Washington County CDA-Mortgage Counseling Program Application Appointment Information Date: Time Specialist: Questions? Call 651-202-2822 Application Checklist To better serve you, please provide all required documents 2 business days in advance of your appointment. Required First Appointment Documents Completed Application Form. Review, sign and date all release forms Monthly Budget Worksheet Proof of All Household Income Pay stubs: Most recent 30 days Benefit Statement/Letter: Example: Social Security, Disability, Pension, Food Support or Unemployment If self-employed, Profit & Loss Statement for most recent quarter Additionally Preferred Documents Two most recent bank statements for all accounts used regularly, all pages If you receive child support and/or spousal maintenance must have copy of Divorce Decree Most recently filed Federal Tax Returns and W2s Recent letters or statements from your lender(s) and foreclosure attorney regarding the delinquency on your mortgage(s) Send completed application packet to: Fax: 651-458-1696 Attn: Homeownership Department Email the Homeownership Specialist: When emailing your application, re-save documents as Last Name_HB_Date homeownership@washingtoncountycda.org Mail: Attn: Homeownership Department Washington County CDA 7645 Currell Blvd. Woodbury, MN 55125
Washington County CDA-Mortgage Counseling Program Application NOTE: If you have impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about housing counseling, please communicate with your homeownership specialist about arranging alternative accommodations. Would you like an interpreter when communicating with your advisor? Yes (language) No I authorize the Washington County CDA to share this data with the Minnesota Home Ownership Center, Fair Housing, MN Housing and/or the U.S. Department of Housing and Urban Development: Yes No How did you hear about us? Agency Friend/Relative Internet Lender Mailer/Brochure Newspaper Realtor Other Name: Birthdate: Social Security # Gender Identity/Expression: Male Female Other (please specify) Ethnicity (select one): Hispanic or Latino Not Hispanic or Latino Race (select all that apply): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race Marital Status (select one): Married Partnered Single Divorced Separated Widowed Are you a single parent head of household? Yes No What is your education level? Are you a veteran? Yes No Are you enlisted? Yes No Are you disabled? Yes No Co-Applicant Name: Birthdate: Social Security # What is your relationship to above applicant? Gender Identity/Expression: Male Female Other (please specify) Ethnicity (select one: Hispanic or Latino Not Hispanic or Latino Race (select all that apply): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Other Race Are you a veteran? Yes No Are you enlisted? Yes No Are you disabled? Yes No What is your education level? Would you like an interpreter when communicating with your advisor Yes (language) No Street Address: City: State: Zip: Home Phone: Cell Phone(s): Email address(s): Is this your primary residence? Yes No
How many people are there in your household? How many of the people living in your household are dependents? Type of home: single family home townhome condo mobile home Other: Condition of Home: Excellent Good Fair Needs repairs When did you move into your home? Month Year Purchase Price: Is this the first home that you purchased? Yes No Are you a first generation home buyer? Yes No When did you last re-finance? Month Year Amount? What caused you to fall behind on payments? Loss of Income Divorce/Separation Medical Death in Family Increase in Expenses Other: Have you fallen behind before? Yes No Have you had a loan modification before? Yes No If yes, when? Have you spoken to your lender(s) about your current situation? Yes No If yes, what have you discussed? Have you paid a company a fee for helping you with your mortgage situation? Yes No What options would you like to learn more about from your homeownership specialist? (select all that apply) Keeping your property Letting your property go back to the bank Selling your property Mortgage Information: Name of Mortgage Company First Mortgage Second Mortgage Homeowners association or other lien? Mortgage Balance Monthly Payment Loan Term (# of years to pay off loan) Interest Rate % % Fixed or Adjustable? Interest-Only Loan? Yes No Yes No Amount Past Due or # of Months Behind Sheriff Sale Date (if applicable)
Employment information: Job 1 Job 2 Job 3 Job 4 Employer Hire Date (MM/DD/YYYY) Job Title Who's Job? Full-time or Parttime Net amount & how often are you paid? (weekly, every two weeks, twice per month, monthly) Have there been any changes in your income in the last 12 months (raise, new job, maternity leave, etc.)? Yes No If yes, please provide details: Other income information: Do you, or ANYONE in your household, receive any of the following? INCOME TYPE Who Receives It? Amount awarded Frequency of Award Child Support Social Security Unemployment Worker's Comp Veteran's Benefits Disability Spousal Maintenance Rental Income Family/Friend Contribution County Cash or Food Support Is anyone in the household self-employed? Yes No If yes: Who is self-employed? What is the name of the business? What kind of business do you do? How do you track your income (profit & loss statements, etc)?
Washington County Community Development Agency Homeownership Program Authorization for Release of Information 7645 Currell Boulevard, Woodbury, MN 55125-2256 Phone: (651) 458-0936 Fax: (651) 458-1696 I/We hereby authorize Washington County Community Development Agency (WCCDA; Federal Tax ID No. 41-xxx8079), its agents or assigns to verify my/our past and present employment earnings, records, past and present employment status, bank accounts, obligations, and all other financial matters that are needed to process my/our application. I/We authorize WCCDA, its agents or assignees to order a consumer credit report from CoreLogic Credco at no cost for the first two credit reports. I/We understand that I/We will pay the CoreLogic Credco fee for any subsequent reports, which is currently 21.10 per person per report. I/we authorize WCCDA to verify other credit information, including past and present mortgages and contracts-fordeed. I/We also give my/our consent to contact my/our accountant, tax preparer, or the Internal Revenue Service, in the event my/our tax returns are needed to verify any reported income. I/We further authorize WCCDA to exchange information with all pertinent parties in order to assist me in identifying my options. Pertinent parties shall include, but are not limited to, attorneys, loan originators, my/our lender or mortgage servicer(s), and the owner of my/our existing mortgage loan(s) (such as Fannie Mae or Freddie Mac), and the U.S. Department of Housing and Urban Development. It is understood that a photocopy of this form will also serve as authorization. The information WCCDA, its agents or assigns obtains is to be used in the processing of my/our application for WCCDA s Homeownership Program, I further allow WCCDA to contact my mortgage lender for a period of up to 36 months from the date of this application to inquire about the status of my/our mortgage, allowing Program staff to track the long-term effects of the program. Applicant Name (please print): Social Security Number: Co-Applicant Name (please print): Social Security Number: Address: City: State: Zip Code: Applicant's Signature: Date: Co-Applicant's Signature: Date: Loan No: Loan No: WCCDA Counselors: Heather Posthumus, Smita Rakshit and Portia Jackson WCCDA Tax ID: 41-xxx8079