HOUSING AUTHORITY OF THE CITY OF SAN BUENAVENTURA 995 Riverside Street * Ventura, CA Phone (805) Fax (805)

Transcription

1 HOUSING AUTHORITY OF THE CITY OF SAN BUENAVENTURA 995 Riverside Street * Ventura, CA Phone (805) Fax (805) AFFORDABLE HOUSING PROGRAM APPLICATION INSTRUCTIONS FOR APPLICANT 1. Important! This application is time-sensitive. Please complete, sign and return this application packet as soon as a decision is made to purchase the Affordable Home or at the minimum 5 days after the open of escrow. Return this application with all necessary documentation to the Housing Authority c/o Affordable Housing Program: 995 Riverside Street Ventura, Ca Please print neatly in ink. Do not leave any sections blank. If the requested Information does not apply, write None or N/A. 3. The applicant and all other adult household members (18 years of age or older) must sign the final page of this application including the General Release form certifying truth and accuracy of disclosed information and authorizing release of information. 4. Identification documents for all household members are required for submission of this application are as follows: A) Copy of Government Picture ID for all adults (persons 18 years old and over). B) Copies of Social Security cards or Alien Registration cards for all persons in the household. 5. All information on this application must be true, complete, and accurate. Incomplete applications will not be accepted. Applications deemed to contain incomplete, misleading or false information will be rejected. 6. Submission of this application does not guarantee that you will be approved for the purchase of an affordable home. It is provided to allow the Housing Authority of the City of San Buenaventura to verify the household income and assets to determine if program guidelines are being met. ***IMPORTANT*** DOCUMENTS REQUESTED BELOW ARE FOR ALL HOUSEHOLD MEMBERS AND REQUIRED FOR SUBMISSION OF THIS APPLICATION. INCOMPLETE OR FALSE INFORMATION WILL CAUSE YOUR APPLICATION TO BE DENIED. Identification Documents: COPIES ONLY - DO NOT INCLUDE ORIGINALS Copy of Government Photo I.D. for all adults (persons 18 years old and over) Copy of Social Security Cards or Alien Registration cards for all persons in the household Employment: COPIES ONLY - DO NOT INCLUDE ORIGINALS Copy of MOST RECENT Earning statement/ paycheck stub for all adult (persons 18 years old and over) Copy of Federal Income Tax Returns three (3) most current & consecutive years; with attached Schedule C and all pages and attachments. Asset Income Information: COPIES ONLY - DO NOT INCLUDE ORIGINALS Copy of most recent bank statements (all pages) See Asset Income Information on page four (4) and five (5) for all required documents needed. 1

2 APPLICANT INFORMATION Applicant Name: Address: Applicant Phone No.: Co-Applicant Name: Street City State Zip Cell Phone No.: address: HH Member # Last Name HOUSEHOLD COMPOSITION First Name & Middle Initial Relationship to Head of Household 1 HEAD of Birth (MM/DD/YYYY) F/T Student (Y or N) Social Security No. EMPLOYMENT INFORMATION Complete this section with income information for each household member over 18 years of age. Monthly gross income includes wages, salaries, overtime pay, commissions, tips, bonuses, and other compensation. Head of Household First and Last Name: Employer: Phone: Employer Address: Street City State Zip Occupation: Length of Employment: yrs. mos. Monthly Gross Income: Employment Status: Full-time ( ) Part-time ( ) Seasonal/Temporary ( ) Self-employed ( ) Retired ( ) HR Representative: Fax: Co-Applicant First and Last Name: Employer: Phone: Employer Address: Street City State Zip Occupation : Length of Employment: yrs. mos. Monthly Gross Income: Employment Status: Full-time ( ) Part-time ( ) Seasonal/Temporary ( ) Self-employed ( ) Retired ( ) HR Representative: Fax: Co-Applicant First and Last Name: Employer: Phone: Employer Address: Street City State Zip Occupation: Length of Employment: yrs. mos. Monthly Gross Income: Employment Status: Full-time ( ) Part-time ( ) Seasonal/Temporary ( ) Self-employed ( ) Retired ( ) HR Representative: Fax: 2

3 OTHER INCOME INFORMATION Monthly Gross Income Yes No (write NA if not applicable) ( ) ( ) I/we receive cash contributions of gifts including rent or utility payments, on an ongoing basis from persons not living with me. If yes, Please provide most current documentation. $ ( ) ( ) I/we receive unemployment benefits. If yes, Please provide most current documentation. $ ( ) ( ) I/we receive Veteran s Administration, GI Bill, or National Guard/ Military Benefits/income. If yes, Please provide most current documentation. $ ( ) ( ) I/we receive Social Security payments (e.g., SSA, SSDI) If yes, list names and provide most recent Award Letter 1) $ 2) $ ( ) ( ) The household receives unearned income from family members age 17 or under (example: Social Security, Trust Fund Disbursements, etc). If yes, please provide most current documentation $ ( ) ( ) I/we receive Supplemental Security Income (SSI). If yes, Please provide most recent Award Letter $ ( ) ( ) I/we am entitled to receive child support payments. $ I/we am currently receiving child support payments. If yes, list all source/persons from which you receive support: and provide most current documentation $ 1) 2) ( ) ( ) I/we receive alimony/spousal support payments. If yes, describe and provide most current documentation: ( ) ( ) I/we receive periodic payments from trusts, annuities, inheritance retirement funds or pensions, insurance policies, or lottery winnings. If yes, list sources and provide most current documentation 1) $ 2) $ $ ( ) ( ) I/we receive income from real or personal property. Describe: $ If yes, please provide most current documentation (use net earned income) 3

4 ASSET INFORMATION (INCLUDE ASSETS HELD BY CHILDREN UNDER 18) Yes No Interest Rate Current Cash Value (write NA if Not Applicable) ( ) ( ) I/we have a checking account(s). If yes, list bank(s) and provide most current Statement (all pages) ( ) ( ) I/we have a savings account(s) If yes, list bank(s) and provide most current Statement (all pages) ( ) ( ) I/we have a revocable trust(s) If yes, list bank(s) and provide most current documentation ( ) ( ) I/we own real estate. If yes, provide description below and provide most current documentation: ( ) ( ) I/we own stocks, bonds, or Treasury Bills If yes, list sources/bank names below and provide most current documentation: $ 3) % $ ( ) ( ) I/we have Certificates of Deposit (CD) or Money Market Account(s) If yes, list sources/bank names below And provide most current documentation: 3) % $ 4

5 ASSET INFORMATION CONTINUED Yes No Interest Rate Current Cash Value (write NA if Not Applicable) ( ) ( ) I/we have a whole life insurance policy. If yes, how many policies? Provide Most current documentation: # of policies $ ( ) ( ) I/we have cash on hand. $ ( ) ( ) I/we have an IRA/Lump Sum Pension/ Keogh Account/401(K) If yes, list financial institution(s) for each account below and provide most current documentation: ( ) ( ) I/we have disposed of assets (i.e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed below and provide most current documentation: 1) $ 2) $ ( ) ( ) I/we have income from assets or sources Other than those listed above. If yes, list Type of income below and provide most current documentation: 1) $ 2) $ AFFORDABLE HOME YOU ARE INTERESTED IN PURCHASING Development Name: Seller s Name: Address: Do you have a real estate agent? Yes No If yes please provide: Name: Phone No.: Has Escrow Opened: Yes No If yes please provide: Escrow Agent: Escrow Phone No.: 5

6 Declaration of U.S. Citizenship or Non-Citizen with Eligible Immigration Status In accordance with the Department of Housing and Urban Development (HUD) every Applicant must complete the following for all family household members. (A). United States Citizen(s) (B). Non-Citizen with Eligible Immigration Status (C). Non-Citizen without Eligible Immigration Status Please list below every person living in the household (PLEASE PRINT). Designate citizenship status as defined above. Applicant Information (PLEASE PRINT). Name Sex Age Relationship A B C Signature Head of Household Spouse Additional Household Member Additional Household Member I declare under penalty or perjury that I or we are giving true and accurate information on every member of our household concerning whether he or she is a U.S. citizen, non-citizen with eligible immigration status or non-citizen without eligible immigration status. Signature, head of household Signature, spouse/co-applicant Signature, additional household member WARNING! Title 18, Section 1001 of the United States Code, states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department or agency of the United States. 6

7 Declaration of Intent to Reside and Response to Certification of Continued Occupancy We/I hereby declare that we/i understand the real property being purchased is subject to the City of San Buenaventura Affordable Home Program restrictions outlined in Declaration of Covenants, Conditions and Restrictions. Upon the purchase of the property we/ I will occupy the home as our/my principal place of residence and at no time will lease or rent the property in whole or in part without the prior written approval of City or the City s designee the Housing Authority of the City of San Buenaventura. We/I acknowledge that lease or rental of City of San Buenaventura Affordable Housing Program home is a violation of the San Buenaventura Municipal Code, the Affordable Housing Program and Declaration of Covenants, Conditions and Restrictions and may result enforcement of the Municipal code Sec We/I also acknowledge that the Housing Authority of the City of San Buenaventura will require a response to a certification of continuing occupancy mailed annually to the Affordable Home. Property Address Signature, head of household Signature, spouse/co-applicant Signature, additional household member 7

8 CERTIFICIATION STATEMENT AND AUTHORIZATION FOR RELEASE OF INFORMATION BY ALL ADULT HOUSEHOLD MEMBERS For myself/ourselves, the undersigned, and for the minor children in our care, I/We certify the following: I/We have read and understand the Instructions for Head of Household in the application for the City of San Buenaventura s Affordable Housing Program. All information we have given in this application is true, complete and accurate. I/We understand that if the information provided on this application is deemed incomplete, Housing Authority of the City of San Buenaventura may not accept it. I/We CERTIFY that the information provided on this application is true and accurate to the best of my/our knowledge. I/we further understand that providing false or incomplete representations on this application constitutes an act of fraud. False, misleading or incomplete information will result in the denial of this application for Affordable Housing Program. I/We authorize, direct and give consent to Housing Authority of the City of San Buenaventura to make any and all inquiries to verify the information in this application. We understand that pursuant to this Statement and Authorization, Housing Authority of the City of San Buenaventura may request information which includes but is not limited to my sources of personal and business income and Social Security numbers. Further, I/we understand that such information regarding other household members included on this application may be requested. I/We understand that this Statement and Authorization cannot be used to obtain information not relevant to this application. I/We authorize, direct and consent to the release of any information known by any federal, state or local agency, organization, business, or individual to Housing Authority of the City of San Buenaventura which is necessary to complete and verify this application for the Affordable Housing Program. I/We understand that information obtained pursuant to this authorization may be used by Housing Authority of the City of San Buenaventura in administering and enforcing the rules and policies of the Affordable Housing Program. The sources that may be asked to release information may include but are not limited to your present employers, sources of credit information which produce consumer reports as defined in the Fair Credit Reporting Act, 15 U.S. Code & 1681 a(d), state and federal offices which administer programs such as welfare, unemployment, Social Security, and assistance to veterans and schools. I/We agree that a photocopy of this authorization may be used for the purposes stated herein. The original of this Statement and Authorization will be included in my file at Housing Authority of the City of San Buenaventura and will have full effect for a year and one month from the date below. I/We understand I/we have the right to review our file and correct any information which we can show as incorrect. I/We agree to notify Housing Authority of the City of San Buenaventura in writing regarding any changes in our current household information, which would make incorrect any of the information given in this application including, but not limited to our address, telephone numbers, income sources and amounts, and household composition. The Housing Authority of the City of San Buenaventura is committed to providing equal housing opportunity for all people regardless of race, color, gender, religion, national origin, familial status or disability. If you believe you have been a victim of discrimination, contact the U.S. Department of Housing and Urban Development s Fair Housing Hotline at 1 (800) Names and Signatures of All Adult Household Members 18 years or Older. Printed Name: _ Signature: : Printed Name: _ Signature: : Printed Name: _ Signature: : Printed Name: _ Signature: : 8