Loan Application Form from Lic by wgg37116

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									                 Mississippi Home Corporation




                                                           APPLICATION FOR RENEWAL OF
                                                               HB 530 LINE OF CREDIT

Please fill in all applicable information in the spaces provided. The application and required documents must be submitted to MHC prior to the
expiration date of the Line of Credit. Failure to provide documents within this timeframe will cause the Line to expire and may not be eligible for
renewal.

BORROWER
Borrower's Name                                                         Federal Tax Identification Number                 Organization Type

                                                                                                                              For-Profit            Nonprofit

Contact Person                                                          Title                                             Contact Phone No.



Business Street Address                                                 Business Mailing Address                          E-Mail Address



Business Phone Number                                                   Business Fax Number                               Website Address




GUARANTOR
Name of Guarantor(s)                     Social Security Number                  Home Address               Home Phone No.                  Alternate Phone No.




GENERAL CONTRACTOR
Is the General Contractor the same as the Borrower?               Yes           No


General Contractor:
Contact Person:
Address:
Phone No.:
Fax No.:
License No.:


DEVELOPMENT TEAM
Developer                             Contact Person              Address                                     Phone No.              Fax No.



General Contractor                    Contact Person              Address                                     Phone No.              Fax No.



Project Manager                       Contact Person              Address                                     Phone No.              Fax No.



Appraiser                             Contact Person              Address                                     Phone No.              Fax No.



Housing Couseling Agent               Contact Person              Address                                     Phone No.              Fax No.



Accountant                            Contact Person              Address                                     Phone No.              Fax No.



Attorney                              Contact Person              Address                                     Phone No.              Fax No.




HB530 LOC RENEWAL / Rev. 07/07                                                                                                                            Page 1 of 11
DEVELOPMENT INFORMATION


Development Type                          Single-Family Subdivision                          Single-Family Scattered Housing

Construction Type                         Site Built                                         Manufactured                                  Modular

Target Market                             Very Low Income                                    Low Income                                    Moderate Income
                                      (Equal to or less than 60% of AMI)                 (Equal to or less than 80% of AMI)             (Equal to or less than 115% of AMI)


Sales Price Range:                    from                            to

Square Foot Range:                    from                            to

Price Per Square Foot:                from                 #DIV/0!    to          #DIV/0!




For Subdivisions:

Development Name

Location (County)                                      1
                                      Area Median Income Limit              $0           (Based on HUD's 2007 Income Limits.)
                                      Max Family Income Allowed             $0           (115% of AMI)


Number of Phases to be completed in this subdivision:
Number of homes to be completed in each Phase:
Number of homes completed to date:
Number of spec homes outstanding:
Number of homes expected to be completed in the next twelve
(12) months:


For Scattered Sites:

List the counties where homes will be built in the next twelve months.
                                                                      Area Median
              County                                   1               Income Limit
                                                                                            $0                   Max Homebuyer Income       $0

                                                                      Area Median
              County                                   1               Income Limit
                                                                                            $0                   Max Homebuyer Income       $0

                                                                      Area Median
              County                                   1               Income Limit
                                                                                            $0                   Max Homebuyer Income       $0


Number of Homes expected to be completed in the next twelve
(12) months:


HOMEBUYER DOWNPAYMENT ASSISTANCE

Check any programs that will be utilized to assist homebuyers with downpayment and/or closing costs.

Grant Funds

    HOME Funds                                                        Administered By:

    Federal Home Loan Bank Funds (FHLB)                               Administered By:

    American Dream Downpayment Initiative (ADDI)                      Administered By:

    Other:                                                            Administered By:

    I will not be utilizing any grant fund programs.



MHC Programs
    Mortgage Revenue Bond (MRB) Program

    Downpayment Assistance Program (DPA)




HB530 LOC RENEWAL / Rev. 07/07                                                                                                                                          Page 2 of 11
CERTIFICATION

Please read the following statement and sign below.

I/We certify that the information provided in this application and any attachments in support thereof are true and correct as of this date.
I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements
when applying for this loan, as applicable under the provisions of Title 18, United States Code, Section 1014, et seq. and liability for
monetary damages to the Mississippi Home Corporation (MHC), its agents, successors and assigns, insurers and any other person who
may suffer any loss due to reliance upon any misrepresentation which I/we have made in this application.


I/We understand that any approval of a line of credit application by MHC shall only constitute approval of me/us as an approved
Borrower and not of any particular existing or future loan application of an Eligible Residential Housing Unit.

I/We also understand that all application fees are non-refundable.


0



 By:                                                                                                                    000-00-0000
                                   (Authorized Signature)                                                  Borrower's Federal Tax Identification Number


                                 Its:
                                                             (Title)                                                         (Date)




Guarantor(s)



Guarantor's Signature / Date                                                                                   Guarantor's Social Security Number




Guarantor's Signature / Date                                                                                   Guarantor's Social Security Number




Guarantor's Signature / Date                                                                                   Guarantor's Social Security Number




Guarantor's Signature / Date                                                                                   Guarantor's Social Security Number



ATTACHMENTS
The following documents must be submitted with the LOC Renewal Application in order to be considered for re-approval:

    $100 Nonrefundable Application Fee
    Current Business and Personal Financial Statements (for all principals, guarantors, and contractors)

    Current Business and Personal Federal Tax Returns (for all principals, guarantors, and contractors)

    Copy of Current Contractor's License

    Contractor's Suppliers List & Certification

    Evidence of Liability Insurance and Worker's Compensation Insurance



SUBMISSION
Submit the completed and signed application, along with attachments, to:
MISSISSIPPI HOME CORPORATION
Attn: Lisa Coleman
P.O. Box 23369
Jackson, MS 39225-3369




HB530 LOC RENEWAL / Rev. 07/07                                                                                                                       Page 3 of 11
     0
     2 Adams                     #####
     3 Alcorn                    #####
     4 Amite                     #####
     5 Attala                    #####
     6 Benton                    #####
     7 Bolivar                   #####
     8 Calhoun                   #####
     9 Carroll                   #####
   10 Chickasaw                  #####
   11 Choctaw                    #####
   12 Claiborne                  #####
   13 Clarke                     #####
   14 Clay                       #####
   15 Coahoma                    #####
   16 Copiah                     #####   Simpson County
   17 Covington                  #####
   18 Desoto                     #####   Memphis, TN
   19 Forrest                    #####   Hattiesburg
   20 Franklin                   #####
   21 George                     #####   Pearl River
   22 Greene                     #####
   23 Grenada                    #####
   24 Hancock                    #####   Biloxi
   25 Harrison                   #####   Biloxi
   26 Hinds                      #####   Jackson, MS
   27 Holmes                     #####
   28 Humphreys                  #####
   29 Issaquena                  #####
   30 Itawamba                   #####
   31 Jackson                    #####   Biloxi
   32 Jasper                     #####
   33 Jefferson                  #####




HB530 LOC RENEWAL / Rev. 07/07                            Page 4 of 11
   34 Jefferson Davis            #####
   35 Jones                      #####
   36 Kemper                     #####
   37 Lafayette                  #####
   38 Lauderdale                 #####
   39 Lawrence                   #####
   40 Leake                      #####
   41 Lee                        #####
   42 Leflore                    #####
   43 Lincoln                    #####
   44 Lowndes                    #####
   45 Marion                     #####
   46 Marshall                   #####   Marshall County
   47 Monroe                     #####
   48 Montgomery                 #####
   49 Neshoba                    #####
   50 Newton                     #####
   51 Noxubee                    #####
   52 Oktibbeha                  #####
   53 Panola                     #####
   54 Pearl River                #####
   55 Perry                      #####   Greene County
   56 Pike                       #####
   57 Pontotoc                   #####
   58 Prentiss                   #####
   59 Quitman                    #####
   60 Scott                      #####
   61 Sharkey                    #####
   62 Simpson                    #####   Simpson County
   63 Smith                      #####
   64 Stone                      #####   Pearl River
   65 Sunflower                  #####
   66 Tallahatchie               #####
   67 Tate                       #####   Tate County
   68 Tippah                     #####
   69 Tishomingo                 #####
   70 Tunica                     #####   Tunica County
   71 Union                      #####
   72 Walthall                   #####
   73 Warren                     #####
   74 Washington                 #####
   75 Wayne                      #####
   76 Webster                    #####
   77 Wilkinson                  #####
   78 Winston                    #####
   79 Yalobusha                  #####
   80 Yazoo                      #####




HB530 LOC RENEWAL / Rev. 07/07                             Page 5 of 11
                                   CONTRACTOR'S SUPPLIERS LIST AND CERTIFICATION



Contractor Name:
Builder's Lic #:                   0
Lic Exp Date:




List the names of all the suppliers that will be used to construct homes under the HB530 program:
(Include suppliers for concrete, lumber, bricks, hardware, and other materials.)


                Company Name                                    Address                             Phone #                 Fax #




Disclosures
1. Are you financing speculative construction through any other source?                      Yes                    No

         If yes, please explain:


2. Are there any labor or material liens on record against you at this time?                 Yes                    No

         If yes, please explain:




Certification
I certify that the information provided above and any attachments in support thereof are true and correct as of this date. I further
authorize the Mississippi Home Corporation to contact any references listed above to verify my character or financial standings and I
authorize such information to be released.



Contractor's Signature                                                                      Date



                                                                                                    Supplier's List Cert - HB 530 Form 530-05
                                                                                                                                    Rev 07/07
                                             CONTRACTOR'S PROJECTS IN PROCESS


Contractor Name:
Builder's Lic #:                   0
Lic Exp Date:                      01/00/00



Please list the status of all construction activity in process.

 Site Location                         Project                                                                  Start / End Date
                                                                   Lending Institution     % Completed
    (Lot #, Subdivision, City)          Type                                                                    (MM/YY - MM/YY)




                                                                                                                         `




Contractor's Signature                                                                   Date




Project Type:               (RS)   Residential Spec Home
                            (RC)   Residential Custom-Built Home
                            (CP)   Commercial Property




                                                                                                Supplier's List Cert - HB 530 Form 530-05
                                                                                                                                Rev 07/07
                                                      PERSONAL FINANCIAL STATEMENT

MISSISSIPPI HOME CORPORATION                                                                                    As of                                    ,

Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning 20% or
more of voting stock, or (4) any person or entity providing a guaranty on the loan.



Name

Residence Address

City, State, & Zip Code

Business Name of Applicant/Borrower


                                    Assets                                                                              Liabilities

Cash on hand & in Banks………………………..                         $               -         Accounts Payable………………………………                              $                 -
Savings Accounts…………………………………                              $               -         Notes Payable to Banks and Others………….                    $                 -
IRA or Other Retirement Account……………….                     $               -         Installment Account (Auto)…………………….. $                                      -
Accounts & Notes Receivable…………………..                       $               -                        Mo. Payments        $             -
Life Insurance-Cash Surrender Value Only……                 $               -         Installment Account (Other)……………………. $                                      -
  (Complete Section 8)                                                                              Mo. Payments        $             -
Stocks and Bonds………………………………..                             $               -         Loan on Life Insurance…………………………                          $                 -
  (Complete Section 3)                                                               Mortgages on Real Estate…………………….                         $                 -
Real Estate………………………………………… $                                              -          (Complete Section 4)
 (Complete Section 4)                                                                Unpaid Taxes……………………………………                                $                 -
Automobiles-Present Value……………………… $                                       -          (Describe in Section 6)
Personal Property…………………………………                             $               -         Other Liabilities………………………………….                           $                 -
 (Describe in Section 5)                                                              (Describe in Section 7)
Other Assets………………………………………                                $               -         Total Liabilities………………………………….                           $                 -
 (Describe in Section 5)                                                             Net Worth………………………………………..                                $                 -


                                  Total                    $               -                                    Total                          $                 -

Section 1. Source of Income                                                                                     Contingent Liabilities

Salary………………………………………………                                   $               -         As Endorser or Co-Maker……………………..                         $                 -
Net Investment Income…………………………..                          $               -         Legal Claims & Judgments……………………                          $                 -
Real Estate Income………………………………                             $               -         Provision for Federal Income Tax…………….                    $                 -
Other Income (Describe below)…………………                       $               -         Other Special Debt……………………………..                           $                 -
Description of Other Income in Section 1.


Section 2. Notes Payable to Banks and Others
Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.

                                                                                        Current         Payment          Frequency
       Name and Address of Noteholder(s)                    Original Balance                                                                        Collateral
                                                                                        Balance          Amount         (monthly, etc.)

                                                           $                   -    $           -      $         -

                                                           $                   -    $           -      $         -

                                                           $                   -    $           -      $         -

                                                           $                   -    $           -      $         -




HB 530 Form 530-03 (07/07)
Section 3. Stocks and Bonds
Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.
 Number of                                                                           Market Value              Date of
                       Name of Securities                   Cost                                                                   Total Value
  Shares                                                                           Quotation/Exchange       Quote/Exchange
                                                     $                 -                                                     $                   -
                                                     $                 -                                                     $                   -
                                                     $                 -                                                     $                   -
                                                     $                 -                                                     $                   -
Section 4. Real Estate Owned
List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part of this statement and signed.
                                             Property A                               Property B                         Property C
Type of Property

Property Address

Date Purchased
Original Cost                  $                                   -          $                         -   $                                    -
Present Market Value           $                                   -          $                         -   $                                    -

Name & Address of
Mortgage Holder

Account Number
Mortgage Balance               $                                   -          $                         -   $                                    -
Monthly Payment                $                                   -          $                         -   $                                    -
Status of Mortgage
Section 5. Other Personal Property and Other Assets




Section 6. Unpaid Taxes
Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.




Section 7. Other Liabilities




Section 8. Life Insurance Held
Give face amount and cash surrender value of policies, name of insurance company and beneficiaries.



Section 9. Other Information (If the answer is "yes" for any question below, please explain on a separate sheet of paper.)
1. Have you declared bankruptcy within the past seven (7) years?                                                             Yes         No
2. Have you had property foreclosed upon in the past seven (7) years?                                                        Yes         No
3. Have you ever been arrested, indicted, or convicted as an adult for any felony criminal violation?                        Yes         No
4. Have you ever been involved in a MHC loan as an individual, developer, builder, sponsor, or management entity?            Yes         No

I authorize MHC/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my
creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date. These
statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in
forfeiture of benefits and possible prosecution by the U.S. Attorney General (Ref 18 U.S.C. 1001).

Signature                                                                  Date:                   Social Security Number:

Signature                                                                  Date:                   Social Security Number:



HB 530 Form 530-03 (07/07)
Collateral




             HB 530 Form 530-03 (07/07)
Total Value

              -
              -
              -
              -



C




              -
              -




              -
              -




 determine my
ed date. These
s may result in




                  HB 530 Form 530-03 (07/07)

								
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