|
Snow Belt Housing Company, Inc. Cheryl L. Shenkle-O’Neill, Executive Director
7500 South State Street * Lowville, NY 13367
(315) 376-2639 * (315) 376-2518 fax
NYS Relay Service No. – TTD 1-800-662-1220
E-mail:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
FIRST TIME HOMEBUYER PROGRAM
If you need more space for any question, please include additional information on an attached sheet.
_ __
APPLICANT DATE OF BIRTH SOC. SEC. #
CO-APPLICANT DATE OF BIRTH SOC. SEC. #
CURRENT ADDRESS:
Street and/or P.O. Box No. ___
Village or Town, and Zip Code
How long have you lived at this address? RENTAL PAYMENT:
HOME PHONE No: ___ CELL PHONE No:
DEPENDENT’S NAMES:
1. AGE: RELATIONSHIP:
2. AGE: RELATIONSHIP:
3. AGE: RELATIONSHIP:
4. ___ AGE: RELATIONSHIP:
EARNED INCOME: Include all employment and self-employment income for adult household members. For self employment – show Net Business Income.
NAME ADDRESS AMOUNT LENGTH OF TIME
$ per YRS.____
$ per YRS.____
$ per YRS.____
OTHER HOUSEHOLD INCOME FOR LAST YEAR and OTHER HOUSEHOLD PROJECTED INCOME FOR CURRENT YEAR: (for example: Veteran’s, SSI, SSD, Pension, Interest, Dividends, Alimony, Child Support)
$ per
__ $ per
_ $ per
OTHER ASSETS: (For example: Savings Accounts, Real Property, Investments, I.R.A.’s, Certificate of Deposit, etc.)
$ (cash value)
$ (cash value)
______________________________________ $ (cash value)
Do you now own, or have you ever owned real property (vacant land, rental house, own home)?
Yes ______ No ______
If yes to the above, how long has it been since you owned your home?
Explain if necessary:
Do you anticipate having any funds to put into this project? Yes No ___________
If yes, approximately how much? $ _________ _
From what source? _______________________
DEBT STRUCTURE:
Have you and/or Co-Applicant ever had debts turned over for collection? Yes_______ No_______
Do you and/or Co-Applicant have any debts currently at a Credit Bureau for collection? Yes_____ No_____
Are you a co-signer on any loans? Yes _______ No __________
If yes, please explain
________________________________________________________________
Have you and/or Co-Applicant ever declared bankruptcy? Yes_______ No_______
If yes, when was the bankruptcy discharged?______________________
Why was the bankruptcy declared?
______________
Please provide below payments for all household debt:
Applicant: Car Loan: $__________/month. How many months remaining? _____
Co-Applicant: Car Loan: $__________/month. How many months remaining? _ __
REFERENCE: APPLICANT CO-APPLICANT
Mo. Payment Balance Mo. Payment Balance
MasterCard $ $ $ $
Visa $ $ $ $__ _
Discover $ $ $ $
Sears $ $ $ $
JC Penney $ $ $ $
Other (Specify)________ $ $ $ $
Other (Specify)________ $ $ $ $
Student Loan $ $ $ $
Personal Loan $ $ $ $
TOTALS $ $ $ $
CONFLICT OF INTEREST – Are you related to:
Any Board Member of Snow Belt Housing Company, Inc.? Yes __ No _ .
Any employee of Snow Belt Housing Company, Inc.? Yes_____ No_____.
Any Public Official of the Municipality in which you live? Yes_____ No_____.
If YES, to what agency?____________________________________ and approximately how much was the Grant for? $_______________. If applied for and not provided, why was it denied? __ ___ ____
______
STATISTICAL DATA:
Federal and State Law prohibits discrimination on the basis of age, sex, race, national or ethnic origin, handicap or familial status. The Snow Belt Housing Company, Inc. and the County of Lewis is committed to serving its community without discrimination, and will comply with all rules and regulations regarding Fair Housing, Equal Opportunity, and Minority and Small Business Participation. The data is for statistical purposes and will not be considered by any local, State, or Federal official in determining an applicant’s eligibility for assistance.
Sex of Head of Household: ______ Male ______ Female
Age of Head of Household: ________years of age
Is any member of household handicapped? ______ Yes ______ No
Is any member of household disabled? ______ Yes ______ No
Are you a citizen of the United States? Yes________ No________
Are you a Veteran? Yes______ No______
Dates: __________ to____________
The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.
1. Check applicable box:
____White ____Black/African American ____Asian _____ Asian & White ____American Indian/Alaskan Native
____Native Hawaiian/Other Pacific Islander ____American Indian/Alaskan Native & White ____Asian/Pacific Islander
____Black/African American & White ____American Indian/Alaskan Native & Black/African American ____Other Multi-Racial
2. Check applicable box:
_____ Hispanic or Latino ____ Not Hispanic or Latino
All information provided will be kept confidential. All applications become the property of the SBHCI.
ACKNOWLEDGEMENT AND CONSENT:
I (we) understand the terms and conditions of the Note and Mortgage. I (we) must sign for receipt of the Grant/Deferred Loan funds and that the term of the Note and Mortgage will be for a FIVE to TEN year period.
I (we) hereby certify that the above statements are true, accurate, and complete to the best of my (our) knowledge and belief. False statements made knowingly by applicant or co-applicant will disqualify the applicant from participation in this Program and may be subject to prosecution.
I (we) hereby consent to and authorize the Snow Belt Housing Company, Inc. to:
(a) obtain verification of information required for compliance within the regulations of this program, including income, expenses, employment, and contractor estimates;
(b) upon giving reasonable notice, to enter the applicant’s property for the purpose of inspecting work in progress or to inspect completed work;
(c) to obtain a TRW credit report from Utica Credit Bureau.
Understanding the conditions of this Program, I (we) hereby apply for Homeownership Assistance from the Snow Belt Housing Company, Inc. for Grant/Deferred Loan for the purpose of purchasing an existing single family home as my primary residence.
__________________________
Applicant Co-Applicant
Date ______ __ ________ Date ______ __________
TRW CREDIT REPORT REQUEST AUTHORIZATION:
I (we) hereby authorize the Snow Belt Housing Company, Inc. to obtain a written credit bureau report from the Credit Bureau of Utica, New York.
I (we) understand there will be a charge of $40.00 to be paid directly to Snow Belt Housing Company, Inc. in ADVANCE.
_________________________
Applicant Co-Applicant
Date ____________ ____ Date ___ __________
*What is the best way to reach you during business hours (Monday – Friday 9:00 am – 4:00 pm) (please provide-contact information)
_____________________________________________________________________________
|
