Program Descriptions HOUSING REHABILITATION - The Town of Jupiter through various funding sources makes available 0% interest forgivable loans to assist homesteaded property owners in making needed improvements to their homes and properties. The intent of the program is to improve the quality and standard of housing for very-low, low and moderate-income residents. EMERGENCY REPAIRS - The Town of Jupiter through its Community Development Block Grant Program (CDBG) makes available grants to assist project area property owners in making improvements to their homes and properties. The Emergency Repair program is being developed to supplement the Housing Rehabilitation Element of the CDBG program to address immediate emergency repairs. If you are completing this application and need assistance, please contact the Housing Leadership Council at (561) 653-4107 or the Town of Jupiter Neighborhood Services Department at (561)741-2278 for assistance. The Town of Jupiter operates all programs in accordance with the Federal Fair Housing Law and does not discriminate on the basis of race, color, religion, sex handicap, familial status or national origin. Anyone who feels they have been discriminated against may file a complaint if housing discrimination by calling toll free 1-800-669-9777 or TTY 1-800-927-9275. 1 P a g e U p d a t e d 3/09/ 15
Applicant Information Name: Social Security No: Daytime Phone No: Town, State, Zip: Landlord Name: Own Rent No. of Years: Landlord Phone: Co-Applicant Information Name: Social Security No: Daytime Phone No: Town, State, Zip: Landlord Name: Own Rent No. of Years: Landlord Phone: Family Information (Complete for each non-applicant household member) Applicant Employment Information Present Employer: Employer Phone: How Long Employed: Years Months Town, State, Zip Monthly Gross Income: $ Position/Title: Years in Profession: Employment Status-Circle One: Full Time, Part- Time, Seasonal, Unemployed Co-Applicant Employment Information Present Employer: Employer Phone: How Long Employed: Years Months Town, State, Zip Monthly Gross Income: $ Position/Title: Years in Profession: Employment Status-Circle One: Full Time, Part- Time, Seasonal, Unemployed 2 P a g e U p d a t e d 3/09/ 15
ANNUAL INCOME (include all working household members, all Social Security, retirement, etc. benefits of all household members) Source Applicant Co-Applicant Other Household Member Salary Overtime Pay Commissions Fees Tips Bonuses Interest/Dividends Net Business Income Net Rental Income Social Security Unemployment Benefits Workers Compensation Alimony; Child Support Welfare Payments Other Other TOTAL Program Eligibility Information Total Income Do you or your co-applicant own any real estate property? Yes No If yes, please list property address How much money do you have available for: Down Payment: $ Source of Funds: Closing Costs: $ Source of Funds: Total : $ Asset Information (List for applicant and co-applicant): Saving(s) Account(s): Checking Account(s): 3 P a g e U p d a t e d 3/09/ 15
Money Market/CD s: IRA/Retirement Accounts: Stocks/Bonds: Other: Debt Information (List for applicant and co-applicant): Current Rental Payment: $ Monthly Debt Obligations: Auto: Year/Make: Min. Payment: $ Balance Owed: $ Auto: Year/Make: Min. Payment: $ Balance Owed: $ Credit Card #1: Min. Payment: $ Balance Owed: $ Credit Card #2: Min. Payment: $ Balance Owed: $ Credit Card #3: Min. Payment: $ Balance Owed: $ Credit Card #4: Min. Payment: $ Balance Owed: $ Total Other: Min. Payment: $ Balance Owed: $ TOTAL (Excluding Rent): $ Min. Payment: $ Balance Owed: $ ACKNOWLEDGEMENT: I/We declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Applicant Signature: Date: Co-Applicant Signature: Date: WARNING - Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying document is subject to penalties that may include fines, imprisonment, or both. 4 P a g e U p d a t e d 3/09/ 15
AFFIRMATIVE ACTION INFORMATION Applicant(s) is/are considered for assistance under the Community Development Block Grant Program Down Payment Assistance without regard to race, color, religion, sex, or national origin. To comply with Federal record keeping, reporting, and other legal requirements, please provide the information below: Size of household (Circle one): 1 2 3 4 5 6 7 8 or more Race of Head of Household (Check): White Black or African American Asian American Indian or Alaska Native Native Hawaiian or other/pacific Islander Other Gender: (Check): Male Female Female Head of Household 5 P a g e U p d a t e d 3/09/ 15
V. APPLICANT INCOME ELIGIBILITY: Table 1 HUD Income Guidelines (as of March 9, 2015) Palm Beach County Based on Area Median Income of $63,300 Income Level Percentage of Annual Median Income Number of Persons in Household 1 2 3 4 5 6 7 8 Extremely Low 30% 13,800 15,930 20,090 24,250 28,410 32,570 36,730 40,890 Very Low 50% 23,000 26,250 29,550 32,800 35,450 38,050 40,700 43,300 Low 80% 36,750 42,000 47,250 52,500 56,700 60,900 65,100 69,300 (Income eligibility limits subject to change as per the U.S. Dept of HUD) The applicant must qualify as a low/moderate/middle income household as defined by Section 8 income guidelines, and cannot exceed the HUD income limits for Palm Beach County. Total Household Size: Total Household Income: $ 6 P a g e U p d a t e d 3/09/ 15