is not limited to employment history and income; bank, money market, and similar account balance; credit history; and copies of income tax returns. A copy of this authorization may be accepted as an original. Your prompt reply to Northeast Colorado Housing, Inc. the Lender, Investor that purchased the mortgage, or the mortgage guaranty insurer (if any), is appreciated. PRIVACY ACT NOTICE This information is to be used by the agency collecting it in determining whether you qualify as a prospective mortgagor under its program. It will not be disclosed outside the agency except to your employer(s) for verification of employment and as required and permitted by law. You do not have to give us this information but if you do not, your application for approval as a prospective mortgagor or borrower may be delayed or rejected. The information requested in this form is authorized by Title 38, USC, 1921 et seq. (If USDA, FmHA). Public reporting burden for this collection of information is estimated to average 10 to 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, Office of Information Policies and Systems, U.S. Department of Housing and Urban Development, Washington D.C and to the Office of Management and Budget, Paperwork Project ( ), Washington D.C, Borrower Date Social Security Number Address Date of Birth Phone # Borrower Date Social Security Number Address Date of Birth Phone #

8 Northeast Colorado Housing, Inc. 801 South West Street #25, Fort Morgan CO (970) Fax (970) TTY Dear: After talking with you, we think that a direct Section 502 single family housing loan through the Rural Housing Service (known as the Agency ) is a good housing loan for you. The Rural Housing Service is an Agency of the United States Department of Agriculture. We do not work for the Agency; we are an outside loan application packager. Northeast Colorado Housing Inc. will assist you in applying for a loan through the Agency. We do not guarantee that your loan application will be approved or funded by the Agency. For our services, you will pay a loan application packaging fee of no more than $1,500. The fee is due only if the Agency approves you for a loan and the loan goes to closing. Under certain circumstances, part or all of this fee may be included in your loan. Otherwise, we will assist you in finding an alternate means to cover the fee from other sources. To the extent other sources are unavailable, we will waive the fee. You are not required to work with a loan application packager to receive assistance from the Agency. You may work directly with the Agency and avoid the loan application packaging fee. Working with our organization provides you with the following benefits: We will act as a go-between for you and the Agency. We will make sure that your paperwork is in order, which should shorten the time it takes for the Agency to make a loan decision. To begin the process, each adult who will reside in the home must sign an Authorization to Release Information (RD Form ). This will allow us to obtain credit histories, verification of income received by all household members, and other documents needed for the Agency to make a loan decision. All information collected will be maintained with the highest degree of confidentiality. We look forward to working with you in preparing an application for an Agency Section 502 direct loan. Potential Applicant s Initials

9 Potential Co-Applicant s Initials Respectfully, Sharon K. Helms Executive Director WAIVER OF PROVISIONS TO THE PRIVACY ACT OF 1974 To better serve as your advocate with the Agency, we need to be kept informed of the Agency s processing of your application and we may need access to items directly obtained by the Agency. Do you authorize the Agency to release to and discuss with [insert name of organization] and [insert name of Intermediary], our partner who will be involved in the loan application packaging process, any information we may seek or request from the Agency s records concerning your application for Agency assistance? Please check one: _ YES (Authorization will terminate upon loan closing or Agency denial of your application.) NO By initialing Page 1, completing the Privacy Act waiver, entering the date you received this letter, and signing/dating below on Page 2, you acknowledge these facts and confirm your desire to work with [insert name of organization]. I/we received this letter on. Potential Applicant s Name/Signature/Date (spell out full name and then sign) Potential Co-Applicant s Name/Signature/Date (spell out full name and then sign)

10 Please provide copies of the following documentation, when applicable: Driver's license, passport, or similar picture identification Social Security Card Federal Income Tax Return with all applicable schedules and all related IRS Forms W-2's Two most recent consecutive pay stubs Most recent Social Security Benefit Award Statement

11 Northeast Colorado Housing, Inc S. West Street #25 Phone: Fort Morgan, CO Fax: HOLD HARMLESS LETTER I/we the undersigned hereby accept the services of Northeast Colorado Housing, Inc., and authorize them to act as a technical assistant and advisor in connection with regard to our loan application. I/we further agree to hold harmless the employees, members, officers and directors of the Northeast Colorado Housing, Inc., in connection with acts performed by them, which would be associated with consultation, technical advice, financial counseling, loan processing, property inspection and other related activities. Dated this day of, 20. Homeowner Date Homeowner Date

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13 Northeast Colorado Housing, Inc. Construction Labor Allocation to Homeowners/ Subcontractors % of Group Sub Construction Activity Total Member Contractor Excavation/Footings/ Foundation 17% 8% 9% Walls/Floor Framing & Sheathing 8% 8% 0% Roof and Ceiling Framing & Sheathing 6% 4% 2% Roofing 5% 5% 0% Siding, Exterior Trim and Porches 8% 8% 0% Windows and Exterior Doors 9% 9% 0% Plumbing 7% 0% 7% Heating 4% 0% 4% Electrical 3% 0% 3% Insulation 2% 2% 0% Dry Wall 8% 4% 4% Floor Covering 6% 3% 3% Interior Carpentry, Trim & Doors 6% 6% 0% Cabinets and Counter Tops 1% 1% 0% Painting 5% 5% 0% Finish Hardware 1% 1% 0% Gutters and Downspouts 1% 0% 1% Grading, Paving and Landscaping 3% 1% 2% 100% 65% 35%

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