CLIENT INFORMATION YOUR Full Name: Date of Birth: / / SSN: - - HIS/HER Full Name: Date of Birth: / / SSN: - -

Transcription

1 Please answer the questions below as accurately as possible. This information will help us to better meet your needs. Date Time CLIENT INFORMATION YOUR Full Name: Date of Birth: / / SSN: - - Is anyone buying/renting the home with you? (Check one): YES NO If YES, fill out the following: HIS/HER Full Name: Date of Birth: / / SSN: - - Total Household Size: Adults (18 and older): Children (18 or younger): CONTACT INFORMATION Phone Number: Address: Address: County: City: State: Zip: When did you move in? Which housing situation best describes you now? (Check One): I rent I own the home Other: INCOME INFORMATION Combined Monthly Household Income (Before Taxes): $ Source(s) of Income: Do you speak English? If NO, list the preferred language: Does anyone in your household have a disability, as defined by Social Security? Are you a single parent? Are you 62 years old or older? Are you a U.S. Citizen? Are you a Veteran? YES NO ETHNICITY (Check One): SEX (Check One): EDUCATION (Check highest level completed): Hispanic Female No High School Diploma Non-Hispanic Male Finished High School GED RACE (Check all that apply): MARITAL STATUS (Check One): Some College American Indian Unmarried 2 year degree Asian Married Professional License Black/African American Separated 4 year degree Pacific Islander/ Hawaiian Divorced Master s degree White Widowed Doctoral degree I came here today seeking information on: Buying a home Obtaining a business loan Needing home repairs Renting a home or apartment Starting a business Other Foreclosure prevention Reverse Mortgage Counseling

2 812 South Washington Street Marion, IN Toll Free: Fax: DISCLOSURE STATEMENT Counseling Services Offered- Affordable Housing Community Development Corporation (AHC) is a HUD-approved local housing counseling agency. We provide comprehensive counseling services for clients seeking information, guidance, and assistance to address their housing needs. Services may include the following types of housing counseling: Homeownership Education AHC offers 3 classes which cover the basics of buying and owning a home. AHC does not guarantee that the classes will assure qualification for a mortgage or any assistance program. Pre-Purchase Counseling AHC counselors meet with clients one-on-one to address their obstacles to home ownership. Counselors review and discuss: client s credit issues and eligibility for mortgage and down-payment assistance programs; client s income and debt in relationship to housing affordability; short-term and long-term financial goals and steps to take to secure and maintain homeownership; and other applicable information. AHC does not guarantee that counseling will assure qualification for a mortgage or any assistance program. Non-Delinquency Post-Purchase Counseling AHC counselors meet with clients who are seeking assistance with needed home repairs/improvements. Counselors review the client s situation and identify resources to address their obstacles, including alternative housing options when appropriate. AHC does not guarantee that counseling will result in mortgage refinancing, repairs or home improvements. Rental Counseling AHC counselors meet with clients who are seeking rental housing to address their obstacles to renting. Counselors provide a guidebook of area rentals and identify other resources and steps to remedy barriers. AHC does not guarantee that counseling will result in occupancy of a rental unit. Homeless Counseling AHC counselors meet with clients who are without permanent housing to assist them in finding shelter. Counselors make referrals to area emergency shelters and transitional housing programs. AHC does not guarantee that counseling will result in admission to housing for the homeless. I understand that it is my responsibility to work cooperatively with the housing counselor and actively participate in the process and that failure to do so will result in the discontinuation of my counseling. I understand that it will not be the responsibility of the counselor to fix the problem, but rather to provide guidance and education which may enable me to resolve my personal financial challenges. (Form continues on next page) AHC is a not-for-profit HUD approved and state certified housing counseling agency and a Community Housing Development Organization certified by the Indiana Housing & Community Development Authority

3 Other Services Offered- AHC builds, rehabilitates and sells properties, administers Individual Development Accounts, weatherizes homes, manages rental properties, packages USDA Direct loans, offers foreclosure prevention counseling, Reverse mortgage counseling, and more. I understand that I am not required to use any of AHC s other services in order to receive housing counseling. Local Partnerships/ Steering- AHC partners with lenders, real estate agents, and other housing professionals to provide accurate information to clients and increase access to down-payment assistance programs. AHC may give information about a variety of professional services available in the area. Clients are not obligated to work with any of these partners in order to use counseling services or receive information about homeownership. I understand that I am free to choose among lenders, lending products, and homes regardless of recommendations made by counselors. Legal Questions- Employees of AHC are not attorneys. Any information provided is to be used as a resource and is based solely on the experiences and training of the counselors. No information provided should be regarded as legal advice. I understand that AHC will not provide me with legal advice, and that when making legal decisions, I should consult with an attorney or a legal advisor. Fees for Service for Homeownership Education and Counseling EXCEPT FOR Grant for Grads Clients Clients may attend Class 1 of the Homeownership Education Course at no cost. A fee of $50 is due at the beginning of Class 2, or at the first face-to-face meeting with a counselor (whichever happens first). Scholarship funds are available for this fee based on income. If AHC pulls your tri-merge (complete) credit report, there is a fee of $16 for one person or $30 for a couple, due when that report is pulled. A final $250 fee is due on the date that you buy your home- this fee is paid as a closing cost, and can be covered by down payment assistance. Fees for Service for Homeownership Education and Counseling ONLY APPLIES TO Grant for Grads Clients Clients may attend Class 1 of the Homeownership Education Course at no cost. A fee of $250 is due at the beginning of Class 2, or at the first face-to-face meeting with a counselor (whichever happens first). Scholarship funds are available for this fee based on income. I understand that AHC charges fees for service, and that I will be responsible for paying those fees. Printed Name of Applicant Date Signature of Applicant

4 812 South Washington Street Marion, IN Toll Free: Fax: DISCLOSURE STATEMENT Counseling Services Offered- Affordable Housing Community Development Corporation (AHC) is a HUD-approved local housing counseling agency. We provide comprehensive counseling services for clients seeking information, guidance, and assistance to address their housing needs. Services may include the following types of housing counseling: Homeownership Education AHC offers 3 classes which cover the basics of buying and owning a home. AHC does not guarantee that the classes will assure qualification for a mortgage or any assistance program. Pre-Purchase Counseling AHC counselors meet with clients one-on-one to address their obstacles to home ownership. Counselors review and discuss: client s credit issues and eligibility for mortgage and down-payment assistance programs; client s income and debt in relationship to housing affordability; short-term and long-term financial goals and steps to take to secure and maintain homeownership; and other applicable information. AHC does not guarantee that counseling will assure qualification for a mortgage or any assistance program. Non-Delinquency Post-Purchase Counseling AHC counselors meet with clients who are seeking assistance with needed home repairs/improvements. Counselors review the client s situation and identify resources to address their obstacles, including alternative housing options when appropriate. AHC does not guarantee that counseling will result in mortgage refinancing, repairs or home improvements. Rental Counseling AHC counselors meet with clients who are seeking rental housing to address their obstacles to renting. Counselors provide a guidebook of area rentals and identify other resources and steps to remedy barriers. AHC does not guarantee that counseling will result in occupancy of a rental unit. Homeless Counseling AHC counselors meet with clients who are without permanent housing to assist them in finding shelter. Counselors make referrals to area emergency shelters and transitional housing programs. AHC does not guarantee that counseling will result in admission to housing for the homeless. I understand that it is my responsibility to work cooperatively with the housing counselor and actively participate in the process and that failure to do so will result in the discontinuation of my counseling. I understand that it will not be the responsibility of the counselor to fix the problem, but rather to provide guidance and education which may enable me to resolve my personal financial challenges. (Form continues on next page) AHC is a not-for-profit HUD approved and state certified housing counseling agency and a Community Housing Development Organization certified by the Indiana Housing & Community Development Authority

5 Other Services Offered- AHC builds, rehabilitates and sells properties, administers Individual Development Accounts, weatherizes homes, manages rental properties, packages USDA Direct loans, offers foreclosure prevention counseling, Reverse mortgage counseling, and more. I understand that I am not required to use any of AHC s other services in order to receive housing counseling. Local Partnerships/ Steering- AHC partners with lenders, real estate agents, and other housing professionals to provide accurate information to clients and increase access to down-payment assistance programs. AHC may give information about a variety of professional services available in the area. Clients are not obligated to work with any of these partners in order to use counseling services or receive information about homeownership. I understand that I am free to choose among lenders, lending products, and homes regardless of recommendations made by counselors. Legal Questions- Employees of AHC are not attorneys. Any information provided is to be used as a resource and is based solely on the experiences and training of the counselors. No information provided should be regarded as legal advice. I understand that AHC will not provide me with legal advice, and that when making legal decisions, I should consult with an attorney or a legal advisor. Fees for Service for Homeownership Education and Counseling EXCEPT FOR Grant for Grads Clients Clients may attend Class 1 of the Homeownership Education Course at no cost. A fee of $50 is due at the beginning of Class 2, or at the first face-to-face meeting with a counselor (whichever happens first). Scholarship funds are available for this fee based on income. If AHC pulls your tri-merge (complete) credit report, there is a fee of $16 for one person or $30 for a couple, due when that report is pulled. A final $250 fee is due on the date that you buy your home- this fee is paid as a closing cost, and can be covered by down payment assistance. Fees for Service for Homeownership Education and Counseling ONLY APPLIES TO Grant for Grads Clients Clients may attend Class 1 of the Homeownership Education Course at no cost. A fee of $250 is due at the beginning of Class 2, or at the first face-to-face meeting with a counselor (whichever happens first). Scholarship funds are available for this fee based on income. I understand that AHC charges fees for service, and that I will be responsible for paying those fees. CLIENT COPY- PLEASE KEEP FOR YOUR RECORDS

6 812 South Washington Street Marion, IN Toll Free: Fax: Thank you for contacting AHC for information on renting a home or apartment! What are your next steps? Action Plan 1. Look through the Rental Resource Guide to determine what places may interest you. 2. Contact the manager for each potential property directly (contact information is listed in Guide) to check on availability and to see if the property will meet your personal housing needs. 3. If you are interested in renting at the Emerson Duplex Townhomes, Evergreen Duplex Townhomes, Springhill Homes, or Gas City School Apartments then return a completed application to AHC. 4. If you need further assistance contact Tequila Page at ext If you are interesting in finding out more about purchasing a home in the future, let AHC know, and we will be happy to assist you further in that area. Potential Renter Signature _ Date AHC can help you in your search for a rental home or apartment by: Providing you with our exclusive Rental Resource Guide Accepting applications for Emerson (duplex), Evergreen (duplex), Springhill (Single Family) rental homes, and Gas City School Apartments (Over 55 years) Advising you through the rental process as needed Helping you to move from renting to purchasing your own home (if that is your desire) AHC is a not-for-profit HUD approved and state certified housing counseling agency and a Community Housing Development Organization certified by the Indiana Housing & Community Development Authority

7 812 South Washington Street Marion, IN Toll Free: Fax: Thank you for contacting AHC for information on renting a home or apartment! What are your next steps? Action Plan 6. Look through the Rental Resource Guide to determine what places may interest you. 7. Contact the manager for each potential property directly (contact information is listed in Guide) to check on availability and to see if the property will meet your personal housing needs. 8. If you are interested in renting at the Emerson Duplex Townhomes, Evergreen Duplex Townhomes, Springhill Homes, or Gas City School Apartments then return a completed application to AHC. 9. If you need further assistance contact Tequila Page at ext If you are interesting in finding out more about purchasing a home in the future, let AHC know, and we will be happy to assist you further in that area. CLIENT COPY- PLEASE KEEP AS A REMINDER AHC can help you in your search for a rental home or apartment by: Providing you with our exclusive Rental Resource Guide Accepting applications for Emerson (duplex), Evergreen (duplex), Springhill (Single Family) rental homes, and Gas City School Apartments (Over 55 years) Advising you through the rental process as needed Helping you to move from renting to purchasing your own home (if that is your desire) AHC is a not-for-profit HUD approved and state certified housing counseling agency and a Community Housing Development Organization certified by the Indiana Housing & Community Development Authority

8 COVER SHEET / FAX TRANSMITTAL AUTHORIZATION TO RELEASE INFORMATION Date: Number of pages including cover sheet: To: From: Affordable Housing Corporation Attention: 812 South Washington Street Company: Marion, IN Address: Phone: Phone: (Lorri Cox at extension 101) Fax: Fax: lorri@ahcgrantcounty.com The undersigned individual has applied for residency at. The property is operated under the Low-Income Housing Tax Credit Program within Section 42 of the Internal Revenue Code and/or United States Department of Housing and Urban Development HOME Investment Partnerships Program, which requires that we obtain written confirmation of the income of all applicants and other household members. In order to comply with federal regulations requesting verification of all income, assets, and allowances for residents of this property, please complete the following form in full and return it to the sender at your earliest convenience. The undersigned understands that, depending on program policies and requirements, previous or current information regarding me/us may be needed. Verifications and inquiries that may be requested include but are not limited to: - Credit and Criminal Activity - Identity and Marital Status - Residences and Rental Activity - Employment, Income, and Assets - Medical Allowances - Student Status The groups or individuals that may be asked to release/verify the above information (depending on program requirements) include but are not limited to: - Courts and Post Offices - Past and Present Employers - Utility Companies - Law Enforcement Agencies - State Unemployment Agencies - Credit Providers and Bureaus - Medical Providers - Veterans Administration - Welfare Agencies - Social Security Administration - Retirement Systems - Internal Revenue Service - Previous Landlords - Banks/Financial Institutions I/we agree that a photocopy of this authorization may be used for the purposes stated above. The original of this authorization is on file in the management office and will stay in effect for two (2) years from the date signed. I/we understand I/we have a right to review my/our file and correct any information that can be proven is incorrect. The undersigned hereby authorizes the release of any information requested in order to determine my/our eligibility for the rental housing program. TO BE COMPLETED BY APPLICANT/RESIDENT: Applicant/Resident Name (Printed): Social Security Number: Authorizing Signature: Date Signed: Co-Applicant/Co-Resident Name (Printed): Social Security Number: Authorizing Signature: Date Signed: Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

9 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 1 of 6 FOR OFFICE USE ONLY Application Received: Time: Date: Please provide answers to all of the questions below. If a question does not apply to you, then answer, N/A. PLEASE PRINT I am applying for a unit at (check all that apply): Springhill Emerson Evergreen Gas City School Apts. Applicant s Name: _ (First) (Middle) (Last) Address: (Street and Apartment #) (City) (State) (Zip) Telephone 1: ( ) Telephone 2: ( ) Marital Status: Single Married Separated Divorced Widowed HOUSEHOLD COMPOSITION: Please complete all boxes for each person that will be occupying the unit (start with you). Full Name Relationship to Head of Household Date of Birth Social Security Number Head of Household Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

10 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 2 of 6 1) Are there any absent household members who under normal conditions would live with you? Yes No If yes, please explain: 2) Does someone other than you or another adult in your household have primary physical custody of each child listed in this application? Yes No If yes, please explain 3) Does your household have or plan to have any pets other than those used as service animals? Yes No If yes, please explain (type, breed, weight): _ 4) Do you consider yourself, or another member of the household, as having a disability? Yes No If yes, please complete the attached Determination of Disability to Determine Eligibility for Housing. 5) Will your household be receiving Section 8 housing assistance? Yes No 6) Have you or any household member Please explain all yes answers to questions a) through g): a) ever been convicted of a crime other than traffic violations? Yes No b) ever been evicted? Yes No c) ever filed for bankruptcy? Yes No d) ever willfully or intentionally refused to pay rent? Yes No e) ever been an illegal user of a controlled substance? Yes No f) ever been arrested/convicted of a drug-related crime? Yes No g) ever lived in subsidized housing and had tenancy or assistance terminated for fraud, nonpayment of rent, or failure to cooperate with recertification procedures? Yes No RENTAL HISTORY Present Landlord Name: _ Phone: ( ) Landlord Address: _ (Street and Apartment #) (City) (State) (Zip) Dates of Occupancy: from _ to Related? Yes No If yes, how are you related? _ Monthly Payment: $_ Reason for Moving: Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

11 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 3 of 6 RENTAL HISTORY (continued) Previous Address: _ (Street and Apartment #) (City) (State) (Zip) Previous Landlord Name: _ Phone: ( ) Landlord Address: _ (Street and Apartment #) (City) (State) (Zip) Dates of Occupancy: from _ to Related? Yes No If yes, how are you related? _ Monthly Payment: $_ Reason for Moving: Previous Address: _ (Street and Apartment #) (City) (State) (Zip) Previous Landlord Name: _ Phone: ( ) Landlord Address: _ (Street and Apartment #) (City) (State) (Zip) Dates of Occupancy: from _ to Related? Yes No If yes, how are you related? _ Monthly Payment: $_ Reason for Moving: PERSONAL/CHARACTER REFERENCES Name: Relationship: Phone: ( ) Name: Relationship: Phone: ( ) CREDIT REFERENCES Loans/Credit Cards/Other: How many automobiles do you own? AUTOMOBILE INFORMATION Please provide Make(s)/Model(s)/Year(s)/Color(s)/License Plate #(s): Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

12 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 4 of 6 INCOME AND ASSETS Amount Hours Per Amount Employee Name Employer Name Per Hour Week Per Week Head of Household: $ $ Other Adult: $ $ Other Adult: $ $ Other Income Sources Household Member TANF $ SSI $ SSI $ Social Security $ Social Security $ Child Support $ Alimony $ Military/Retirement $ Pension $ Income on Rental Property $ Unemployment $ Disability $ Worker s Compensation $ Student Financial Assistance $ for Tuition Only: Student Financial Assistance $ for Books, Etc. (Non-Tuition): Other: $ Other: $ Other: $ Amount Per Month Contact Information Asset Household Member Cash on Hand $ Checking $ Savings $ Certificates of Deposit (CDs) $ Stocks/Bonds $ Real Estate $ Other: $ Other: $ Estimated Balance/Value Contact Information and Account Numbers Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

13 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 5 of 6 EMERGENCY CONTACT NUMBER In case of emergency, notify: Telephone 1: ( ) Telephone 2: ( ) APPLICANT CERTIFICATIONS Applicant certifies the above information is true and accurate and understands that false or inaccurate information, including but not limited to, misrepresentation or omission of information, shall be cause for denial of this application or termination of any subsequent rental agreements. I/We are the only person(s) who will reside in the rental unit if this application is approved. The owner or management agent may verify all information given directly or through reporting agencies. Acceptance of the application is not binding on the owner or management agent until approved in writing. You have applied to live in a subsidized unit that requires us to certify all of your income, asset, and eligibility information as part of determining your household s eligibility. Program requirements state we must verify each income and asset source as well as other claims of eligibility. We must determine this prior to granting your eligibility and, if such eligibility is granted, each subsequent year you remain in the unit. The undersigned is the person(s) named above and hereby authorizes Affordable Housing Corporation to conduct verifications and inquiries, including but not limited to, information about my Criminal Record, Police Record, Motor Vehicle Record, Credit Report, Employment, Income, Assets, Identity, Marital Status, Medical Allowances, Residences and Rental Activity, and Student Status for the purpose of obtaining housing. Additionally, I authorize all companies and law enforcement agencies to release such information, and release them from any liability and responsibility for doing so. A faxed copy of this authorization shall be as valid as the original. If applicant cancels after two (2) days, all monies deposited shall be forfeited to the owner. If approved, all monies deposited with this application will be applied toward security deposit and/or processing fee at owner s discretion. If an application is denied for ANY reason, a ninety (90) day wait period is required before reapplying to this property. Applicant Signature Applicant Printed Name Date Applicant Signature Applicant Printed Name Date Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.

14 Affordable Housing Corporation S. Washington Street Marion, IN Phone Management Agent/Owner RENTAL APPLICATION FOR SUBSIDIZED HOUSING Applicants must be 18 years of age or older and have the legal capacity to sign a lease. Page 6 of 6 DETERMINATION OF DISABILITY TO DETERMINE ELIGIBILITY FOR HOUSING Do you consider yourself, or another member of the household, as having a disability? Yes No If no, stop here. If yes, who has this disability? What is the disability? physical please note the type of physical limitations and if any accommodation is required within the housing: mental developmental chemical dependency alcohol drugs currently receiving treatment date treatment to end: place of treatment: in-patient out-patient have received treatment and in recovery date when finished last treatment: place of treatment: in-patient out-patient have received treatment and not in recovery date when finished last treatment: _ place of treatment: in-patient out-patient have not received treatment How long have you been sober or clean? Has this disability been diagnosed? Yes. By whom? Attach written diagnoses, certification, evidence. No. Why? Have not pursued a diagnosis. Have pursued but not able to have it diagnosed. Equal Opportunity Housing * Equal Opportunity Employer We encourage and support the nation s affirmative housing program in which there are no barriers to obtaining housing because of race, color, religion, sex, national origin, handicap, or familial status.