The City of Gainesville is committed to providing all persons with equal access to its services, activities, education and employment regardless of race, color, national origin, religion, sex, familial status, disability, or age.

 Downpayment Assistance Process

Page 1 of 2

City of Gainesville Community Development Department

Housing Division

DOWNPAYMENT ASSISTANCE PROCEDURES Application Process Applications are mailed to prospective homebuyers in response to telephone requests or picked up at the office. The client completes and returns the application as well as all other attached documents, and copy of three most recent paycheck stubs. After income is verified, staff contacts client to come in to sign other documents and discuss process. Downpayment assistance funds are not approved until: (1) client and lender submits all required documentation including the loan underwriter’s statement and (2) Georgia Department of Community Affairs (DCA) sends project number. Homebuyer Education All prospective homebuyers must attend homebuyer education training and receive a certificate of completion. These classes are provided by HUD approved counseling agencies. The homebuyer education program is designed for clients who want to learn about purchasing a home. The curriculum is based on the American Homeowner Education and Counseling Institute’s (AHECI) Core Curriculum. Topics include: Credit and Credit Scores, Saving and Budgeting, Keeping Your credit Safe, Shopping for a Home, Understanding the Mortgage Loan Process, Home Inspection and Appraisal, Homeowners Insurance, Closing Your Loan, and How to Avoid Foreclosure. Students must attend each of the three classes to receive a Certificate of Completion. Attendees are given pre-purchase counseling workbooks free of charge. Please call 866-625-0129 to register for the class or see attached list of counseling agencies. Applicants are given information and referrals to public and private service agencies to meet their needs. Examples of referrals include, but are not limited to: USDA Rural Development, Georgia Department of Community Affairs, local lenders with Spanish speaking loan officers, Spanish speaking real estate agents, Clearpoint Counseling Services, battered women's shelters, and Disability Resource Center for the handicapped. Inspections and Lead-Based Paint When a prospective homebuyer enters into contract negotiations to purchase a home, the seller provides: 1) a disclosure statement including all known information about the presence of lead-based paint or lead-based paint hazards; 2) any records or reports pertaining to the presence of lead-based paint or lead-based paint hazards; 3) a ten (10) – day opportunity to inspect the dwelling for lead-based paint or lead-based paint hazards. The property is inspected to make sure that it meets minimum property standards and if the house was built prior to 1978 performs a visual assessment of all interior painted surfaces, including common areas such as hallways,

The City of Gainesville is committed to providing all persons with equal access to its services, activities, education and employment regardless of race, color, national origin, religion, sex, familial status, disability, or age.

 Downpayment Assistance Process

Page 2 of 2

laundry rooms or garages, and exterior to identify deteriorated paint. Please get a Miscellaneous Building Permit (office located on second floor of 311 Henry Ward Way) if the house is more than one year old or the Occupancy Permit if the house is new construction. All deteriorated paint surfaces must be stabilized before the prospective homebuyer moves into the home. Safe work practices must be used when conducting paint stabilization. Safe work practices include safe work methods, occupant protection, worksite preparation, and cleanup. After the completion of the work, the home must pass clearance. A Clearance Exam is performed before occupancy if the home is vacant or immediately after receipt of the downpayment assistance for a home currently occupied. For the majority of the downpayment assistance projects, clearance would be required before occupancy. Any surfaces that fail the clearance examination must be re-cleaned and re-tested until the area passes clearance. A Notification of Lead Hazard Evaluation and Reduction is provided to the prospective homebuyer within 15 calendar days of the completion of the lead hazard evaluation or reduction activities. Contract Signing At sales contract signing, the prospective homebuyer gives Notice to Seller form to seller. The client contacts a lender and begins the mortgage loan process. The Lender supplies a copy of the following documents: Sales Contract, loan application, paycheck stubs, appraisal, credit report, closing attorney information, Loan Underwriting Mortgage approval with conditions and certification that the mortgage loan is underwritten to one of the following standards: Fannie Mae, Freddie Mac, FHA, VA or Georgia Dream. This office verifies income; purchase price limits and sends Truth in Lending statement to the client within 3 days. A project set-up request and environmental report are then sent to Georgia Department of Community Affairs (DCA). Closing The Lender notifies this office of a target closing date. After DCA approves the Project and returns the set-up report with a project number, a drawdown request is signed by local government official and sent to DCA. A memo is forwarded to City of Gainesville Accounting department giving check preparation data. DCA wires the funds to Local Government's checking account. The Accounting Department cuts a check and sends to either the Closing Attorney or GNPDF if funds have been advanced. After closing is held, the attorney sends the following documents back to the office: Downpayment Assistance Grant Agreement, HUD Settlement Statement, Promissory Notes, Warranty Deed, and Deed to Secure Debts for Downpayment Assistance and first mortgage, Loan Agreement and Homeowner Insurance Certificate. A completion report is sent to DCA.

The City of Gainesville is committed to providing all persons with equal access to its services, activities, education and employment regardless of race, color, national origin, religion, sex, familial status, disability, or age.

 

City of Gainesville Community Development Department

Housing Division 311 Henry Ward Way, 2nd Floor

P. O. Box 2496, Gainesville, GA 30503 Phone (770) 531-2693, Fax (678) 989-3397

Thank you for your interest in the City of Gainesville Affordable Housing Programs. Income limits will apply to receive monetary assistance. To start the process, please complete the entire application including signatures were required. Once complete, please return all of the following to our office: Downpayment Assistance

1. Official Application 2. Authorization for Release of Information 3. Paycheck stubs (3), Current W-2 (1), Current Tax Return (1) 4. Most recent bank statement (3) 5. Must attend a home buying and budgeting seminar. Please call 770-297-1800 to

register. If you cannot attend the dates you are given, please contact this office so that other dates can be arranged.

Applications are processed on a first-come first-served basis. Please call the Community Development Department at 770-531-2693 to schedule an appointment to discuss specific information about the program.

DCA’s Approved Housing Counseling Agencies

*Online Homebuyer Education Course Available

Homebuyer counseling is required for ALL Georgia Dream Loans. Borrowers must attend and complete either a homebuyer education workshop, OR, individual housing counseling sessions, OR an online homebuyer education course through E-Home America. Workshops and counseling sessions must be completed with one of the DCA-Certified Housing Counseling Agencies listed below or with a HUD-Approved Housing Counseling Agency. A list of HUD approved agencies is available at www.hud.gov or call HUD's interactive voice system at 1-800-569-4287.

AGENCY

COUNTIES SERVED

Georgia Department of Community Affairs * 60 Executive Park South, N.E. Atlanta, GA 30329 (404) 327-6858 ONLINE COURSE ONLY www.ehomeamerica.org/dca www.dca.ga.gov

All Georgia Counties

ALBANY City of Albany 230 South Jackson St., Suite 315 Albany, GA 31701 229-483-7650 www.albany.ga.us

Baker, Calhoun, Colquitt, Crisp, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Sumter, Terrell, Thomas, and Worthy

ALBANY CCCS of Southwest GA* 409 N. Jackson St. Albany, GA 31702 800-309-3358 / 229-883-0909 www.ehomeamerica.org/cccswga www.cccsalbany.org

Baker, Colquitt, Crisp, Dougherty, Lee, Mitchell, Terrell, Worth, and Lowndes

ATHENS Athens Land Trust Housing Counseling 685 N. Pope St. Athens, GA. 30601 706-613-0122 www.athenslandtrust.org

Athens-Clarke, Barrow, Elbert, Franklin, Greene, Jackson, Madison, Newton, Oconee, Oglethorpe, Rockdale, and Walton

ATHENS Hancock CDC 300 Henderson Extension Athens, GA 30601 706-546-1154 www.hancock.cdc.org

Athens-Clarke, Barrow, Greene, Jackson, Oconee, Oglethorpe, Madison, Stevens, Walton, and Washington

ATHENS UGA-Cooperative Extension Program 1262 Government Circle Jonesboro, GA 30236 706-542-4877 www.fcs.uga.edu/extension/home

Clayton, Monroe, Glimer Burke, Lauren, Chattahm

ATLANTA 1st Choice Credit Union 315 Auburn Ave Atlanta GA 30303 404-832-5800 www.1stchoicecu.org

Fulton, Gwinnett, DeKalb, Cobb

ATLANTA ClearPoint Credit 270 Peachtree St. Suite 1800 Atlanta, GA 30303 800-251-2227 www.clearpointcccs.org Bilingual Counselors (Spanish)

Fulton, Cobb, Gwinnett, DeKalb, Hall

ATLANTA Center for Pan Asian Community Services 3510 Shallowford Rd Atlanta GA 30341 770-936-0969 www.icpacs.org Bilingual counselors (Korean, Burmese, Chinese)

DeKalb and Gwinnett

ATLANTA D&E, A Financial Education and Training Institute 4532 Jonesboro Rd., 2nd Floor Forest Park GA 30297 770-961 6900 www.depower.org Biligual Counselors ( Spanish)

DeKalb, Fulton, Gwinnett, Fayette, Cobb, Rockdale

ATLANTA Fulton County Department of Housing and Community Development 137 Peachtree St. Atlanta, GA 30344 404-614-2304 www.fultoncountyga.gov

Fulton

ATLANTA Help the People Program Housing Counseling 1401 Hosea L. Williams Dr. SE Atlanta, GA 30317 404-688-7766

Cherokee, Clayton, Cobb, DeKalb, Douglas, Fulton, Gwinnett, Henry, Newton, and Rockdale

ATLANTA Housing Authority of Fulton County 4273 Wendell Dr. Atlanta GA 30336 404-588-4972 www.hafc.org 404-588-4950

Cherokee, Clayton, Cobb, DeKalb, Douglas, Fulton, Gwinnett, Henry, Newton, and Rockdale

ATLANTA NID-HCA Southern Crescent 4580 Welcome All Rd Atlanta GA 30349 404-763-1553 www.atlhca.com Bilingual Counselors (Spanish)

Fulton, DeKalb, Clayton, Cobb

ATLANTA Resources for Residents and Community of Georgia, Inc. 100 Flat Shoals Ave. SE Atlanta, GA 30316 www.rrc-atl.org

Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Paulding, and Rockdale

ATLANTA Urban League of Greater Atlanta 229 Peachtree St. Suite 300 Atlanta GA 30303 404-659-1150 www.ulgatl.org

Fulton, DeKalb, Gwinnett, Henry, Douglas, Rockdale, Cobb

ATLANTA Women Watch Afrika 3700 Market Street Building E, Suite 2 Clarkston, GA 30021 404-759-6419 www.womenwatchafrika.org Bilingual counselors (Amharic, Arabic, Afghani, French, Somali, Bhutanese, and Swahili)

Clayton, DeKalb, Fulton, and Gwinnett

AUGUSTA First East Central Georgia Partnership 3514 Wrightsboro Rd. Augusta GA 30909 706-495-2304

Richmond, Columbus

AUGUSTA CSRA EOA 1761 Broad St. Augusta, GA 30904 706-364-6548 www.csraeoa.org

Burke, Columbia, McDuffie, and Richmond

BLAKELY Early County CDC 1259 South Main St. Blakely, GA 39823 229-724-7552 www.earlycocdc.webs.com

Baker, Calhoun, Colquitt, Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas, and Worth

BRUNSWICK Totally Free, Inc. * 2517 Norwich Street Brunswick, GA 31520 912-265-1515 www.ehomeamerica.org/TFI www.totallyfreeinc.org

Appling, Atkinson, Bacon, Brantley, Bryan, Camden, Candler, Charlton, Chatham, Clinch, Coffee, Effingham , Glynn, Jeff Davis, Liberty, Long, McIntosh, Pierce, Toombs, Ware, and Wayne

COLUMBUS CCCS of West GA 1350 15th Avenue Columbus, GA 31902 800-757-2227 / 706-327-3239 www.cccs-wga.com

Chattahoochee, Harris, Marion, Muscogee, Stewart, Talbot, and Troup

COLUMBUS NeigborWorks Columbus 5021 12th Ave Columbus GA 31904 706-324-4663 www.nwcolumbus.org

Muscogee, Harris, Marion, Chattahoochee,

CONYERS The Homeowners Employment Corporation SunTrust Bank Building 1530 Hwy 138 SE, Suite 200 Conyers, GA 30013 404-492-6554 www.homeownerscorp.com

Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Newton, and Rockdale

DALTON Dalton- Whitfield CDC P.O. Box 248 Dalton, GA 30722 706-876-1630 www.dwcdc.org Bilingual Counselors (Spanish)

Whitfield

DECATUR DeKalb Metro Housing Counseling Center 4151 Memorial Dr., Suite 106D Decatur, GA 30032 404-508-0922 dekalbmetrohousing.org

Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Forsyth, Henry, and Rockdale

DECATUR GreenForest CDC 3299 Rainbow Dr. Decatur GA 30034 404-486-5768 www.gfcdc.org

DeKalb, Rockdale, Newton, Clayton, Gwinnett, Henry, Fulton

FORT VALLEY Fort Valley State University Cooperative Extension Program 1005 State University Dr. Fort Valley Ga 31030 478-835-6577 www.fvsu.edu

Peach, Houston, Macon, Marion, Twiggs, Taylor, Jones, Bibb

GRIFFIN Affordable Housing Enterprise 333 South 9th St. Griffin GA 30224 404-451-6488

Butts, Clayton, Douglas, Lamar, Meriwether, Pike, Spalding, Upson, Fulton

HINESVILLE JC Vision and Associates* 135 E. Martin Luther King, Jr. Dr., Suite C Hinesville, GA 31313 912-877-4243 www.ehomeamerica.org/jcvision www.jcvision.com

Bryan, Liberty, Long, McIntosh, and Tattnall

LAGRANGE DASH for LaGrange* 1200 4th Ave. LaGrange, GA 30204 706-298-0581 www.ehomeamerica.org/dash www.dashlagrange.org Bilingual counselors ( Spanish)

Troup, Heard, and Harris

MACON CCCS of Middle Georgia 901 Washington Ave Macon, GA 31201 478-745-6197 www.cccsmacon.org Bilingual counselors ( Chinese, Mandarin)

Bibb, Baldwin, Burke, Columbia, Crawford, Glascock, Hancock, Jasper, Jefferson, Jenkins, Jones, Macon, McDuffie, Peach, Putnam, Richmond, Taliaferro, Twiggs, Warren, Wilkes, and Wilkinson

MACON HomeFirst Housing Resources 682 Cherry St., Suite 103 Macon, GA 31201 478-803-2373 www.homefirstga.org

Bibb and Jones

SAVANNAH Consumer Credit Counseling Service of Savannah 7505 Waters Ave., Suite C-11 Savannah, GA 31406 1-800-821-4040 www.cccssavannah.org ADDITIONAL OFFICE LOCATIONS: Hinesville, Brunswick and Statesboro

Appling, Bleckley, Bryan, Bulloch, Camden, Candler, Chatham, Dodge, Effingham, Emanuel, Evans, Glynn, Jeff Davis, Johnson, Laurens, Liberty, Long, McIntosh, Montgomery, Screven, Tattnall ,Telfair, Treutlen, Wayne, Wheeler, and Wilcox

SAVANNAH Neighborhood Improvement Association 1816 Abercorn St. Savannah GA 31401 912-447-5577 www.niacdc.org

Chatham, Bryan, and Effingham

STONE MOUNTAIN Refugee Family Assistance 5405 Memorial Dr. Suite 101, Stone Mountain GA 30083 404-296-8743 www.refugeefamilyassistanceprogram.org Bilingual Counselors ( Somali, Arabic, Amharic, Farsi, Nepalse, Burmese, and Sawahili,

Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry

VALDOSTA Valdosta-Lowndes County Habitat for Humanity 2010 E. Cypress St. Valdosta, GA 31601 229-245-1330 www.valdostahabitat.org

Cook, Lanier, Brooks, Berrien, and Coffee

VIENNA Southwest Georgia United Empowerment Zone, Inc. 1150 Industrial Dr. Vienna, GA 31092 229-268-7592

Crisp and Dooley

WASHINGTON City of Washington 102 E. Liberty St. Washington GA 30673 706-678-3277

Wilkes, Lincoln, Elbert, Warren, McDuffie, Taliaferro

WINDER Housing Authority of the City of Winder 11 Horton St. Winder, GA 30666 770-867-7495 www.winderhousing.com

Barrow and Jackson

Updated: January 7, 2015

1  

CDBG/CHIP INTAKE APPLICATION

HOUSEHOLD CHARACTERISTICS -List the Head of Household and all other persons who will be living in the unit. Indicate the relationship of each family member to the Head of Household.

Name Relationship to Head of Household

Date of Birth

Age Gender

(Male or Female)

Social Security Number

Head Household

Contract Administrator: Contract Number:

Applicant Name(s):

Current Address: P.O. Box

City, State, Zip: Home Phone:

Cell Phone: Email:

Emergency Contact Name: Emergency Contact Phone:

Please check one: I am applying for Rehabilitation Assistance Down Payment Assistance

For Office Use Only

APPLICATION DATE: ___________________ Income $_______________________________ Family Size _______ Income Limits _____ % Signature Date

Type of Assistance: Rehabilitation Reconstruction New Construction Down Payment Assistance

Eligible: Yes No

2  

HEAD of HOUSEHOLD (check one) – THIS INFORMATION IS REQUIRED. It is being collected to ensure compliance with federal Fair Housing and Equal Opportunity regulations.

Race of Head of Household: White Black/African American Asian American Indian/Alaska Native Native Hawaiian/Other Pacific Islander Asian and White Black/African American and White American Indian/Alaska Native and White American Indian/Alaska Native and Black/African American Other Multi Racial

Ethnicity of Head of Household:

Hispanic – A person of Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Terms such as “Latino” or “Spanish Origin” apply to this category.

Non-Hispanic – A person not of Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Is this a Female Head of household? Yes No

Number of household members with disability.____________

INCOME INFORMATION Includes: Wages, salaries and tips, alimony, child support, military income, part-time income, temporary income, Social Security, TANF, other benefits, other income. FOOD STAMPS ARE NOT CONSIDERED INCOME – do not list food stamps. List ALL household members and their incomes. Attach a separate sheet if you need more space.

Household Member Name Full

Time Student?

Source of Income (include employer name and phone

number) Rate of Pay

Payment Basis (weekly, monthly,

etc.)

3  

ASSET INFORMATION Do you have a mortgage on your house? Yes No N/AIf yes, what is the current balance owed on the mortgage? _______________ Name of the company that holds the mortgage on your home._____________________

What are your yearly property taxes? __________________. Are your property taxes current? Yes No N/A

What year was your house built? _____________________ N/A

Do you have homeowners insurance? Yes No N/A

Name of insurance company________________________________________ N/A

Have you ever received a federal, state or local agency grant for your home? Yes No N/A

If yes, please state the program, the year assistance was provided and the amount?

Do you own any other real estate property? Yes No N/A

If Yes, what is its current market value? _______________________ N/A

List below the types and sources of any household assets. Provide both the current cash value and the estimated annual income from the asset.

Household Member Name Type and Source of Asset

(savings/checking accounts, investments, etc.)

Cash Value of Asset

Annual Income From Asset

Credit History Please answer all questions. If the answer is yes please attach a written explanation.

Are there any outstanding financial judgments or liens against you? Yes No

Have you declared bankruptcy within the last 36 months? Yes No

Have you lost any property through foreclosure or given title or deed to anyone to avoid foreclosure? Yes No

Are you a co-signer on any note or loan? Yes No

4  

EXPENSE INFORMATION Indicate the MONTHLY dollar expenditures for your family. Circle any of the listed expenses that are delinquent. Creditor/Expense City, State of

Creditor

Year Loan Opened

Current Balance

Monthly Payment

Is Debt Business Related?

Mortgage Yes No

Electric Yes No

Gas Yes No

Phone Yes No

Cable Yes No

Car Payment Yes No

Car Insurance Yes No

Medical Expenses Yes No

Medical Insurance Yes No

Child Care Yes No

Credit Card $ Yes No

Credit Card $ Yes No

Loan Yes No

Other (specify) $ Yes No

Are you related to the City Mayor or a Member of City Council? Yes No

Are you employed by the City of Gainesville? Yes No

Are you related to a City Employee? Yes No Do you serve on any Board or Agency associated with the City of Gainesville? Yes No If yes to above, give name and relationship ______________________________________________________

The proposed property is and/or will be my Primary Residence for (at least) the required period of affordability as specified in the CDBG/CHIP loan documents: Yes No

APPLICANT CERTIFICATION

I understand that by signing below that: (a) I will forfeit any Assistance if any information I provide is false. (b) The Community Development/Housing Department office does not guarantee that I can purchase or rehab a home. (c) I have received a copy of the EPA pamphlet entitled: Protect your Family From Lead in Your Home. (d) I acknowledge by signing, that all information I have given is true and factual to the best of my knowledge. (e) I agree to abide by those requirements and conditions in connection with any loan and/or grant that may be made or

referred by the City of Gainesville pursuant to this application.

Signature of Applicant: Date

Signature of Applicant: Date Warning: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government.

Page 1 of 2 CC- 3

Georgia Department of Community Affairs Community HOME Investment Program

DECLARATION OF CITIZENSHIP STATUS FOR HOUSEHOLD MEMBER 18 YEARS OF AGE OR OLDER

NOTICE TO APPLICANTS AND TENANTS: Section 214 of the Housing and Community Development Act of 1980, as amended, prohibits the Secretary of HUD from making financial assistance available, through the department’s programs, to persons other than United States citizens, nationals, or certain eligible non-citizens. In order to be eligible to receive the housing assistance sought, each applicant for, or recipient of, housing assistance must be lawfully within the United States. Please read the Declaration statement carefully, sign and return it to the Housing Authority office. Please feel free to consult with an immigration lawyer or other immigration expert of your choice.

A complete Declaration must be provided for each member of the household.

I, _______________________________________, certify, under penalty of perjury, that, to the best of my knowledge, I am lawfully within the United States because (please check appropriate box): ( ) I am a citizen by birth, a naturalized citizen, or a national of the United States; or ( ) I have eligible immigration status and I am 62 years of age or older. (Attach proof of age); or ( ) I have eligible immigration status as checked below (see reverse side of this form for

explanations). Attach INS document(s) evidencing eligible immigration status and signed verification consent form.

[ ] Immigrant status under 101(a or 1010(a) (20) of the INA 3/; or [ ] Permanent residence under 249 of INA 4/; or [ ] Refugee, asylum, or conditional entry status under 207, 208, or 203 of the INA /5; or [ ] Parole status under 212(d) (5) of the INA /6; or [ ] Threat to life or freedom under 243(h) of the INA /7; or [ ] Amnesty under 245A of the INA 8/.

_________________________________________ _______________________ Signature Date _________________________________________ _______________________ Printed Name Date

Page 2 of 2 CC- 3

Eligible immigration status may be confirmed by providing one of the following forms of documentation: (1) A noncitizen lawfully admitted for permanent residence, as defined by section 101 (a) (20) of the Immigration and Nationality Act (INA), as an immigrant, as defined by section 101(a) (15) of the INA (8 U.S.C. 1001(a) (20) and 1101(a) (15), respectively) [immigrants]. (This category includes a noncitizen admitted under section 210 or 210A of the INA (8 U.S.C. 1160 or 1161) [special agricultural worker], who has been granted lawful temporary resident status). (2) A noncitizen who entered the United States before January 1, 1972, or such later date as enacted by law, and has continuously maintained residence in the United States since then, and who is not eligible for citizenship, but who is deemed to be lawfully admitted for permanent residence as a result of an exercise of discretion by the Attorney General under section 249 of the INA (8 U.S.C. 1259). (3) A noncitizen who is lawfully present in the United States pursuant to an admission under section 207 of the INA (8 U.S.C. 1157) [refugee status]; pursuant to the granting of asylum (which has not been terminated) under section 208 of the INA (8 U.S.C. 1158) [asylum status]; or as a result of being granted conditional entry under section 203(a) (7) of the INA (8 U.S.C. 1153(a) (7)).

CC-6

Georgia Department of Community Affairs Community HOME Investment Program

CERTIFICATION AS TO CONFLICT OF INTEREST

Name of Applicant/Co-Applicant:

This is to certify that we are not aware of any conflict of interest that exists between the family benefitting from the receipt of CHIP funds and any person who is an employee, agent, consultant, officer, or elected official or appointed official of the state, the

(Name of State Recipient or Sub-recipient)

or of the (Name of administrator, if applicable)

whom are in a position to participate in a decision making process or are responsible for the administration or oversight of the Community HOME Investment Program. Signature of Applicant Date Signature of Co-Applicant (if applicable) Date Signature of Certifying Officer of State Recipient/Sub-recipient Date Signature of Administrator (if applicable) Date

CC-7

Georgia Department of Community Affairs Community HOME Investment Program

CERTIFICATION TO USE UNIT AS PRINCIPAL RESIDENCE

This is to certify that if my (or our) application for financial assistance through the Georgia Department of Community Affairs’ Community Home Investment Program (CHIP) is approved, that I (or we) will occupy the property for which we are receiving the CHIP funding as my (or our) principal residence throughout the required affordability period which as been defined as number of years. Applicant Signature Date Applicant Printed Name Co-Applicant Signature Date Co-Applicant Printed Name

Georgia Department of Community Affairs Community HOME Investment Program

INCOME VERIFICATION FORM Format for Calculating Part 5 Annual Income

CC-8

1. Name of Applicant(s):

2. Total Number of Persons in Household:

ASSETS Family

Member Asset Description Current Cash Value

of Assets Actual Income from

Assets 3. Net Cash Value of Assets………………. 3. 4. Total Actual Income from Assets…………………………………. 4. 5. If line 3 is greater than $5,000, multiply line by ____(Passbook Rate) and enter results here; otherwise, leave blank

5.

ANTICIPATED ANNUAL INCOME Family Members

a. Wages/ Salaries

b. Benefits/ Pensions

c. Public Assistance

d. Other Income

e. Asset Income

6. Totals a. b. c. d. e. 7. Enter total of items from 6a. through 6e. This is Annual Income………… 7. 8. Applicable income limit for county as adjusted for household size: 8. ___________________________________________ Applicant Signature of Homeowner or Home Buyer _____________________________________________ Co-Applicant Signature of Homeowner or Home Buyer