3117 N. 16 th St., Suite 100, Phoenix, AZ (602) Fax: (602)

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1 3117 N. 16 th St., Suite 100, Phoenix, AZ (602) Fax: (602) Dear Homeowner, This packet contains the legal documents required to begin the repairs on your house. As you know, the work done is a free service if you continue to live in the home for at least 10 years. Regulations impose this in order to safeguard against program abuse, such as a person buying a property, utilizing federal funds to improve it then selling it for personal gain. For this reason, the value of the work done on your home is reflected as a forgivable loan, which forgives at the rate of 15% for the first 5 years (75%), and 5% per year for the remaining 5 years (25%). If you should pass away (during this 10-year time period) and bequeath the home to your relatives, then they would have the option of keeping the home, selling it, or putting it up for rent. If they sell it, they can pass the loan on to the new homebuyers. If they decide to rent it, and if the renters are in the same income bracket (80% of median) as the original homeowners, the loan will continue to forgive. Whatever the case, no one would ever be required to pay money out-of-pocket. For example, if the value of your home improvements is $12,000 and your children inherit the house 5 years from now, $9,000 would have already been forgiven. If they should decide to sell the home, they could repay the remaining $3,000 from the proceeds of the sale or simply attach the loan to the sale of the home. If they should decide to keep the home for at least another 5 years, the loan would continue to forgive and they would never have to pay for any of the work perfomed, even if they sold it for a considerable profit. If you would like help completing the application, or if you need more information, please let us know. SI NECESITA AYUDA PARA COMPLETAR ESTA FORMA - FAVOR DE LLAMAR AL TELEFONO (602) Page 1 of 8

2 INFORMATION NEEDED TO COMPLETE APPLICATION SI NECESITA AYUDA PARA COMPLETAR ESTA FORMA - FAVOR DE LLAMAR AL TELEFONO (602) FAX, , MAIL OR DROP OFF YOUR APPLICATION WITH A COPY OF THE FOLLOWING AS IT APPLIES TO YOUR SITUATION: Recorded Deed with legal description. Most recent statement from Mortgage Company showing loan to be current, original loan amount, principal balance and monthly payment (including tax and insurance escrow if applicable.) Homeowner's insurance policy (face or cover page) showing effective dates, coverage, agent's name, address and phone number. Two (2) recent pay stubs for all employed members of the household 18 and over. Most recent tax returns. If self-employed, last 2 years of income tax returns and provide all schedules as well as year-to-date Profit and Loss Statement. Divorce decree (statement from Superior Court if child support not being received) Death certificate from spouse or partner if he/she appears on the Deed. Award letter or verification for Social Security, Supplement Security Income (SSI), VA, Civil Service Pension, AFDC, food stamps, interest, etc. include all other sources of income (babysitting, pension, child support, alimony, disability, general assistance, unemployment, etc.) Last two rent receipts on other property owned (or tax statement). Social Security record (card) for all members of the household and picture ID for homeowner and adult members of the household. Most recent utility bills; water, electricity and gas. Bank statements for the last two months; checking & savings. Page 2 of 8

3 HOME REPAIR APPLICATION Applicant Information Name: Age: Race: Hispanic: Y / N Address: City: State: Zipcode: Best Telephone #: ( ) - Secondary/Message #: ( ) - Are you currently Employed: Y / N Employer: Marital Status (Circle One): Single Married Divorced Widowed Spouse Information Name: Age: Race: Hispanic: Y / N Are you currently Employed: Y / N Employer: Household Information Is anyone in your household disabled? Y / N If yes, relationship to you: Name of Mortgage Company: 2 nd Mortgage: How long have you lived in your home? How many Bedrooms are in your house? Names and ages of ALL individuals living in the House : NAME Age Relationship to You: Are you related to anyone that works or volunteers at Labor s Community Service Agency? What home repairs does your house need? Page 3 of 8

4 FINANCIAL ANALYSIS FOR PROGRAM QUALIFICATIONS Monthly Income Earned Income (e.g. wages) Social Security Benefits Pension / Annuities Rental Income Interest/Investment Income Other (Specify) Other (Specify) Other (Specify) Total Gross Income Head of Household Spouse Other Individuals Living in the Household ages 18 and over. Total Monthly Household Income: Monthly Expenses & Obligations Mortgage (include Principal, Interest & Mortgage Insurance) 2 nd Mortgage Hazard Insurance Property Taxes Total Utilities (Electric, Water, Sewer, Was) Car Payment Auto Insurance Other Loans & Credit Cards Child Support Medical Expenses Medical/Dental/Life Insurance Child Care Total Phone/Cable/Internet Other (specify): Total Monthly Expenses and Obligations: Head of Household Checking and Savings Account Primary Checking Account Additional/Spouse Checking Account Primary Savings Account Additional/Spouse Savings Income Additional Bank Account Name of Bank Account Number Current Balance TOTAL I (We), certify that all the household information including income and expenses have been disclosed and are correct to the best of my (our) knowledge. Client Signature & Date Client Signature & Date Page 4 of 8

5 OWNERS RELEASE OF LIABILITY AND PERMISSION TO PERFORM I (We) hereby give my (our) permission to the Labor's Community Service Agency (LCSA) and its employees to act on my (our) behalf as my(our) representative for the express purpose of rehabilitation work to be performed on my (our) property: Address: City: State: Zipcode: I (We) give LCSA permission to perform rehabilitation activities in my(our) home to address health and safety concerns and absolve any and all parties involved in the rehabilitation, of the property mentioned above, of any liability for negligence to myself, my family, visitors and to the property itself and to the contents thereof. I (We) consent to allow the property mentioned above to be photographed and/or filmed at any stage of the rehabilitation work. I (We) understand that all photographs and/or films are the sole property of Labor s Community Service Agency and may be used for, but not be limited to, brochures, newsletters, videos, digital media, and may be shared with funders, investors, community, and the City of Phoenix; I (we) also understand that such images may be used without further notification. It is further understood and agreed that this rehabilitation work and materials used are performed and provided without any warranty, either express or implied whatsoever, including but not limited to, any implied warranties of merchantability and implied warranties of fitness for a particular purpose. (initial) (initial) (initial) By signing below, I (we) acknowledge that I (we) have read and understood each section. Homeowner Signature: Date: Homeowner Signature: Date: LCSA Staff Signature: Date: LETTER OF INTENT TO REMAIN AT PROPERTY Page 5 of 8

6 ADDRESS: 1. I (We) understand that the purpose of the Rehabilitation Programs is to address health and safety hazards for low income homeowners. It is not the purpose of the programs to repair a house that the owner plans to sell when the repair work has been completed. My (Our) house has not been on the real estate market for the past six (6) months. At this time, I (we) do not have plans to sell the house that I (we) have asked to be repaired. 2. I (We) understand that a no interest forgivable loan may be made available to me(us) for home repairs and that if the value of such repairs exceeds $5,000 a lien in the form of forgivable loan promissory note will be filled on the property as security for the loan. I (We) understand that this loan does not require a monthly payment and is forgiven at 15% per year for the first 5 years and 5% per year for the remaining 5 years. 3. I (We) further understand that I (we) must have homeowner s insurance and if my property is located in a flood zone, flood insurance may be required as well. I (We) do understand the importance of having insurance on the property in case of loss. I (We) understand that LCSA staff will further discuss additional insurance requirements with me (us) if it applies to my (our) circumstances and they may contact my (our) insurance agent. HOMEOWNER HOMEOWNER DATE DATE REHABILITATION STAFF DATE DECLINING LOAN AND MAINTENANCE AGREEMENT Page 6 of 8

7 I (We),, are applying to receive a home rehabilitation loan from Labor's Community Service Agency (LCSA) in the amount to be determined at a later date. The loan will be in the form of materials and labor used in rehabilitating my residence: I (We) as the owner and/or resident of the above Address: mentioned property agree to the terms of the declining loan which states that seventy five percent (75%) of the loan amount will be forgiven over a period of five (5) years and the remaining twenty five percent (25%) will be forgiven over the next five years. During this time NO PAYMENTS are due unless I (we) cease to occupy the property or the property is sold or otherwise transferred at which time the balance is due and payable to Labor's Community Service Agency. In the event of my (our) death and my (our) children inherit the property the terms of the agreement will continue for the remainder of the 10 year period. I (We) further agree to maintain the above mentioned property for the same period, ten (10) years. I (We) understand that periodic site inspections may be conducted by LCSA staff to determine if the property is being maintained in accordance with the standards listed: 1) Removal of debris, salvage, junk cars, trash in/and around premises; 2) Ongoing maintenance of landscaping of premises; 3) "Good Faith Effort" to maintain and clean the exterior of the structure; I (We) understand that if the property is not maintained the whole amount of the loan becomes due and payable to Labor's Community Service Agency. Applicant: (Please Print) (Signature) (Please Print) (Signature) LCSA Staff Page 7 of 8

8 CDBG REHABILITATION COMPLAINT RESOLUTION Homeowners will be given a four-step grievance procedure: THE FIRST STEP: Involves the on-site supervisor and the homeowner. THE SECOND STEP: If there is still an issue to be resolved, then the program coordinator will schedule a time to meet with the homeowner. THE THIRD STEP: If there is still no resolution, then the homeowner will meet with the Supervisor of Construction. THE FORTH STEP: If these three steps are not successful and all other means have been exhausted, then the agency s Executive Director will arbitrate the matter. ACKNOWLEDGEMENT OF RECEIPT OF LEAD AWARNESS PAMPHLET I (WE) (Printed homeowner s name(s)) to have received a copy of Protect Your Family From Lead in Your Home pamphlet provided by Labor s Community Service Agency. hereby acknowledge Homeowner Signature: Date: Homeowner Signature: Date: Rehabilitation Staff Signature: Date: Page 8 of 8

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