HOMES FOR ARIZONANS PRE-APPLICATION 

Applicant Full Name

Date of Birth:  

   

Soc Sec Number:

Marital Status:

 Single

 Married

 Legally Separated

 Divorced

Current Address:

City

State

Zip

County in which you plan to purchase

 Rent
$_______Per Month

 Own
 

 Other (Explain)
 

How Long at this address?
From:                          to                 

 Home or day time Phone where best to call you:

Email or additional phone numbers to contact you:

Current Employer or income information (please explain):

Address

City

 State

Zip

 Work Phone:

Position and Title:
 

Dates Employed at this job
From:                       to

Hourly Wage: $

How many hours do you work per week:?: 

Gross Annual Income (before taxes):                $
                           

 

Spouse or Co-Applicant Full Name: (even if you will not be on the Mortgage loan)
 

Date of Birth:  

   

Soc Sec Number:

Marital Status:

 Single

 Married

 Legally Separated

 Divorced

Current Mailing Address:

City

State

Zip

 

 Rent
$______Per Month

 Own

 Other (Explain)

How long at this address?
From:                          to                 

 Home or day time phone where best to call you:

Email or additional phone numbers to contact you:

Current Employer or income information if any (please explain):

Address

City

 State

Zip

Work Phone

Position and Title:

Dates Employed
From:                       to

Hourly
Wage:  $

How many hours do you work per week? 

Gross Annual Income:
(before taxes)                 $
                           

 

Additional Household Members who will "OCCUPY" the home.  (do not include Applicant or Co-Applicant)

Name

Date of Birth

Soc Sec Number

Relationship to Applicants
Example: Son, Daughter etc.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Additional Income Source(s) of all household members.

Source of Income.  How long will this income continue?

Amount

This income to benefit what Family Member (name)

Indicate how often income is paid.  Weekly, Monthly...

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

 

$

 

 

Asset Information for ALL family members.  List all savings and checking accounts.  Include IRAs and other pensions, stocks,
bonds and real estate and other investments.  Include assets disposed of within past two years.

Name on Account

Bank/Credit Union, etc Name

Bank/Credit Union etc.  Address

Account No.

 Interest  Rate
Required

Type of Account

Current Balance

 

 

 

 

  

 

 

 

 

 

 

  

 

 

 

 

 

 

  

 

 

 

 

 

 

  

 

 

 Debt Information -- if more than 4, please list on separate paper and attach to this application

Name on Account

Company Name

Account Number

Balance

Monthly Payment

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 

 

 

$

$

 HAVE YOU OWNED A HOME IN THE LAST 3 YEARS? (circle one)    YES      NO

To the best of my knowledge and belief, all information is accurate and complete.  I understand that providing
false statements or false information will make me ineligible for program assistance and is also punishable under
federal and state law. 

 

 

 

 

 

Signature of Applicant

Date

 

Signature of Co-Applicant

Date

 

 

 

 

 

 

 

 

 

 

Signature of Additional
Adult Household Member (18 and Over)

Date

 

Signature of Additional Adult
Household Member (18 and Over)

Date

 

MAIL OR FAX COMPLETED PRE-APPLICATION TO:   
 
FOR COCONINO AND YAVAPAI COUNTIES,
NACOG / HOMEBUYERS
119 E. ASPEN AVENUE
FLAGSTAFF, AZ  86001
FAX: (928) 214-0430 		FOR NAVAJO AND APACHE COUNTIES:
 NACOG / HOMEBUYERS
 205 N. WILLIAMSON AVE.
WINSLOW, AZ  86047
FAX : (928) 289-2156