Rocky Corner Homes. Attached you will find an application for the New Haven HomeOwnership Center s First-Time Homebuyers Education Program.

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1 Rocky Corner Homes PLEASE SUBMIT ALL DOCUMENTS LISTED BELOW WITH THE APPLICATION PACKET PLEASE REMEMBER TO PROVIDE US WITH COPIES ONLY!!! (WE WILL NOT MAKE COPIES FOR YOU IN THE OFFICE) Dear Homebuyer, Attached you will find an application for the New Haven HomeOwnership Center s First-Time Homebuyers Education Program. Please complete the application and return it with copies of the following documents: Copy of a valid driver s license or State-issued ID card. Copy of four (4) most recent pay stubs. Copies of your 2013 & 2014 income tax returns & W-2 statements (if selfemployed, also bring in Profit & Loss Statements for 2013 and **No application will be accepted without the supporting documents listed above** When you return your completed application and copies of the requested documents, you will be scheduled for an eligibility determination session. Thank you for your cooperation. Michael B. Haynes Manager of Community Development Neighborhood Housing Services of New Haven Revised 4/1/ Sherman Avenue, New Haven, Connecticut (203) 562-REAL T (203) F

2 PERSONAL PROFILE INTAKE FORM APPLICANT Name:_ First MI Last Street City State Zip Code Home: ( ) - Work: ( ) - Cell ( ) - Pager: ( ) / / Social Security Number ITIN Date of Birth How did you learn about our program? (Please choose all that apply): Print Advertisement Bank Government TV Real Estate Agent Radio Walk-In Friend Staff/Board Member Lender Newspaper Article Agency Outreach HUD Website Other: If referred by a bank or realtor, which one? Have you been pre-qualified for a mortgage? Yes No If yes, please state lender/mortgage company Race (Check all that apply): American Indian/Alaskan Native Asian Black /African American Unknown Other Other: Ethnicity (If you select Hispanic origin, please choose) Hispanic Native Hawaiian/ Pacific Islander White Chose not to respond Cuban Mexican/Chicano Puerto Rican Other Hispanic/Latino Preferred Language: English Spanish Other

3 English Proficiency: English Proficient Not English Proficient Immigrant Status: US Citizens Foreign Born Marital Status: Single Married Divorced Separated Widowed Head of Household: Yes No Gender: Male Female Veteran: Yes No Disabled: Yes No Current Housing Arrangement (Please Choose): Rent Homeowner with Mortgage Homeowner with mortgage paid off Homeless Living with family member and not paying rent Current Housing Length of Occupancy Years Months Do you live in public housing? Yes No Do you receive Section 8 or any other kind of housing subsidy? Yes No If other than Section 8, please explain? Family/Household Size: Are there dependents/ non-dependents that will be living in the home? Yes No Relationship Age Relationship Age Relationship Age Relationship Age Relationship Age Relationship Age Disabled Dependent: Yes No Annual family or Household Income: $ Are you a first time buyer (you do not currently own a home and have not owned a home in the past three years)? Yes No

4 Education: Below High School Diploma High School Diploma or Equivalent Attended College Associates Degree Bachelors Degree Masters Degree Above Masters Degree CO-APPLICANT Name:_ First MI Last Street City State Zip Code Home: ( ) - Work: ( ) - Cell ( ) - Pager: ( ) / / Social Security Number ITIN Date of Birth Race (Check all that apply): American Indian/Alaskan Native Asian Black /African American Unknown Other Other: Ethnicity: (If you select Hispanic origin, please choose) Hispanic Native Hawaiian/ Pacific Islander White Chose not to respond Cuban Mexican/Chicano Puerto Rican Other Hispanic/Latino Preferred Language: English Spanish Other English Proficiency: English Proficient Not English Proficient Immigrant Status: US Citizens Foreign Born Marital Status: Single Married Divorced Separated Widowed Head of Household: Yes No Gender: Male Female

5 Disabled: Yes No Are you a first time buyer (you do not currently own a home and have not owned a home in the past three years)? Yes No Education: Below High School Diploma High School Diploma or Equivalent Attended College Associates Degree Bachelors Degree Masters Degree Above Masters Degree Relationship to Applicant: Spouse Daughter Son Sister Brother Girlfriend Boyfriend Mother Father Other: APPLICANT S EMPLOYMENT Last 2 Years Primary Employer: Title _ Hire Date Street City State Zip Code Phone: ( ) - Part-Time Full Time Gross Income (before Taxes): $ Is this amount paid: Hourly Weekly Every Two Weeks Twice a Month Monthly If less than 2 years, please continue listing previous employers on reverse side of sheet of paper. Secondary Employer: Title _ Length of Employment Street City State Zip Code Phone: ( ) - Part-Time Full Time Gross Income (before Taxes): $

6 CO-APPLICANT S EMPLOYMENT Last 2 Years Primary Employer: Title _ Length of Employment Street City State Zip Code Phone: ( ) - Part-Time Full Time Gross Income (before Taxes): $ Is this amount paid: Hourly Weekly Every Two Weeks Twice a Month Monthly If less than 2 years, please continue listing previous employers on reverse side of sheet of paper. Secondary Employer: Title _ Length of Employment Street City State Zip Code Phone: ( ) - Part-Time Full Time Gross Income (before Taxes): $ Is this amount paid: Hourly Weekly Every Two Weeks Twice a Month Monthly

7 INCOME Type of Income APPLICANT Monthly Amount CO-APPLICANT Monthly Amount Salary Alimony/Child Support Rental Income Social Security Pension Income Public Assistance Self-employment Income Dependent SSI Income Disability Income Other Employment APPLICANT CO-APPLICANT Can you document your child support/alimony income? Yes No Yes No If yes, how long will it continue? If your child or a family member receives SSI, how many more years will the payments continue? If you receive disability income, Is it for a permanent disability? Yes No Yes No Regarding other employment, have you worked in this field for two years or more? LIABILITIES/DEBT Yes No Yes No Please list any debts you have, including credit cards, auto loans, student loans, child-care expenses. Do NOT include rent or utilities. Please use back side of this paper if necessary Paid To: Current Balance Monthly Payment Who s Debt? A=Applicant C=Co-Applicant B=Both

8 APPLICANT CO-APPLICANT Have your payments been made on time? Yes No Yes No Are your currently in Chapter 13 bankruptcy? If yes, when did it begin? If yes, when will it be paid out? If yes, how much is the payment? Have you had a Chapter 7 bankruptcy? If yes, when was it discharged? LIQUID FUNDS/SAVINGS/INVESTMENTS Please list the approximate value of the following: List Bank Name (below) APPLICANT CO-APPLICANT Checking Account Savings Account Cash CD s Securities (stocks, bonds, etc.) Retirement accounts Other liquid funds Are you about to receive additional funds (e.g. tax refunds, proceeds from property sales, etc.) Yes No If yes, how much? $ LIVING EXPENSES Current monthly rent or mortgage Electric/Gas/Oil/Solid Waste Telephone Cellular/Pager Cable/Satellite TV Other living expenses APPLICANT CO-APPLICANT

9 AUTHORIZATION I authorize Neighborhood Housing Services of New Haven, Inc. and the New Haven HomeOwnership Center, Inc. to: Pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property. Pull my/our credit report and review my/our credit for informational inquiry purposes; and Obtain a copy of the HUD-1 Settlement Statement, appraisal, 1003-mortgage application, Good Faith Estimate, truth in Lending Disclosure Statement, commitment letter, purchase and sales agreement and real estate note(s) when I purchase a home, from either the lender who made me/us a loan and/or the attorney and/or title company that closed the loan. I/We understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section Applicant s Signature Date Co-Applicant s Signature Date Internal Office Use Only Date Application Received: Processing fee: $_ Orientation Date: Post-Purchase Client Received HUD issued HECM Certificate: Yes No Client is a victim of Predatory Lending Practices: Yes No Revised 4/1/2015

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