Dear Applicant: Sincerely. Missy Frost Community Development Coordinator

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1 City of Fairborn 44 W. Hebble Avenue Fairborn, OH p: f: Community Development Department Missy Frost Community Development Coordinator Dear Applicant: Thank you for your interest in the City of Fairborn's Housing Rehabilita=on Loan Program. ABached you will find the materials necessary for your applica=on. The City provides financial assistance to low- and - moderate income homeowners to correct property maintenance issues, lead based paint hazards as well as needed home repairs and improvements. Several factors are reviewed prior to approval; those include the urgency of repair needed, overall condi=on of the property, and the financial need of the applicant. The assistance given will be in the form of a 5 year zero (0%) interest deferred/forgivable loan reduced 5% each year with 25% remaining due upon transfer of the property. This will be secured by a mortgage and promissory note with a declining repayment agreement. Some generally accepted types of rehabilita=on include: Roofs Electrical Water/Sewer line repair GuBers Walk stairs Hot Water Tanks Windows Plumbing Structural Deficiencies Furnaces Doors Upon the submission of all required documents, your applica=on will be reviewed for compliance. At that =me, the City's Rehabilita=on Specialist will contact you to evaluate your home as part of the applica=on process. Once these items have been completed you will be no=fied of your eligibility in the program. Only complete applica=ons will be processed. Appointments are available with staff to review your applica=on and assist in ensuring all documenta=on is received by calling Sincerely Missy Frost Community Development Coordinator

2 Docmenta)on Required for a Housing Rehabilita)on Loan All items must be included to ensure a complete applica)on is submi;ed. Please contact us to schedule an appointment to review the completed applica=on. Photo iden=fica=on of all loan applicants (driver's license or State ID) 2 WriBen verifica=ons of all household income listed that applies (all persons over the age of 8) Last 2 months pay stubs Verifica=on form signed by employer(s) Recent Bank statements (at least 6 months) Verifica=on form signed by bank(s) Recent statements from savings accounts, investments, or other assets (at least 6 months) Social Security Award leber(s), if applicable Proof of Child Support or Alimony, if applicable Proof of Re=rement income (VA, OPERS, IRA, Annui=es, Civil Service), if applicable Last 3 year's tax returns (040 form with W-2's, if self-employed) IRS Form 4506 (if self-employed) 3 Proof of Ownership; Property Deed 4 Homeowner's Insurance Declara=on Page from Insurance Policy 5 Proof Property Taxes are current 6 Proof City Income Taxes are current 7 Mortgage Statement (payment informa=on) 8 Home Equity Statement (payment informa=on), if applicable 9 Current monthly u=lity obliga=ons Water Gas Electric 0 Owner Occupancy Statement Receipt for Lead Based Paint Booklet and Fair Housing Informa=on 2 Walk Away Provision Statement 3 Not employed, please provide signed statement regarding same 4 The applica=on has been signed by all property owners listed on the deed

3 Housing Rehabilita)on Loan Applica)on In order for this applica=on to be complete, all items listed on the "Documents Required" checklist must be included.. Applicant (Head of Household) Name SSN# Birthdate Gender: Male Female Marital Status: Married Separated Unmarried (includes single, divorced, widowed) 2. Co-Applicant (Spouse or Co-Owner) Name SSN# Birthdate Gender: Male Female Marital Status: Married Separated Unmarried (includes single, divorced, widowed) 3. Address Address No. and Street City Years at residence: Number of Bedrooms Year Built Zip Number of Baths 4. Contact Informa=on Home # Cell # Co-Applicant Cell # Work # Co-Applicant Work #

4 5. Household Members Full Name DOB Age Rela=onship Are any of these members handicapped or disabled? Yes No Age Please indicate what type of special housing accommoda=ons are needed, if applicable. Are any of these members an Armed Forces Veteran? Yes No Are any of these members experiencing Elevated Blood Levels from Lead Based Paint? 6. Race and Ethnicity Yes No Age Please check which one applies to you. I do not wish to furnish this informa=on White (Caucasian) Black/African American Asian American Indian/Alaskan Na=ve Na=ve Hawaiin/Other Pacific Islander American Indian/Alaskan Na=ve & White Asian & White Black/African American & White American Indian/AlaskanNa=ve & Black/African American Asian & Pacific Islander Hispanic Not Hispanic 7. Employment (List all income for household members over the age of 8) Applicant's Employer 2

5 Address Phone No. Posi=on Date Employed Applicant's 2nd Employer Address Phone No. Posi=on Date Employed Co-Applicant's Employer Address Phone No. Posi=on Date Employed Co-Applicant's 2nd Employer Address Phone No. Posi=on Date Employed 7. Employment (List all income for household members over the age of 8) Other Member's Employer Address Phone No. 3

6 Posi=on Date Employed Other Member's 2nd Employer Address Phone No. Posi=on Date Employed 8. Gross Monthly Income of all household members over the age of 8 Base Pay Hourly rate Over=me Pay Social Security Rental Income Disability Pension/Re=rement Alimony/Child Sup Unemployment Other/Royal=es Military Pay Workers Comp Self-Employment Investments Total Monthly Income Applicant Co-Applicant Other Member Descrip=on of Other Income: 9. Assets Real Estate Owned (other than primary residence): Address Mortgage Balance Gross Monthly Rent Value Return 4

7 0. Expenses st Mortgage 2nd Mortgage Taxes Mortgage Insurance Past Due Taxes Water Gas Electric Monthly Payments Balances Homeowner's Insurance Provider Name Address Phone Number Policy Number. Credit History Applicant Check if Yes Both the Applicant and Co-Applicant must answer all that apply. Co-Applicant Check if Yes Do you have any outstanding judgements? Have you declared bankruptcy in last 7 years? Have you had a property foreclosed upon? Are you a co-maker, co-signer or endorser of a note? Are you obligated to pay alimony, child support or maintenance? Are you party to a lawsuit? 2. Home Improvements Needed Please list the items at your residence that you feel are in need of rehabilia=on. Give a brief descrip=on/ explana=on as to why these items are needed. Keep in mind that some of the generally accepted types of rehabilita=on include: Roofs, gu;ers, windows, doors, furnaces, electrical upgrades, walk stairs, plumbing, water/sewer line repairs, hot water tanks, structural deficiencies. 5

8 3, Cer=fica=ons by Applicant All applicants must read and ini)al the following statements. If you do not understand any part of it or have any ques=ons about what you are asked to sign, please ask someone at the City of Fairborn to help you. 6

9 * I (we) hereby cer=fy that all the informa=on in this applica=on is true and complete to the best of my (our) knowledge, and hereby give the City of Fairborn, Department of Community Development (or any lender ac=ng on the City's behalf) to conduct further credit and financial inves=ga=ons, as deemed necessary to determine eligibility. Furthermore, I (we) agree to abide by the eligibility and program requirements set forth in connec=on with any opportuni=es that may be offered to me (us) by the City of Fairborn pursuant to this applica=on. I (we) understand that false, inaccurate, or incomplete informa=on in the foregoing applica=on shall be considered cause for me to be disqualified from par=cipa=on in the City of Fairborn's Housing Rehabilita=on Program, and I (we) must immediately no=fy the City of any change in my (our) income or household size prior to closing for re-verifica=on. I also understand that if there are delays beyond six (6) months, then updated income informa=on will be required. (Ini=als) * I (we) understand that we are applying for a loan which may be secured by a mortgage or deed of trust on the property described herein and represent that the property will not be used for any illegal or restricted purposes. (Ini=als) * * I (we) hereby consent to and authorize the City of Fairborn, HUD, ODSA, and/or the designated lender, aoer the giving of reasonable no=ce, to enter the improved property for the sole purpose of determining that the improvements specified in this applica=on have been completed and Minimum Property Standards have been met. (Ini=als) I (we) understand that the construc)on contract will be between me (us) and the contractor/dealer. I (we) will be responsible for the selec)on of the contractor, acceptance of the materials used, and the work performed. Neither the City of Fairborn, HUD, ODSA guarantees the materials or workmanship. (Ini=als) * * I (we) understand that the personal financial informa=on contained in this applica=on is necessary for evalua=on of my applica=on for rehab assistance. This informa=on, however, will remain confiden=al and will not be disclosed to the news, media or other third par=es. I further understand that my name, address and total amount of rehabilita=on assistance will be subject to public disclosure since public funds are being u=lized to rehabilita=on my property. (Ini=als) WARNING: Whoever knowing makes any false statement, including over-valua=on of any asset or omission of any liability on this or any other document in connec=on with any transac=on with this lender, will be subject to fine and/or imprisonment under provisions of the US Criminal Code. (Ini=als) The undersigned hereby submit this applica)on for a Housing Rehabilita)on Loan from the City of Fairborn. Furthermore, I/We swear that the informa)on provided in this applica)on is true, correct and complete. Signature of Applicant Date Signature of Co-Applicant 7

10 AUTHORIZATION AND RELEASE OF CONFIDENTIAL INFORMATION Permission to order a lien search and/or verify other informa)on relevant to this applica)on. I/We give permission to the City of Fairborn, its agents and/or employees to obtain and access informa=on relevant to the loan applica=on and evalua=on process. I/We understand that this informa=on is used to determine if I/We qualify for assistance through the City of Fairborn Housing Rehabilita=on Program. This release and authoriza=on specifically includes, but not limited to a =tle lien search, municipal income tax informa=on, municipal water bill records, other city obliga=ons, items listed below and the ability to repay an obliga=ons arising out of the loan or other financial assistance for which I am applying. Municipal Income Tax Alimony/Separa=on Payments Income from Business Municipal Water Assets (all sources) Pension/Annui=es County Property Tax Bank Accounts Social Security Benefits Municipal Services Child Support Payments Tax Returns (all) High Grass and Weed Invoice Employment Unemployment Benefits Property Liens Income (all sources VA Benefits Privacy Act No=ce Statement: The U.S. Department of Housing and Urban Development (HUD) is requiring the collec=on of the informa=on derived from this applica=on to determine an applicants eligibility to par=cipate in the CDBG and HOME-funded City of Fairborn Housing Rehabilita=on Program. This informa=on will be used to establish the level of benefit from the CDBG and/or HOME program; to protect the Government's financial interest; and to verify the accuracy of the informa=on furnished. It may be released to appropriate Federal, State, and Local agencies when relevant, to civil, criminal, or regulatory inves=gators, and to prosecutors. Failure to provide any informa=on may result in a delay or rejec=on of your eligibility approval. The Department is authorized to ask for this informa=on by the Na=onal Affordable Housing Act of 990. I/We further understand that I must be current with the City of Fairborn at the =me of applica=on and must remain current throughout the process. Failure to come current and remain current shall result in this applica=on being void. I authorize and release the City of Fairborn and/or HUD to obtain informa=on, about me and my household, that is per=nent to my eligibility for par=cipa=on in the City of Fairborn Housing Rehabilita=on Program, and to verify the informa=on I provided. Printed Name of Applicant Date Printed Name of Co-Applicant Date Signature of Applicant Date Signature of Co-Applicant Date Printed Name of Adult family member Date Printed Name of Adult family member Date Signature of Adult family member Date Signature of Adult family member Date

11 City of Fairborn 44 W. Hebble Avenue Fairborn, OH p: f: Community Development Department Missy Frost Community Development Coordinator Request for Verifica)on of Employment TO: RE: This employee is applying to the City of Fairborn for a home rehabilita=on program that is funded via federal grants. We ask your coopera=on in supplying this informa=on as it will be used only to determine the eligibility status and level of benefit to the household. Posi=on Held: Dates of Employment: From To Base Pay Rate: $ /Hour or $ /Week or $ /Month Average hours worked per week: Over=me Pay Rate: $ /Hour or $ /Week or $ /Month Average hours worked per week: Expected average number of hours over=me worked per week during the next 2 months: Any other compensa=on not included above (specify for commissions, bonuses, =ps, etc.) For : $ Per Comments: Signature of Employer: Title: Date: Phone Number: Signature of Applicant: Date:

12 City of Fairborn 44 W. Hebble Avenue Fairborn, OH p: f: Community Development Department Missy Frost Community Development Coordinator Request of Verifica)on of Assets TO: RE: This client is applying to the City of Fairborn for a home rehabilita=on program that is funded via federal grants. We ask your coopera=on in supplying this informa=on as it will be used only to determine eligibility status and level of benefit to the household. Checking Acct. No. Checking and Savings 6 Month Avg. Balance Interest Rate Savings Acct. No. 6 Month Avg. Balance Interest Rate Cer=ficate of Deposit Balance Interest Rate Withdrawal Penalty IRA, Keogh, Re)rement, Money Market Accounts Account No. Amount Interest Rate Withdrawal Penalty Signatures Signature of Representa=ve Title Date Signature of Applicant Date

13 OWNER OCCUPANCY STATEMENT I/We hereby cer=fy that I/We are the owner(s) of (property address) and u=lize it as my/our primary residence. I/We further state that I/We will con=nue to reside at (property address) throughout the =me period of financial assistance/loan repayment. I/We understand the failure to do so shall result in the loan accelera=on with remaining loan balance becoming immediately due and payable. Signature of Applicant Date Signature of Co-Applicant Date

14 RECEIPT OF LEAD BASED PAINT & FAIR HOUSING INFORMATION By signing, I/We acknowledge receipt of the following documents about protec=ng our family from lead based paint and ensuring our rights accessing housing are not discriminatory in nature. Please check that you received: Protect your Family From Lead in your Home, published by the US EPA Fair Housing - Summary of Fair Housing Laws, published by the City of Fairborn Signature of Applicant Date Signature of Co-Applicant Date Property Address

15 WALK AWAY PROVISION The City reserves the right to "Walk Away" from a housing unit that poses undue threat to health or safety of the inspector or contract at any =me. Housing units that violate the following will not be assisted: Structurally unsound dwellings that are, or should be condemned for human habita=on. Evidence of substan=al, persistent infesta=on of rodents, insects and other vermin. Excessive odors, cluber, garbage or other unsanitary condi=ons in any area of the unit. Negligent housekeeping prac=ces that limit access /create a cumbersome working environment. Presence of/and or use of any controlled substance before or during rehab. Suspected manufacturing of a controlled substance before or during rehab. Threat of violence. Occupants allowing only limited access to the dwelling. Environmental hazards such as serious moisture problems, friable asbestos or other hazardous materials, which cannot be resolved before rehab work is to start. Staff Cost Es=mate exceeds maximum amount of per unit limits The presence of animal feces in any are of the dwelling unit. Signature of Applicant Date Signature of Co-Applicant Date