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Application for Housing Programs 1 Updated 2/5/2014 APPLICATION CHECKLIST When you apply for the Lewiston Housing Program, we need the following information to start the application process. Please check type of loan you are applying for: Homebuyer Assistance Program (purchase of properties with 1-4 units) Homeowner Rehabilitation Loan Program (rehabilitation of owner occupied unit) Rental Rehabilitation Loan Program (rehabilitation of properties with 1-4 rental units) Homeowner Emergency Loan Program (emergency repair single family property) For all applicants: Copy of latest W-2 form(s) for each applicant and completed tax return(s). If self-employed, a copy of the last 2 years completed tax return(s). Copy of most recent pay stub, with a year to date income figure, for each applicant. Copy of other sources of income such as Social Security Benefits, etc. Copy of last 2 checking and savings account statements and proof of assets listed in your application. For Rehabilitation requests: The City of Lewiston has a contract relationship with Community Concepts, Inc (CCI) to inspect the property to determine the amount and scope of the rehabilitation work that is needed, conduct a pre- bid inspection and write the scope of work needed, bid the work to two qualified contractors and to manage the rehabilitation work. Call [PHONE REDACTED] to make an appointment for an inspection with Code Enforcement and CCI Copy of hazard and liability insurance on property For Homebuyers only: Copy of certificate signifying that you have attended a homebuyers class Pre-approval loan letter from lender Copy of the Purchase and Sale Agreement Appraisal Return to: Jayne Jochem, Community Development Coordinator City of Lewiston Economic and Community Development Department 27 Pine Street Lewiston, ME 04240 Telephone 513-3126 ext. 3233 Email: [EMAIL REDACTED] ---PAGE BREAK--- Application for Housing Programs 2 Updated 2/5/2014 Property Address: APPLICANT CO-APPLICANT NAME: NAME: DATE OF BIRTH: DATE OF BIRTH: SOCIAL SECURITY SOCIAL SECURITY MAILING ADDRESS: MAILING ADDRESS: EMAIL: EMAIL: PHONE NUMBERS: HOME: CELL: WORK: PHONE NUMBERS: HOME: CELL: WORK: How do you prefer to be reached: (please circle:) Email Home Cell Work Number of people who live in the applicant(s) household Please provide additional information: (Place additional names on separate paper and attach it to the application) NAME RELATIONSHIP AGE The Economic and Community Development Department reports certain information to the federal government. Please provide the race and ethnicity of the head of household (check one box): Race: White American Indian/Alaskan Native & White Black/African American Black/African American & White Asian Asian & White American Indian or Alaskan Native American Indian/Alaskan Native & Black Native Hawaiian/Other Pacific Islander Other Multi-Racial ---PAGE BREAK--- Application for Housing Programs 3 Updated 2/5/2014 Ethnicity: Hispanic Not Hispanic ---PAGE BREAK--- Application for Housing Programs 4 Updated 2/5/2014 APPLICANT EMPLOYMENT CO-APPLICANT EMPLOYMENT NAME OF EMPLOYER NAME OF EMPLOYER EMPLOYER’S ADDRESS EMPLOYER’S ADDRESS PHONE PHONE # OF YEARS EMPLOYED # OF YEARS EMPLOYED ASSETS: Check yes or no for each asset, enter the value, and who owns the asset. If you need more space thaen what is available, please attach additional sheets to the application. Type of Asset Yes No Asset Owned by Amount of Debt on Asset Market Value of Asset Real Estate $ $ Stock, Bonds, Retirement Auto $ $ Auto $ $ Savings $ $ Recreational Vehicle $ $ Other $ $ INCOME: Check yes or no for each type of income. Enter the amount of all money that household members have received for the past 30 days, or money that you expected to receive. Provide a copy of your most recent check stub or statement for any other source of income listed below with your application. Source of Income Yes No Money Received by Applicant Other Household Members (Age 18 and older) Office Use Only Total Applicant Employment $ $ $ Temporary Assistance to Needy Families $ $ $ Social Security $ $ $ Military/Veterans Benefits $ $ $ Retirement or Pension Plan $ $ $ Unemployment Benefits $ $ $ Worker’s Compensation $ $ $ Child Support/Alimony $ $ $ SSI/Supplemental Security $ $ $ Interest/Dividends Income $ $ $ Earned Income Credit $ $ $ Other $ $ $ ---PAGE BREAK--- Application for Housing Programs 5 Updated 2/5/2014 DEBT ON PROPERTY: Mortgages on Property Original Amount Of Mortgage Balance Remaining on Mortgage Payment Information Terms of the Loan 1st Mortgage $ $ Principal Interest Taxes Insurance Interest Rate: # of Yrs: 2nd Mortgage/Home Equity $ $ Principal Interest Interest Rate: # of Yrs: PERSONAL DEBT: Type (credit card, auto, etc.) Name & Address of Creditor Account # Balance Payment PERSONAL EXPENSES: Auto Insurance $ Auto Operating Expense $ ---PAGE BREAK--- Application for Housing Programs 6 Updated 2/5/2014 Electricity $ Medical Insurance $ Life Insurance $ Child Care Cost $ Telephone $ Cable/Internet $ Child Support Payment $ Food $ Rent $ Food Stamp Benefit $ Auto Loan: $ Auto Loan: $ Other: $ Other: $ Please use a separate sheet to list additional expenses. APPLICANT'S CERTIFICATION AND AUTHORIZATION TO RELEASE INFORMATION: I/we understand that all information in this application is given for the purpose of evaluating eligibility for the City of Lewiston's Housing Assistance Program. I/we authorize the City of Lewiston to obtain verification of all sources named to verify income and employment, and to obtain a credit report. I/we understand that by signing this application I/we authorize release of this information to the City of Lewiston. Client information will be shared with only those individuals, entities, or committee members designated or acknowledged by the City as an interested party to the client’s application process excluding information declared as public records pursuant to M.R.S.A. Title 1 §401, Public Records and Proceedings. Otherwise, the information furnished will be held in strict confidence. I/we hereby certify the information contained in this application is accurate and complete to the best of my/our knowledge and belief. If I/we have intentionally falsified any of this information or omitted information necessary to prevent statements from being misleading, I/we understand that I/we will be liable to the City of Lewiston and that such falsification or omission(s) would be considered a Class D Crime. Date Applicant's Signature Co-Applicant's Signature Consumer Credit Authorization - (Required for loan applicants) I authorize the CITY OF LEWISTON to contact credit reporting agencies and creditors with regard to the status of any past or outstanding debt, or such other credit information that such agencies normally hold available for credit worthiness evaluation at present or at any time in the future for the purpose of making or monitoring the loan. ---PAGE BREAK--- Application for Housing Programs 7 Updated 2/5/2014 APPLICANT CREDIT AUTHORIZATION CO-APPLICANT CREDIT AUTHORIZATION LEGAL NAME: LEGAL NAME: SIGNATURE X SIGNATURE X STREET ADDRESS: STREET ADDRESS: CITY, STATE ZIP: CITY, STATE ZIP: SSN: SSN: DATE OF BIRTH: DATE OF BIRTH: Have you applied for credit within the last 3 months? ___yes no Do you or anyone in your household currently work for the City of Lewiston? Are you related to any person that is currently on the city council? Please list the name and relationship: