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Bonafide Certificate Request document sample
Document Sample
NSP Grant #______________
FOR INTERNAL USE ONLY
NEW YORK STATE HOUSING FINANCE AGENCY
NEIGHBORHOOD STABILIZATION PROGRAM
INITIAL PROPERTY SET-UP AND OBLIGATION FORM *
SECTION 1: GRANTEE INFORMATION
Grantee Name Address, City and State Zip Code
Contact Name Phone Number Email
Program Partner Address, City and State Zip Code
Contact Name Phone Number Email
Program Partner Address, City and State Zip Code
Contact Name Phone Number Email
SECTION 2: NSP ACTIVITY INFORMATION: (Select all that apply)
A: Financing Mechanisms B: Acquisition/Rehab – B: Acquisition/Rehab –
Acquisition Homeownership or Rental
Disposition* Homeownership/Rental Acquisition
Relocation Acquisition Disposition*
Direct Homeownership Disposition* Relocation
Assistance Relocation Rehabilitation
Rehabilitation Rehabilitation
Direct Homeownership
Assistance
C: Land Banking D: Demolition E: Redevelopment
Acquisition Clearance Acquisition
Disposition* Disposition*
Public Facilities and
Improvements
New Construction
Rehabilitation
Direct Homeownership
Assistance
*Disposition includes carrying costs and property maintenance.
Page 1 of 5 Version May 2010
NSP Grant #______________
FOR INTERNAL USE ONLY
SECTION 3: PROPERTY INFORMATION
Address
City State Zip Code County
Census Tract Block Group (if applicable)
Estimated Construction/ Estimated Construction/
Rehab Start Date Rehab Completion Date
PROPERTY STATUS (per NSP definition): (select one)
Foreclosed Residential Structure Foreclosed Vacant Lot Abandoned
Blighted Vacant Residential Structure Non-Residential Vacant Structure
Vacant Lot - Date structure removed
SOURCE OF PROPERTY: (select one)
Tax Lien Foreclosure REO Privately Owned Publicly Owned
PURCHASE INFORMATION: (Fill in this section only if NSP funds are being used for acquisition.)
Purchase Price: $
Purchase Price Discount Percentage % Date of Final Offer
(Fill in only if funds are being used for Types A, B or C) to Purchase
As is Appraised Value $ Proposed or Actual
(Appraisal unnecessary for Types D and E) Closing Date
Value Upon Completion (if available) $ Date of Appraisal
Must be within 60 days prior to
OCCUPANCY COMPLIANCE: ( Final Offer to Purchase. )
1) Was the URA seller notification delivered?
Yes No
2) Was there a bonafide tenant in the property at time of foreclosure?
Yes No
a) If yes, do you or the successor in interest have documentation that complies with NSP's 90 day notice?
Yes No
i) If no, are you assuming the responsibilities for any penalties that may be required?
Yes No
ENVIRONMENTAL REVIEW:
Environmental review complete; did not require published notice and Request for Release of Funds (RROF).
Environmental review complete; did require published notice and Request for Release of Funds (RROF).
Authority to Use Grant Funds (AUGF) received. Date:
Statutory Checklist and required documents submitted to and approved by HFA.
Date: (if a Non-Profit Grantee)
Statutory Checklist completed and required documents collected and maintained by Grantee.
(if a Municipal Grantee)
Page 2 of 5 Version May 2010
NSP Grant #______________
FOR INTERNAL USE ONLY
SECTION 4: PROPOSED REUSE
Single Family # of units (1-4 units) Homeownership Rental Both
# of Homeowner Units
# of Rental Units
# of Low Income (≤ 50% AMI) Units
# of Moderate Income (> 50% to ≤ 80% AMI) Units
# of Middle Income (> 80% to ≤ 120% AMI) Units
Multifamily # of units Rental Only
# of Low Income (≤ 50% AMI) Units
# of Moderate Income (> 50% to ≤ 80% AMI) Units
# of Middle Income (> 80% to ≤ 120% AMI) Units
NSP Project Funds NSP Low Income Set-Aside Funds
Land Banking Only:
Interim Use:
SECTION 5: TOTAL NSP AMOUNT OF
PROPOSED BUDGET * BUDGETED BUDGETED NSP FUNDS
AMOUNT AMOUNT OBLIGATED
Acquisition
Demolition
Soft Costs
Hard Costs
Disposition/ Holding Costs
Housing Counseling
Other Costs
Developer Fee
TOTAL $0.00 $0.00 $0.00
Homebuyer Assistance Only
* Preliminary budget acceptable if property is at acquisition stage.
Page 3 of 5 Version May 2010
NSP Grant #______________
FOR INTERNAL USE ONLY
As applicable, please check below each required document being submitted with this form. Please
name each file by the title indicated in italicized brackets below. This form and all accompanying files
should be submitted in one email. (Note: These documents do not need to be submitted if activity is
limited to Homebuyer Assistance.)
Title Report and Title Policy Proposal [Title Report] and [Title Policy Proposal]
Purchase Agreement (or other documentation confirming site control for Use D) [Purchase Agreement]
Construction/Rehab/Demolition Contract* (if available at this submission) [Construction Contract]
Professional Services Contract* (if available at this submission) [Services Contract]
Other legal commitments to incur costs or distribute funds* (if available at this submission)
[Other Legal Commitments]
* Documented cost estimates are sufficient if Grantee is a Project Developer, or Grantee has executed a
Pass-Through Agreement with a Project Developer.
Please check below each document you have on file. These documents need to be submitted to HFA
only if this is your first submission of an Initial Property Set-Up and Obligation Form.
Appraisal Report indicating As-is Value (required) & Value Upon Completion (if available)
(Uses A, B, C and E) [Appraisal]
Proof of Abandonment (Use B) or Foreclosure (Uses A, B and C) as applicable
[Proof of Abandonment] or [Proof of Foreclosure]
Proof of Blight (Use D) [Proof of Blight]
Proof of Vacancy (Use E) [Proof of Vacancy]
URA notices [URA Notices]
Copy of Property Insurance Certificate, updated annually (Uses B, C, and E) [Property Insurance]
Page 4 of 5 Version May 2010
NSP Grant #______________
FOR INTERNAL USE ONLY
The Grantee certifies the following as of the date of submission of this Initial Property Set-Up and
Obligation Form:
● The above information is true and correct and has complied with all terms, conditions and requirements of
the New York State Housing Finance Agency Neighborhood Stabilization Program ("NSP") including but
not limited to federal CDBG and NSP requirements, documentation of eligible activities, National
Objectives, required property acquisitions limitations, appraisal requirements, and household income
eligibility;
● Contracts and other legal encumbrances or permitted documentation submitted with this Initial Property
Set-Up and Obligation Form meet the NSP program definition of "obligation";
● The original copies of the documents submitted and/or checked above as part of this Initial Property Set-
Up and Obligation Form are on file with the Grantee at its place of business and are identical to the
documents that have been submitted;
● The property financed with NSP funds will meet the housing quality standards as set forth in the New
York State HFA NSP Substantial Amendment;
● The property financed with NSP funds will meet the lead-based paint requirements of 24CFR Part 35;
● The above referenced property and proposed activity(ies) are an eligible use of NSP funds;
● The Local Project is in an Area of Greatest Need and directly benefits Low Income, Moderate Income
and/or Middle Income residents;
● The Grantee has obtained, or has reasonable assurances that it will obtain, all federal, state and local
government approvals and reviews required by law to be obtained by the Grantee for the Project;
● The Part 58 environmental review for this property is completed; and
● If this property is occupied, the requirements of the Uniform Relocation Act (URA) have been met.
Signature of Officer or Authorized Non-Officer Date
*This form should be submitted for each property assisted by NSP, prior to or at the time the first NSP
disbursement request form is submitted for acquisition activities (or, if the property was already owned,
when the disbursement form is submitted before rehab/construction begins).
Page 5 of 5 Version May 2010
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