Tooele County HOMEOWNER HOUSING REHAB LOAN APPLICATION

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1 ELIGIBILITY Income Eligibility: This program is available to households with a maximum of 80 percent of the median family income for Tooele County. If your household income is greater than the limits, as outlined below, you are not eligible for this loan program. Family Size Income Limit $38,100 $43,500 $49,000 $54,500 $58,800 $63,150 $67,500 $71,850 * Federal income guidelines of 80% of area median incomes are used to determine eligibility. Income guidelines above revised by HUD effective June 2011 for Tooele County. Information provided by the applicant must be true to the applicant s knowledge. Income will be verified prior to approval of a loan. We reserve the right to terminate assistance and to recover funds expended if the applicant is found to have willfully withheld accurate information or to have deliberately falsified the application. Property Eligibility: Only owner-occupied units on permanent foundations and on land owned by the homeowner are eligible for this program. Mobile homes that are not on land owned by the homeowner are not eligible. REHABILITATION PROCESS AND TIMELINES 1. Complete application and required documentation submitted to Community Development Corporation of UT. 2. CDC determines homeowners eligibility based upon income and household makeup. 3. If the homeowners are eligible, CDCU schedules an appointment to inspect the property. 4. Once physical inspection identifies the deficiencies of the property: lead based paint testing may be required if the home was built before 1978; an estimated rehabilitation cost is determined; and the repair items are put out for bid by contractors. Page 1 of 14

2 5. Project costs (estimated or bids) are taken to the CDCU Loan Committee for approval. 6. Once a project and its cost has been approved, a closing of the loan/grant occurs. 7. A three day waiting period is required after closing before work can begin. 8. A pre-construction meeting is held with homeowners, contractor and CDCU housing specialist. All parties sign construction contract and agree upon a start date. 9. Work begins. 10. CDCU Construction Manager conducts periodic inspections. 11. Work is completed. 12. CDCU Construction Manager performs final inspection with the homeowner and contractor. 13. Final payment is made to contractor(s). 14. Completion certificate signed by all parties. Submit Application To: Community Development Corporation of Utah 501 East 1700 South, Salt Lake City, Utah For more information call xt. 106 APPLICANT INFORMATION Applicant Name Marital Status: Married Single (Last, First, Middle) Divorced Separated Widowed Age: Birth Date Social Security Number Page 2 of 14

3 Co -Applicant Name (Last, First, Middle) Marital Status: Married Single Divorced Separated Widowed Age: Birth Date Social Security Number Relationship to applicant: Property Address City Zip Code Mailing Address (if different): City Zip Code Home Phone Cell Phone Work Phone I am the homeowner and have lived at this address for years How did you hear about this program? The next questions are for survey purpose only, and do not affect an Applicant s Eligibility Applicant Gender: Male Female Ethnicity: Hispanic Non-Hispanic Race: American Indian/Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White American Indian or Native Alaskan & White Asian & White Black or African American & White American Indian or Native Alaskan & Black or African American Other Multiple Race HOUSEHOLD INFORMATION Page 3 of 14

4 Household Size: Number of Dependents: Please provide the following for all family members living in the home or may be living in the home in the next six months: (use back of page if more space needed): Full Name Relationship Age Social Security # HOUSEHOLD INFORMATION continued List all others (non-family) living in the home or may be living in the home in the next six months: Full Name Relationship Age Social Security # Is there a household member who is a Veteran Elderly Disabled Foreign Born Please identify which family member is disabled and provide a brief description of disability: Household Type (please select the most accurate)? Page 4 of 14

5 Single adult Two or more unrelated adults Married w/ children Married w/out children Female headed single parent household Male headed single parent household Is head of household over 62 years old? Other: Have any of your children been tested for lead based paint poisoning? Yes No HOUSEHOLD INCOME INFORMATION Gross Annual Household Income:$ (Total yearly income for entire family, before taxes & deductions) Applicant: Employer: or Name & Address of previous employer if at current job less I am self-employed than 2 years: Position: Number of years at job Start Date: Hourly Income: $ Phone number: Average Hours Worked/Week: How often are you paid: Page 5 of 14

6 Co-Applicant: Employer: or Name & Address of previous employer if at current job less I am self-employed than 2 years: Position: Number of years at job Start Date: Hourly Income: $ Phone number: Average Hours Worked/Week: How often are you paid: Are you employed by the Community Development Corporation of Utah? Yes No Were any adult household members exempt from filing a federal income tax return last year? Yes No If yes, please list which members were exempt: Were any adult household members exempt from filing a federal income tax return last year? Yes No If yes, please list which members were exempt: Page 6 of 14

7 FINANCIAL & MORTGAGE INFORMATION SOURCES OF INCOME Applicants Hourly Wage $ Based on above hourly wage your yearly salary is: Mark with an X if applicable Applicant Household Member 1 Household Member 2 Household Member 3 1 Wages, salaries, tips 2 Taxable Interest 3 Dividends Taxable refunds/credits/offsets of state & local incme 4 taxes (exclusive of exceptions) 5 Alimony Received 6 Business income (or loss) 7 Capital gains (profit/loss) 8 Other gains 9 Taxable Iamount of IRA distributions 10 Taxable amount of pensions and annuities 11 Rental real estate, royalties, partnerships, trusts, etc. 12 farm income (or loss) 13 Unemployment Compensation 14 Total Social Security Benefits Other Income (Overtime, bonuses, foster care by 15 agency, state or county) 16 IRA Deduction 17 Meidcal Savings Account deduction 18 Moving Expenses 19 One-half of self employment tax 20 Self employed health insurance deduction 21 Keough and self-emplouyed SEP or SIMPLE Plans 22 Penalty on early withdrawal of savings 23 Paid Alimony FINANCIAL & MORTGAGE INFORMATION continued Child Support received: Other untaxed income: Existing Debt on property to be rehabilitated (For mortgage verification) Page 7 of 14

8 Name of Titleholders Date Purchased: Year house built Purchase Price $ Payment made to: Type of Mortgage FHA VA Conventional Contract Homeowner s Insurance Company name and Address: Agent Name & Telephone # Policy # Policy Type: Paid by Owner Mortgage Holder DEBTS / RECURRING MONTHLY BILLS Account Number & Business Name Monthly Payment Balance Auto Loan: Make Year Auto Loan: Make Year Credit Card Credit Card Credit Card Credit Card Credit Card Non-reimburseable extraordinary medical costs that are likely to continue for more than a year. Health Insurance Premiums Property tax Property Insurance Land Payments 1st Mortgage 2nd Mortgage Other (describe) Included in house payment? Yes No Included in house payment? Yes No If large medical/dependent care bills are considered as any ongoing debt, please attach documentation to substantiate reason. Page 8 of 14 Include account #, business name, address, monthly payment and balance.

9 Do you own any real estate other than the home in which you reside? Please explain: FINANCIAL & MORTGAGE INFORMATION continued Does either head of household or other member of family: Have any outstanding unpaid judgments Yes No Declared bankruptcy within the past ten years Yes No Been party to a lawsuit Yes No Page 9 of 14

10 If yes to any of the above list, please explain when, where, and why (use back of page if you need more space). About Your Home Is your home on a permanent foundation? Yes No Property Type: 1 unit property 2 to 4 unit property Was your home weatherized by the Weatherization program? Yes No If yes what year? Please describe the repairs your house needs: *Our construction manager will visit you and walk through your home with you to determine the highest priority repairs and develop a scope of work. Page 10 of 14

11 SUPPORTING DOCUMENTATION & CERTIFICATION Attach the following (your application will not be complete if these documents are not provided): COMPLETED AND SIGNED APPLICATION COMPLETED AND SIGNED RELEASES COPY OF DRIVERS LICENSE OR STATE I.D. FOR ALL HOUSEHOLD MEMBERS Page 11 of 14

12 COPY OF SOCIAL SECURITY CARD FOR ALL HOUSEHOLD MEMBERS COPY OF LAST TWO YEARS INCOME TAXES COPY OF THE LAST TWO PAY STUBBS (for all wage earners in the household) COPY OF SOCIAL SECURITY BENEFIT LETTER (if applicable) For every one receiving social security. TWO MONTHS OF BANK STATEMENTS FOR ALL HOUSEHOLD MEMBERS **including savings accounts. PROOF OF ANY OTHER INCOME FOR ALL HOUSEHOLD MEMBERS (i.e. food stamps, child support, etc). DIVORCE DECREE (if applicable). Page 12 of 14

13 CERTIFICATION The applicant certifies that all information in this application and all information furnished in support of this application is given for the purpose of obtaining financial assistance under the applicable program(s) and is true and complete to the best of applicants knowledge and belief. The applicant understands and agrees that if false information is provided in this application, the State of Utah, Division of Housing and Community Development may hold the applicant ineligible to apply for any program funds for a period of 1 year or until any issue of restitution is resolved and may terminate the applicant's contract and recapture all funds expended. The applicant will not, in the provision of services, or in any other manner, discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, familial status, or handicap. Verification of any of the information contained in this application may be obtained from any source named here in. The applicant will at all times indemnify and hold harmless the State of Utah, Division of Housing and Community Development or it's agencies against all losses, costs, damages, expenses, and liabilities of any nature directly or indirectly resulting from, arising out of, or relating to the State acceptance, consideration, approval, or disapproval of this request and the issuance or non-issuance of program funds herewith. In accepting this loan, I/We will pay property taxes, homeowner's insurance, and keep liens off property as long as the loan is in place. Sign I/We certify that the property will be our principal residence for the term of the loan. WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offence to make willful false statements or misrepresentations to any Department or Agency of the U.S. as to any matter within it's jurisdiction. The information provided above is true and complete to the best of my/our knowledge and belief. I/We consent to the disclosure of such information for purposes of income and verification related to my/our application for financial assistance. I/We understand that any willful misstatement of material fact will be grounds for disqualification. Here 1. Applicant signature date 2. Applicant signature date 3. Applicant signature date 4. Applicant signature date For Agency Only I have explained the above application and certification to the applicant(s) Reviewed by: Name of Agency: Community Development Corporation of Utah Date: Page 13 of 14

14 Eligibility Release Form: Organization requesting release of information Name: Community Development Corporation of Utah Information Covered: Inquiries may be made about items initiated by applicant. Address: Phone: 501 East 1700 South ext 106 Required Verification: Borrowers Initials Date: 11/17/2009 Purpose: Your signature on this Eligibility Release Form, and the signatures of each member of your household who is 18 years of age or older, authorizes the above-named organization to obtain information from a third party, relative to your eligibility and continued participation. Privacy Act Notice Statement: The Department of Housing and Urban Development (HUD) and the State of Utah, Division of Housing and Community Development are requiring the collection of the information derived from this form to determine an applicant s eligibility in a Housing Program and the amount of assistance necessary using Federal and/or State funds. This information will be used to protect the Government s financial interest; and to verify the accuracy of the information furnished. It may be released to appropriate Federal, State, and local agencies when relevant, to civil, criminal, or regulatory investigators, and to prosecutors. Failure to provide any information may result in a delay or rejection of your eligibility approval. The Department is authorized to ask for this information by the National Affordable Housing Act of Authorization: I authorize the above-named Participating Jurisdiction and HUD to obtain information about my household and me that is pertinent to eligibility in the Housing Program. Instructions: Each adult member of the household must sign an Eligibility Release Form prior to the receipt of benefit. NOTE: THIS GENERAL CONSENT MAY NOT BE USED TO REQUEST A COPY OF A TAX RETURN. IF A COPY OF A TAX RETURN IS NEEDED, IRS FORM 4506, REQUEST FOR COPY OF TAX FORM MUST BE PREPARED AND SIGNED SEPARATELY. I acknowledge that: 1 A photocopy of this form is as valid as the original 2 I have the right to review the file and the information received using this form (with a person of my choosing to accompany me) Here Sign 3 I have the right to copy information from this file and to request Full time student correction of information I believe inaccurate. 4 All adult household members will sign this form and cooperate with Disabled family member the owner in this process. Page 14 of 14 Head of Household- Family Member Head Other Adult Member of Household- Family Member #2 Printed Name: 0 Printed Name: 0

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