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1 CITY OF MODESTO Existing Single Family Deferral Application Sewer Cost Share Wastewater Capacity Deferral A. Applicant Information Full Name: Last First M.I. Relationship to Owner: Physical Address: Street Apartment/Unit # City State ZIP Code Mailing Address (if different than above): Street Apartment/Unit # City State ZIP Code Phone: ( ) Work: ( ) Fax: ( ) Email : B. Project Information Parcel Number(s): Site Address: Street Address Apartment/Suite Number City State Zip Name of Project: Type of Project: Warning: Furnishing false information on a loan application is a crime! U.S. Code Title 18, Section 1001 makes it unlawful for anyone to knowingly or willfully conceal a material fact, make any materially false, fictitious or fraudulent statement or make or use any false, fictitious or fraudulent writing or document. Violation of this section may be punishable by fine or imprisonment for not more than five years, or both. I/We certify that the statements contained in the above schedules are true and accurate statements to the best of the applicant’s knowledge and belief. Signature: Date: Print Name: Title: Phone: ( ) ---PAGE BREAK--- 2 Cost-Share Procedures Document Checklist: Upon approval, complete and return of a the following: Cost-Share Agreement signed and notarized by Applicant Map Exhibit detailing property location Cashier’s Check made out to City of Modesto for $250.00 (Administrative Fee) Cashier’s Check made out to City of Modesto for $500.00 (Title Guarantee) Remit to: IFP Administrator City of Modesto – Infrastructure Financing Programs 1010 Tenth Street, Suite 3300 PO Box 642 Modesto, CA 95353 (209) 577-5211 Approval Process: 1. Applicant will be notified in writing of approval status. 2. A Cost-Share Loan and Repayment Agreement will be drafted by the City and forwarded to Applicant for review, signature and notarization. 3. Upon approval, the Cost-Share Loan and Repayment Agreement will be executed by the City. An original copy will be forwarded to Applicant. 4. The terms and conditions of the deferral shall be set forth in an agreement which shall also provide that the unpaid balance of the Cost-Share loan shall be due and payable on the sale or the transfer to the property. Deferral Procedures Document Checklist: Upon approval, complete and return of a the following: Applicable Agreement signed and notarized by Applicant Map Exhibit detailing property location Cashier’s Check made out to City of Modesto for $250.00 (Administrative Fee) Cashier’s Check made out to City of Modesto for $100.00 (Title Guarantee) Cashier’s Check made out to City of Modesto for $20.00 (Removal of Lien) [Due with last installment] Remit to: IFP Administrator City of Modesto – Infrastructure Financing Programs 1010 Tenth Street, Suite 3300 PO Box 642 Modesto, CA 95353 (209) 577-5211 Approval Process: 1. Applicant will be notified in writing of approval status. 2. A Deferral of Wastewater Capacity Fees Agreement Notice of Lien or Deferral of Sewer Cost Share Deferral will be drafted by the City and forwarded to Applicant for review, signature and notarization. Summary of Terms & Conditions: 10% due at time of permit issuance. Fees deferred over 10 years. 90% plus interest due in 10 annual payments Penalties apply if fees are not paid within the deferral period. 3. Upon approval, the Deferral of Wastewater Capacity Fees Agreement Notice of Lien will be executed by the City and forwarded to the Stanislaus County Recorders Office for recordation. An original copy will be forwarded to Applicant. 4. The terms and conditions of the deferral shall be set forth in an agreement which shall also provide that the unpaid balance of the Deferred Fees shall be due and payable on the sale or the transfer to the property.