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APPLICATION FOR ASSISTANCE

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APPLICATION FOR ASSISTANCE Powered By Docstoc
					Sumner County First Time Homebuyer Program

FHLBANK Topeka—Affordable Housing Program Caldwell State Bank, member bank APPLICATION FOR
South Central Kansas Economic Development District, non-profit sponsor Please complete all pages and attach proof of income. Please note: Applicants must meet income guidelines, and there are only enough funds to assist 15 first time homebuyers.
Questions? Call (800) 658-1742 and ask for help with the First Time Homebuyer Application. STEP 1 Information about you: Name: _______________________________________ Current address: _____________________________________ City: _______________________ ZIP: _____________ Home Phone: ___________ Work: ______________ Cell: ___________ Are you the head of household? Yes No If not, who is? ____________________________ Information about you & your family:

Please list every member of your household that lives with you, starting with yourself.
Name: _______________________________________ Social Security Number: _______________________ Birthdate: ______________ Race: _______________ Gender: ________ Disabled? Yes Yes No No Student?

Name: _______________________________________ Social Security Number: _______________________ Birthdate: ______________ Race: _______________ Gender: ________ Relationship to you: _________

Disabled? Yes Yes No No Student?

Name: _______________________________________ Social Security Number: _______________________ Birthdate: ______________ Race: _______________ Gender: ________ Relationship to you: _________

Disabled? Yes Yes No No Student?

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Sumner County First Time Homebuyer Program
Name: _______________________________________ Social Security Number: _______________________ Birthdate: ______________ Race: _______________ Gender: ________ Relationship to you: _________ Name: _______________________________________ Social Security Number: _______________________ Birthdate: ______________ Race: _______________ Gender: ________ Relationship to you: _________ Disabled? Yes Yes No No Student?

Disabled? Yes Yes No No Student?

(If you need more space, please use the back of this sheet.)

Step 2

Information about your family’s assets:

Do you have a checking account? _____________ Bank name: __________________________________ Address: _____________________________________ City: _______________________ ZIP: _____________
Do you have a savings account? _____________

Bank name: __________________________________ Address: _____________________________________
City: _______________________ ZIP: _____________

(If you have other accounts, please use the back of this sheet.)

Step 3

Information about your Realtor:

Are you working with a Realtor? _____________ Realtor name: __________________________________ Address: _____________________________________
City: _______________________ ZIP: _____________ Office Phone: ___________

___________ E-mail address: ________________________
Cell:

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Sumner County First Time Homebuyer Program

Step 4

Information about your Lender:

Are you working with a lender, or a mortgage broker? _____________ Lender name: __________________________________ Address: _____________________________________
City: _______________________ ZIP: _____________ Office Phone: ___________ Cell: ___________ E-mail address: _______________________________

Step 5

Information about the house you want to buy:

Do you have a signed contract on a house? _____________ House Address: _____________________________________
City: _______________________ ZIP: _____________ Contract sales price, or asking price: _____________ Number of bedrooms: _________ What type of repairs does the house need? ________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

Step 6

Sworn statement of truthfulness & releases: PENALTY FOR FALSE OR FRAUDULENT STATEMENT

“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 or 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 or imprisoned not more than five (5) years, or both”. ~ U.S.C. TITLE 18, SECTION 1001
I, THE APPLICANT(S) CERTIFY ALL INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I understand the statement above concerning the penalty of making a fraudulent statement. If Caldwell State Bank and/or SCKEDD determines that the property cannot be cost-effectively rehabilitated to eliminate all imminent threats to health and safety, I acknowledge that with respect to the FHLBANK Topeka—Affordable Housing Program grant funds I shall have no further interest, right, or claim. If this application is approved, I understand that I will have to attend a one-day homebuyer education class before Affordable Housing Program grant funds can be used to purchase and/or rehabilitate my new home. I agree to furnish at least $500 towards the cost of the purchase of my new home. I agree to apply for the Kansas Weatherization Assistance Program through SCKEDD (if I am income eligible) after I purchase my home. I covenant and agree I will not discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the property herein assisted with the FHLBank Topeka Affordable Housing Program grant funds. I hereby state that I have not owned a site-built house within the last thirty-six months. 3

Sumner County First Time Homebuyer Program I authorize Caldwell State Bank & SCKEDD to make inquiries as necessary to verify the accuracy of the statements made, including, but not limited to income. I authorize Caldwell State Bank & SCKEDD to discuss my income, financial resources, my credit report, my credit score, my ability to obtain financing, and the condition of the house I want to buy with my Realtor and my lender and staff of the Affordable Housing Program of the Federal Home Loan Bank of Topeka. _____________________________ _____________________________ Homebuyer signature Date Homebuyer signature Date

Step Waiver of liability: I hereby release Caldwell State Bank, the South Central Kansas Economic 7

Development District (SCKEDD) and the Federal Home Loan Bank of Topeka from any and all claims of liability arising from the Caldwell State Bank and SCKEDD Sumner County first time homebuyer program using FHLBTopeka Affordable Home Program grant funds. I stipulate that I am participating voluntarily, and that I understand that by applying I am not guaranteed assistance.

_____________________________ Homebuyer signature Date Step What to expect

_____________________________ Homebuyer signature Date

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Below is a list of what you should and should not expect during the course of this project. Please initial each item and then sign at the bottom.

____ Completing this application does not guarantee that I will receive assistance. ____ I understand that preference has to be given to homebuyers that have the ____ ____ ____ ____

lowest incomes. I understand that preference has to be given to homebuyers that plan to buy homes with 3 or more bedrooms. I understand that the maximum amount of assistance that I can receive is $4,250.00. That amount can be applied to down payment assistance or closing costs or rehabilitation of the home I want to buy. I understand that I have to attend a homebuyer education class, before I can purchase my home. I understand that the FHLBTopeka will have to review my eligibility after I provide my application to Caldwell State Bank and SCKEDD, and that I may be required to furnish additional information at that time.
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____ ____

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Sumner County First Time Homebuyer Program I understand that I will not be able to complete the sale of my home until FHLBTopeka and Caldwell State Bank provide funds to the closing company. Even if I am income-eligible, I may still be denied assistance after the housing inspection. I understand that the FHLBTopeka Affordable Housing Program is unable to serve some homes needing extensive repairs because of funding limitations. The project inspector will determine what type of housing rehabilitation assistance I receive. Rehabilitation will be limited to items that are a threat to health and safety and/or items that must be repaired to eliminate further deterioration to the dwelling. I do not get to decide which items are repaired and/or how they are repaired. The work on my home will be bid out to area contractors. I will not get to choose who does the work on my home. The rehabilitation work won’t take place until after I have completed the purchase of my home. Payment to the contractor will be handled as a twoparty check through the title company. I understand that payment can’t be made to the contractor until after the project inspector has determined that the work is complete and performed properly. Rehabilitation work is inconvenient. There will be workers around my house. My life as well as the lives of my family and pets will be disrupted by the construction work. I will move my possessions out of the way of the contractor, as the contractor may deem necessary. This is not a remodeling program. The goal of the program is not to make my house look better, but to make it safer. I will have only a limited selection when it comes to paint color or other choices, if these repairs are even eligible. I understand that a five-year self-amortizing mortgage will be filed against my new home if I am selected. I understand that, if I sell or move out of the home within five years of the date that I purchased the home, I will have to repay a pro-rated amount of the FHLBTopeka Affordable Housing program assistance that I receive. I agree to all of the above.

_____________________________ _____________________________ Homebuyer signature Date Homebuyer signature Date

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Sumner County First Time Homebuyer Program Submit your completed application to: Step Michael L. West 9 SCKEDD 209 East William, Suite 300 Wichita, KS 67202 Include these items with your application:
1. 2. 3. 4. Copies of your federal tax returns for 2004. The most recent paycheck stubs for every member of the household that works. Printed record of all child support and/or alimony payments received in 2005. The most recent Social Security Administration benefits letter and/or monthly pension statements to prove income that doesn’t come from an employer.

Only a signed original application can be accepted. Do not send your application via facsimile.

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