APPLICATION FOR HOMES FOR ARIZONANS PROGRAM

There is a non-refundable $30.00 application fee.  The application fee must accompany this application

NORTHERN ARIZONA COUNCIL OF GOVERNMENTS
119 E. ASPEN AVENUE, FLAGSTAFF, AZ 86001
(928) 774-1895 EXT. 1148 * FAX (928) 214-0430
     
1. Applicant Name  
2. Co-Applicant Name  
3. Street Address  
4. City, State, Zip Code  
5. Daytime Phone Number  
6. E-mail Address  
7. Race/Ethnicity of Applicant (circle one)  
White Black or
African American		 Asian American Indian or
Alaska Native		 Native Hawaiian or
other Pacific Islander
American Indian/
Alaska Native & White		 Asian & White Black or African American & White
American Indian or Alaska Native and Black or African American
 		 Other Multi-Racial
8. Ethnicity of Applicant: Hispanic £Yes £ No
 
(Important note: This information is requested to comply with federal equal opportunity reporting requirements.  This information will not affect your eligibility for assistance and is voluntary.)
9. County in which you wish to purchase a home  

10.
£Yes
£ No
Do you or the co-applicant currently own a home, or have you or the co-applicant owned a home during the past three years?  If the answer to this question is YES, stop here.  You are not eligible to receive assistance through the Homes for Arizonans Program.
 
B. Commitment to Program
£Yes £ No 1. I have at least $  1000*  in savings or investments that I will contribute toward the purchase of a home.* I understand that this is a minimum amount and that my contribution may exceed this amount.
 
£Yes £ No 2. I understand that I must complete home purchase counseling in order to be eligible to use the Homes for Arizonans Program.
 
C. Identification of All Household Members
In the space below provide the information requested on all members of the household.  Please include information on the applicant and co-applicant.  Provide copies of social security cards for all household members.
Name Date of Birth Social Security Number Relationship to Applicant
      Self
      Co-Applicant
       
       
       
       
       
       


 

D. Employment and Income Information
Applicant      
Current Employer and Address   Position/Title:  
    How Long?  
    Supervisor:  
    Bus. Phone:  
Annual Income  $   Hours worked per Week   Hourly Wage  $
Previous Employer and Address
(If less than one year at current employer)		   Position/Title:  
    How Long?  
    Supervisor:  
    Bus. Phone:  
Annual Income  $   Hours worked per Week   Hourly Wage  $
Co-Applicant      
Current Employer and Address   Position/Title:  
    How Long?  
    Supervisor:  
    Bus. Phone:  
Annual Income  $   Hours worked per Week   Hourly Wage  $
Previous Employer and Address
(If less than one year at current employer)		   Position/Title:  
    How Long?  
    Supervisor:  
    Bus. Phone:  
Annual Income  $   Hours worked per Week   Hourly Wage  $
Other Income Information            
Family Member   Income Source   Amount   Received Monthly
         $    
         $    
         $    
         $    
Non-regular Employment            
Family Member   Ave Monthly Amt   Type of Work Performed
         
         
         
         

 

 

E. Other Information
1. Have you ever had a mortgage?  If no, skip to number 7. £Yes    £ No
2. If yes, complete the following information:
3. Original Mortgage Amount:  $  
4. Date Mortgage Made:    
5. Date Mortgage Paid:    
6. £Yes    £ No
Have you ever been obligated on a home loan that went into foreclosure?
    If yes, when and why?  
7. £Yes    £ No
Have you ever filed for or taken bankruptcy?
    If yes, when and why?  
8. £Yes    £ No
Have you ever been a defendant in a lawsuit?
    If yes, explain.  
9. £Yes    £ No
Are there any judgments, suits or legal proceedings pending against you at this time?
    If yes, explain.  
10. £Yes    £ No
Are there any existing judgments, garnishments, suits or other legal proceedings against you (not pending, not paid)?
    If yes, explain.  

 

F. Certification To Occupy Property as a Principal Residence
This is to certify that I (we) will occupy the property we acquire with the assistance of the Homes for Arizonans Program as my (our) principal residence.  This certification is made in accordance with my (our) understanding that to be qualified as an eligible household under the Homes for Arizonans Program, I (we) must intend to occupy the property as a principal residence.
 
Printed Name of Applicant

 

 Printed Name of Co-Applicant
Signature of Applicant

 

 Signature of Co-Applicant
Date

 

 Date

 

 

 

 

 

 

G. Asset Information
Applicant Account Number   Name of Bank/Other   Balance or Value
  Checking Account          $
  Savings Account          $
  Business Account          $
  Other Savings          $
  US Savings Bonds          $
  Marketable Securities          $
  Certificates of Deposit          $
  Other          $
  Other          $

Co-Applicant		 Account Number   Name of Bank/Other   Balance or Value
  Checking Account          $
  Savings Account          $
  Business Account          $
  Other Savings          $
  US Savings Bonds          $
  Marketable Securities          $
  Certificates of Deposit          $
  Other          $

Other Household Members		          
Family Member:   Account Number   Name of Bank/Other   Balance or Value
             $
             $
             $
             $

 

 

 

 

 

 

 


 

H. Outstanding Debt (Applicant and Co-applicant only)
  Creditor Name   Monthly Payment Amount   Balance Due   Past Due Amount
Auto Loan              
Auto Loan              
Bank Loan              
Purpose of Loan              
Credit Union Loan              
Purpose of Loan
Life Insurance Loan              
Purpose of Loan              
Credit Card              
Credit Card              
Credit Card              
Alimony              
Child Support              
Medical Bills              
Other:              
Purpose              
Other:              
Purpose              
Other:              
Purpose              
Other:              
Purpose              
Other:              
Purpose              

 

 

 

 

 

 

 

 

I. Release of Information and Applicant Certifications

Release of Information
 
I (we) understand that I (we) have an application on file with NACOG.
 
I (we) understand that my (our) application along with other verification and documents related to my application my be released to other agencies.
 

I (we) authorize NACOG to release information from my application file to other agencies.  I (we) also authorize the housing agency to obtain a copy of my (our) credit report(s) and other documentation to verify my (our) eligibility for assistance and the information in the application for assistance.
 
IMPORTANT - READ BEFORE SIGNING
 

I/we certify that the statements made in this application are true, accurate, and complete to the best of my/our knowledge and belief.  I/we authorize the agency to obtain verifications from any source named in this application and further, to check my/our credit and employment history and to ask questions about me/us.  I/we acknowledge and authorize the contacted agencies to answer questions and provide verification about their credit experience with me/us.  I/we hereby give permission to the agency and/or state of Arizona to examine personal documents of mine/ours and to inquire into my/our financial affairs in order to determine my/our qualification for assistance under any of the housing programs provided by agency and/or the state of Arizona.  I/we also give permission to agency to release an pertinent information to a lending institution for the purposes of determining eligibility for private funding.  I/we realize that the completing of this application does not imply that I/we am/are assured of receiving financial assistance, and I/we also realize that any conversations, inspections, or other actions do not imply that my/our assistance has been approved.  I/we understand that the assistance, and all details of the work discussed, has been approved only when all final contracts and other legal documents are fully executed.  I understand that providing false statements and/or information may be grounds for termination of this application.
 

PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sect. 1001 provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies...or makes any false, fictitious or fraudulent statements of representation, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement  or entry, shall be fined not more than $10,000.00 or imprisoned not more than five years, or both."
 
Printed Name of Applicant
 		 Printed Name of Co-Applicant
Signature of Applicant
 		 Signature of Co-Applicant
Date
 		 Date
FOR HOUSEHOLDS WITH OCCUPANTS OVER THE AGE OF 18.
Printed Name of Adult Household Member
 		 Printed Name of Adult Household Member
Signature of Adult Household Member
 		 Signature of Adult Household Member
Date
 		 Date


THIS PROGRAM IS FUNDED BY THE ARIZONA DEPARTMENT OF HOUSING AND THE ARIZONA HOUSING FINANCE AUTHORITY

 

 

THIS INFORMATION MUST BE SUBMITTED WITH YOUR APPLICATION OR YOUR APPLICATION WILL NOT BE ACCEPTED FOR PROCESSING
 
Income Verification Documents

You must include the following applicable documentation with this application.
 
Provide the following information for each household member 18 years of age or older:
 
£ Employment income: 1) A copy of last three years' federal tax returns, including copies of W-2s and all schedules.  AND 2) A letter of income, verifying current income, from each employer OR copies of last three pay check stubs OR a current pay stub indicating year-to-date income.
 
£ Pension/Social Security income: Copy of most recent award letter OR copy of last Social Security or Pension check.
 
£ Veteran's Administration benefits: Copy of check, check stub or award letter.
 
£ Unemployment compensation: Copy of check, check stub or award letter.
 
£ Public assistance: Copy of most recent award letter, specifying the amount of assistance.
 
£ Alimony, child support, or separate maintenance income:  Copy of award letter(s) from the courts.
 

Provide the following information for all household members:
 
£ Social Security cards: Copy of Social Security card for each member of the household.
 
£ Photo identification: Copy of photo identification such as driver's license or passport for each adult member of the household.
 
£ Bank/investment account statements: Copies of most recent savings, checking and investment account statements that indicated account balance and interest/dividends earned (if any).  NOTE: You must submit statements for all household accounts, even those held by children.
 
Attach a personal check or money order in the amount of $30.00.  Make your check or money order payable to NACOG.  DO NOT SEND CASH.