HESPERIA REDEVELOPMENT AGENCY

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					                                                                   Restaurant Attraction/Incentive Program
                                                                                       Program Application


                        UPLAND COMMUNITY REDEVELOPMENT AGENCY
                        RESTAURANT ATTRACTION/INCENTIVE PROGRAM
                             460 N. Euclid Avenue, Upland, CA 91786
                                          (909) 931-4300

                                         PROGRAM APPLICATION

Restaurant’s Name:
Property Address:
APN:
Original Lease Date:                         Expiration Date:                     Monthly Lease: $


Property Owner’s Name(s):
Owner’s Mailing Address:

Applicant Name:
                         Last                              First                       M.I.

Mailing Address:

Telephone:
                         Business Telephone No.                    Work Number

Social Security Number:


Co-Applicant Name:
                         Last                              First                       M.I.

Mailing Address

Telephone:
                         Business Telephone No.                    Work Number

Social Security Number:




Restaurant Attraction/Incentive Program Application 2009                                         Page 1 of 5
                                                                         Restaurant Attraction/Incentive Program
                                                                                             Program Application



DESCRIBE INCOME


Applicant’s Current Employer                                             Applicant’s Occupation

                                                                         Telephone:
Employer’s Address                                                                      Employer’s Number

Date Employed:                                                            Monthly Gross Income:
Length of Employment:
Previous Employer:                                                       Applicant’s Occupation:


Co-Applicant’s Current Employer                                          Co-Applicant’s Occupation

                                                                         Telephone:
Employer’s Address                                                                      Employer’s Number

Date Employed:                                                           Monthly Gross Income:
Length of Employment:


NOTICE: INCLUDE ALL INCOME FROM ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE,
SOCIAL SECURITY, DISABILITY, TANF, PENSION, ANNUITY, ETC.

LOAN COLLATERAL (Assets real or personal property to be used as security for the Program Loan).

(Collateralized security may include but not limited to interest in machinery, equipment, furniture fixtures, land, building,

property, inventory, and receivables).




Restaurant Attraction/Incentive Program Application 2009                                                            Page 2 of 5
                                                                          Restaurant Attraction/Incentive Program
                                                                                              Program Application



ASSETS DISCLOSURE
                                           Schedule of Real Estate Owned
                         Type of         Market        Mortgage         Gross              Mtg.        Taxes,
           Address                                                                                                  Income
                         Property        Value          Amt             Rents              Pmts         Ins




 Totals


Name of Bank                         Address                              Account #           Savings or Checking or Stocks


Name of Bank                         Address                              Account #           Savings or Checking or Stocks


Name of Bank                         Address                              Account #           Savings or Checking or Stocks

CREDIT INFORMATION

Creditor Name - Mortgage             Account #                    Mo. Pmts.                   Approx. Balance


Creditor Name                        Account #                    Mo. Pmts.                   Approx. Balance


Creditor Name                        Account #                    Mo. Pmts.                   Approx. Balance


Creditor Name                        Account #                    Mo. Pmts.                   Approx. Balance

                     THESE QUESTIONS APPLY TO BOTH THE APPLICANT AND CO-APPLICANT

                                                                                              Applicant         Co-Applicant
                                                                                              Yes or No         Yes or No

Are there any outstanding judgments against you?

Have you been declared bankrupt within the past 7 years?

Have you had property foreclosed upon or given deed in lieu thereof in the last 7 years?

During the past five years, have you directly or indirectly been obligated on any loan
which resulted in foreclosure, transfer of the title in lieu of foreclosure or judgment?
(This would include such loans as home mortgages, SBA loans, home improvement
loans, educational loans, manufactured (mobile) home loans, any mortgage,
financial obligation, bond or loan guaranty).

Are you presently delinquent or in default on any debt to the Federal Government (e.g.,
Public Health Service, U.S. Guaranteed Student Loan, GI Bill Education Benefits, etc.)?



Restaurant Attraction/Incentive Program Application 2009                                                            Page 3 of 5
                                                             Restaurant Attraction/Incentive Program
                                                                                 Program Application



DESCRIBE BUSINESS OPERATIONS: (ex: days and hours of operation, type of licenses, entertainments, status
with local agencies)




LIST BUSINESS LICENSE(S)

Type:                             No.:              Type:                            No.:

Type:                             No.:              Type:                            No.:


DESCRIBE IMPROVEMENT NEEDS: (Subject to evaluation by representatives of the Upland Community
Redevelopment Agency (the “Agency”).




Restaurant Attraction/Incentive Program Application 2009                                          Page 4 of 5
                                                                       Restaurant Attraction/Incentive Program
                                                                                           Program Application



                                       CONSENT AND DECLARATION
I/We, as undersigned, hereby consent to allow authorized representatives of the Upland Community Redevelopment Agency
(the “Agency”) to enter my/our property for the purpose of evaluating the building. The undersigned and the representatives
of the Agency will perform this evaluation jointly. In addition, by signing below, I/We declare that the information
provided herein is true and accurate to the best of my/our belief and knowledge that I/We made no misrepresentations in the
application or other documents, nor did I/We omit pertinent information and that I/We under penalty of perjury have
received and read the Restaurant Attraction/Incentive Program Policies Manual.

The undersigned certify the following: I/We have applied for a loan under the Restaurant Attraction/Incentive Program
funded by the Agency. In applying for assistance, I/We completed an application containing various information for the
purpose of obtaining a loan. I/We acknowledge that the Agency will keep this application in a confidential file and shall not
disclose it to any third party unless required to do so pursuant to applicable law or legal order.

I/We understand and agree that the Agency, reserves the right to change the review process to a full documentation program
on a case-by-case basis. This may include independent verification of the information provided on the application. I/We
expressly consent to and authorize Agency to verify the information on the application and hereby instruct all persons so
requested to fully cooperate with Agency, including, but not limited to providing further confirmation or documentation as
the Agency may request from time to time.

I/We understand and agree that the Owner’s Acknowledgement and Request for Bidding Assistance (Attachments 1 and 2)
are a part of this Application.

I/We understand and agree that the Agency reserves the right to change the requirements of this application and program at
any time.



                                                               ______________________
Applicant’s Signature               Date                       Co-Applicant’s Signature            Date




                        PROPERTY OWNER(S) ACKNOWLEDGMENT/CONSENT

I/We the undersigned owners currently hold title (property owners) to the property for which this Restaurant
Attraction/Incentive Program application is being submitted and hereby consent to the applicant (tenant) submitting such
application.

                                                               ______________________
Print Name                          Date                       Signature                           Date


                                                               ______________________
Print Name                          Date                       Signature                           Date




Restaurant Attraction/Incentive Program Application 2009                                                         Page 5 of 5

				
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