HOMEBASE AFFORDABLE HOMES PROGRAM

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1 HOMEBASE AFFORDABLE HOMES PROGRAM INCOME ELIGIBILITY APPLICATION Revised April 2013 Please provide ALL applicable information on this form. It will be used to determine your eligibility; HomeBase Income Verification requirement may be more restrictive than the City of Austin SMART Housing Program's requirement. Type of Mortgage amd Terms of Loan Mortgage Applied for: VA Conventional Other (explain): USDA/Rural FHA Housing Service Amount Interest No. of Months Amortization Type: Fixed Rate GPM Other (explain): ARM (type): Property Information and Purpose of Loan Subject Property Address (street,city,state,& ZIP) No. of Units Legal Property Address (street,city,state, & ZIP) Year Built Purpose of Loan: Purchase Construction Other (explain): Property will be: Investment: Refinance Construction- Permanent Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain) Primary Residence Secondary Residence Applicant Information First and Last Name: Social Security # Home Address (street, city, state, ZIP) Own Rent No. Yrs. DOB (MM/DD/YYYY) Yrs. School Gender Dependents (not listed by Applicant): no. ages Married Separated Unmarried (include single, divorce, widowed) Race: Black/African American AIAN* Pacific Islander Other *American Indian and Alaskan Native White Asian Ethnicity: Hispanic/Latino Not Hispanic/Latino Home Telephone: Employment Information Name & Address of Employer : Self Employed Yrs. On this job Yrs. Employed in this line of work/profession If employed in current position for less than two years or if currently employed in more than one position, complete the following: Co-Applicant Information First and Last Name: Social Security # Home Address (street, city, state, ZIP) DOB (MM/DD/YYYY) Yrs. School Gender Dependents (not listed by Applicant): no. ages Race: Black/African American Ethnicity: Home Telephone: Own Rent No. Yrs. Married Unmarried (include single, divorce, widowed) Separated AIAN* Pacific Islander Other White Hispanic/Latino *American Indian and Alaskan Native Asian Not Hispanic/Latino 1 of 4 Income Eligibility Application (Rev 04/15/2013)

2 Employment Information Name & Address of Employer : Self Employed Yrs. On this job Yrs. Employed in this line of work/profession If employed in current position for less than two years or if currently employed in more than one position, complete the following: Household Information Provide information for each household member who will be living in the home INCLUDING anyone who will be on the property title, regardless of whether you are married. Enter the number of members in your household. Name (List Applicant First) Relationship to Applicant Age of Birth (Month/Day/Year) Applicant Days per year child resides with you If Employed Total number of members in household: Housing Information Please check or fill in the correct boxes to tell us about your current housing situation and what you are looking for. Do you currently own a home? yes no Special Needs? Are you a first-time homebuyer? yes no Senior Only Please check from which source the down payment is coming from How much money do you have for down payment? Own funds D D Down payment Gift Handicap-Accessible I IDA $ _ Have you attended a Homebuyer Education class? yes no Projected Annual Income Regular Annual Income Wages/ Salaries/Business Income (Annual) Overtime Bonuses Commissions Dividends/Interest Net Rental Income For every household member who is receiving any of the following sources of income or asset, please enter the requested information under the person's name. If an income or asset type doesn't apply, skip it. Applicant Co-Applicant Total Other (before completing, see the notice in "describe other income," below) Total *Other includes Child Support, Alimony, other public assistance, VA payments, unemployment, investment or trust distributions, or other income received. *Self-employed borrowers are required to submit 2 years of tax returns, YTD statements, PL for 12 months Assets Applicant Co-Applicant Liabilities Monthly Payments Checking Savings 401k/IRA CD Cash Stocks Real Estate *Other: Total Assets *Include description and value of other assets held by any member of the household. Unpaid Balance Total 2 of 4 Income Eligibility Application (Rev 04/15/2013)

3 DEBTS: Please list all monthly debts, the minimum payment, and balance owing. This includes car payments, mortgages, credit cards, child support, etc. Paid To Minimum Monthly Approximate Balance Estimated Purchase Price: Has any borrower filed for bankruptcy in the last 7 years? Yes or No Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet) Cash Down 3% 5% 10% 20% + Property Address (enter S if sold, PS if Pending scale or R if rental being held for income) Type of Property Present Market Value Amount of Mortgages & Liens Gross Rental Income Mortgage Payments Insurance Maintenance, Taxes & Misc. Net Rental Income Totals Checklist INITIAL, if applicable: Review this list for required documentation to submit with your application. Completed application signed and dated by all applicants (all household members must be included on the application). A completed Employer Verification Form for every employed household member OR last THREE (3) pay stubs. Indicate frequency of pay/wages, if pay stubs provides (e.g., monthly, bi-monthly, weekly, or bi-weekly): Monthly Bi-monthly (2 times per month) Weekly Bi-weekly (every 2 weeks) Other IF SELF EMPLOYED: In addition to the 2 COMPLETE years of federal returns please include a current profit & loss estimate projecting income and expenses for 12 months. Last THREE (3) MONTHS of all checking & savings accounts Most current statements for CDs, brokerage accounts, stock investments, mutual funds, etc., and proof of value any other asset held by any member of the household. Certifications Proof of value, as evidenced by a taxing authority or a certified real estate appraiser, and proof of current balance of any debt for any real estate owned. TWO YEARS of signed FEDERAL income tax returns and corresponding W2 s (If you don t have copies please fill out the transcript request form in this packet and fax it to , or call the IRS at ). * Award letter(s) if receiving social security, pension, survivor or disability payment. * If you have been divorced since your last filed federal tax return, a copy of your executed divorce decree OR if you are in the process of a divorce, a copy of the petition for divorce. * If you are divorced or legally separated, a copy of your court ordered custody arrangements, order for child support and/or alimony. * If receiving a financial gift from another person, the person will need to provide a letter that includes the amount of the gift and when the gift will be given. *as it may apply I hereby certify that all the information provided and submitted in support of this application is true and correct as of the date set forth below my signature and that I will be disqualified if it is determined that any or all information provided is inaccurate or non-verifiable. I hereby authorize HomeBase and its related entities and any lender that I request either an Income Eligibility determination, a prequalification approval or a loan approval, the City of Austin, Austin Housing Finance Corporation or any other agency to which this information is provided on behalf of the City, to make any and all inquiries for the purpose of verifying the truthfulness and validity of the information provided. I understand that I may be required to submit additional documentation to verify employment, income, and assets or any additional information deemed necessary to make such eligibility determination. I understand that income certification is valid for six months, or until I have a signed contract for purchase, whichever occurs first. Signatures: I understand and agree that HomeBase and its related entities, the City of Austin, Austin Housing Finance Corporation or any agency or authority it has designated to act on its behalf reserves the right to revise or revoke its eligibility determination based on any information received after a certification determination is made, including discovery of false information. The information contained and programs described herein are intended as a general descriptions relating to affordable housing, are current as of the date of preparation hereof to the knowledge of HomeBase and are subject to change without notice. HomeBase its affiliates, employees and consultants make no warranties or representations of any kind or nature whatsoever regarding the information contained and programs described herein. Applicant: : Co-Applicant: : INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. YOU MUST SUBMIT THE COMPLETED APPLICATION, THE COMPLETED AND SIGNED ELIGIBILITY INSTRUCTIONS, AND ALL SUPPORTING DOCUMENTATION FOR INCOME AND ASSET ELIGIBILITY DETERMINATION. 3 of 4 Income Eligibility Application (Rev 04/15/2013)

4 Optional Information This information is requested for demographic and statistical purposes only. It is not used in determining your eligibility How did you hear about this program (Select all that apply and list source below)? Source: Newspaper Website Brochure Other Word-of-Mouth Realtor I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title18, United States Code, Section 1001, et seq. Loan Originator's Signature Loan Originator's Name (print or type) NMLS # Ramon G. Valeriano Loan Origination Company's Name HomeBase Loan Originator's Phone Number (including are code Borrower's Signature Co-Borrower's Signature Loan Origination Company's Address 55 N IH-35 #240 Austin, TX EQUAL OPPORTUNITY: There will be no discrimination against an applicant on the basis of race, age, sex, marital status, sexual orientation, national origin, religion, handicap, or source of income. 4 of 4 Income Eligibility Application (Rev 04/15/2013)

5 Borrower's Certification & Authorization Certification The undersigned certify the following: 1. I/We have applied for a mortgage loan from, herein referred to as the Lender. In applying for the loan, I/We completed a loan application containing various information on the purpose of the loan, the amount and source of the down payment, employment and income information, and assets and liabilities. I/We certify that all of the information is true and complete. I/We made no misrepresentations in the loan application or other documents, nor did I/We omit any pertinent information. 2. I/We 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. 3. I/We 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 AUTHORIZATION TO RELEASE INFORMATION To Whom It May Concern: 1. I/We have applied for a mortgage loan from,, herein referred to as the Lender. As part of the application process, the Lender may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program. 2. I/We authorize you to provide the Lender and to any investor to whom the Lender may sell my/our mortgage, any and all information and documentation that they request. Such information includes, but is not limited to, employment history and income; bank, money market, and similar account balances; credit history; and copies of income tax returns. 3. The Lender or any investor that purchases the mortgage may address this authorization to any party named in the loan application. 4. A copy of this authorization may be accepted as an original. 5. Your prompt reply to the Lender or the investor that purchased the mortgage is appreciated. NOTICE TO BORROWERS: This notice to you as required by the Right to Financial Privacy Act of 1978 that HUD/FHA has a right of access to financial records held by financial institutions in connection with the administration of assistance to you. Financial records involving your transaction will be available to HUD/FHA without further notice or authorization but will not be disclosed or released by this institution to another government agency or department without your consent except as required or permitted by law.

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