HOMEBASE AFFORDABLE HOMES PROGRAM

Mortgage Applied for: VA  Conventional  Other (explain):  FHA 

USDA/Rural Housing Service



Amount Interest No. of Months Amortization Type:

Fixed Rate  Other (explain): 

GPM ARM (type): 

No. of Units Year Built

Purpose of Loan:

Purchase  Construction  Other (explain): 

Property will be:

Investment: 

Refinance  Construction-

Permanent Primary Residence  Secondary Residence 

Own Rent _______ No. Yrs.

DOB (MM/DD/YYYY) Yrs. School Gender

Married

Dependents (not listed by Applicant): no. ages

Separated

Race:  AIAN*  Pacific Islander  Other

*American Indian and Alaskan Native  White  Asian Ethnicity:

 Not Hispanic/Latino

Home Telephone: E-Mail:

Name & Address of Employer : Self Employed Yrs. On this job Yrs. Employed in this line of

work/profession

Position/Title/Type of Business: Work Telephone:

Name & Address of Employer : Self Employed Dates (from-to) Monthly Income

Position/Title/Type of Business: Work Telephone:

Name & Address of Employer : Self Employed Dates (from-to) Monthly Income

Position/Title/Type of Business: Work Telephone:

Own Rent _______ No. Yrs.

DOB (MM/DD/YYYY) Yrs. School Gender Married

Dependents (not listed by Applicant): no. ages Separated

Race:  AIAN*  Pacific Islander  Other

 White *American Indian and

Alaskan Native  Asian

Ethnicity:  Not Hispanic/Latino

 Hispanic/Latino

HOMEBASE AFFORDABLE HOMES PROGRAM INCOME ELIGIBILITY APPLICATION

Revised April 2013

Subject Property Address (street,city,state,& ZIP) Legal Property Address (street,city,state, & ZIP)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

First and Last Name: Social Security #

Home Address (street, city, state, ZIP)

Unmarried (include single, divorce, widowed)

 Black/African American

Please provide ALL applicable information on this form. It will be used to determine your eligibility; HomeBase Income Verification requirement may be more restrictive than the City of Austin SMART Housing Program's requirement.

Type of Mortgage amd Terms of Loan

Employment Information

Co-Applicant Information Property Information and Purpose of Loan

Applicant Information

First and Last Name: Social Security #

Home Address (street, city, state, ZIP)

Unmarried (include single, divorce, widowed)

 Black/African American

 Hispanic/Latino

Name & Address of Employer : Self Employed Yrs. On this job Yrs. Employed in this line of work/profession

Position/Title/Type of Business: Work Telephone:

Name & Address of Employer : Self Employed Dates (from-to) Monthly Income

Position/Title/Type of Business: Work Telephone:

Name & Address of Employer : Self Employed Dates (from-to) Monthly Income

Position/Title/Type of Business: Work Telephone:

Household Information

Name (List Applicant First) Age Date of Birth

(Month/Day/Year)

Days per year child resides with you

 If Employed

Total number of members in household:

Housing Information

Do you currently own a home? yes  no

Are you a first-time homebuyer? yes  no Senior Only

How much money do you have for down

payment? $ _________________  

yes no

Projected Annual Income

Regular Annual Income Wages/ Salaries/Business Income

(Annual) Overtime Bonuses Commissions Dividends/Interest Net Rental Income

Total

*Other includes Child Support, Alimony, other public assistance, VA payments, unemployment, investment or trust distributions, or other income received.

*Self-employed borrowers are required to submit 2 years of tax returns, YTD statements, PL for 12 months

Assets Co-Applicant Liabilities Monthly Payments Unpaid

Balance Total

Checking Savings 401k/IRA CD Cash Stocks Real Estate

*Other: _____________________

Total Assets

*Include description and value of other assets held by any member of the household.

Employment Information

For every household member who is receiving any of the following sources of income or asset, please enter the requested information under the person's name. If an income or asset type doesn't apply, skip it.

Special Needs?

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Applicant

Applicant Co-Applicant Total

Gift 

I IDA 

Handicap-Accessible

Have you attended a Homebuyer Education class?

Provide information for each household member who will be living in the home INCLUDING anyone who will be on the property title, regardless of whether you are married. Enter the number of members in your household.

Please check or fill in the correct boxes to tell us about your current housing situation and what you are looking for.

Own funds 

D

D Down payment



Other (before completing, see the notice in "describe other income," below)

Relationship to Applicant

Please check from which source the down payment is coming from

Applicant

2 of 4 Income Eligibility Application (Rev 04/15/2013)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet)

Property Address (enter S if sold, PS if Pending scale or R if rental being held for

income)

Type of Property

Present Market

Value Amount of Mortgages & Liens Gross Rental Income Mortgage Payments

Insurance Maintenance,

Taxes & Misc. Net Rental Income

Totals Checklist

INITIAL, if applicable:

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

________________

*as it may apply Certifications

Signatures:

Applicant: Co-Applicant:

Date: Date:

I hereby certify that all the information provided and submitted in support of this application is true and correct as of the date set forth below my signature and that I will be disqualified if it is determined that any or all information provided is inaccurate or non-verifiable.

■ IF SELF EMPLOYED: In addition to the 2 COMPLETE years of federal returns please include a current profit & loss estimate projecting income and expenses for 12 months.

 Most current statements for CDs, brokerage accounts, stock investments, mutual funds, etc., and proof of value any other asset held by any member of the household.

Estimated Purchase Price:

Please list all monthly debts, the minimum payment, and balance owing. This includes car payments, mortgages, credit cards, child support, etc.

INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. YOU MUST SUBMIT THE COMPLETED APPLICATION, THE COMPLETED AND SIGNED ELIGIBILITY INSTRUCTIONS, AND ALL SUPPORTING DOCUMENTATION FOR INCOME AND ASSET ELIGIBILITY DETERMINATION.

Has any borrower filed for bankruptcy in the last 7 years? Yes or No

Minimum Monthly Approximate Balance

DEBTS:

Paid To

Cash Down 3% 5% 10% 20% +

Review this list for required documentation to submit with your application.

 Completed application signed and dated by all applicants (all household members must be included on the application).

 Indicate frequency of pay/wages, if pay stubs provides (e.g., monthly, bi-monthly, weekly, or bi-weekly):

 Last THREE (3) MONTHS of all checking & savings accounts

 A completed Employer Verification Form for every employed household member OR last THREE (3) pay stubs.

 Monthly

 Bi-monthly (2 times per month)

 Weekly

 Bi-weekly (every 2 weeks)

 Other _________________________________________

* If you have been divorced since your last filed federal tax return, a copy of your executed divorce decree OR if you are in the process of a divorce, a copy of the petition for divorce.

* If you are divorced or legally separated, a copy of your court ordered custody arrangements, order for child support and/or alimony.

 Proof of value, as evidenced by a taxing authority or a certified real estate appraiser, and proof of current balance of any debt for any real estate owned.

 TWO YEARS of signed FEDERAL income tax returns and corresponding W2’s (If you don’t have copies please fill out the transcript request form in this packet and fax it to 801-620-6922, or call the IRS at 1-800-829-1040).

* Award letter(s) if receiving social security, pension, survivor or disability payment.

* If receiving a financial gift from another person, the person will need to provide a letter that includes the amount of the gift and when the gift will be given.

I hereby authorize HomeBase and its related entities and any lender that I request either an Income Eligibility determination, a prequalification approval or a loan approval, the City of Austin, Austin Housing Finance Corporation or any other agency to which this information is provided on behalf of the City, to make any and all inquiries for the purpose of verifying the truthfulness and validity of the information provided. I understand that I may be required to submit additional documentation to verify employment, income, and assets or any additional information deemed necessary to make such eligibility determination. I understand that income certification is valid for six months, or until I have a signed contract for purchase, whichever occurs first.

I understand and agree that HomeBase and its related entities, the City of Austin, Austin Housing Finance Corporation or any agency or authority it has designated to act on its behalf reserves the right to revise or revoke its eligibility determination based on any information received after a certification determination is made, including discovery of false information. The information contained and programs described herein are intended as a general descriptions relating to affordable housing, are current as of the date of preparation hereof to the knowledge of HomeBase and are subject to change without notice. HomeBase its affiliates, employees and consultants make no warranties or representations of any kind or nature whatsoever regarding the information contained and programs described herein.

Optional Information

How did you hear about this program (Select all that apply and list source below)?

Source: Newspaper  Website  Brochure  Other 

Word-of-Mouth  Realtor 

Loan Originator's Signature

Loan Originator's Name (print or type) NMLS #

Ramon G. Valeriano 339292

Loan Origination Company's Name

HomeBase 512-410-6616

Date Date

Loan Origination Company's Address

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title18, United States Code, Section 1001, et seq.

EQUAL OPPORTUNITY: There will be no discrimination against an applicant on the basis of race, age, sex, marital status, sexual orientation, national origin, religion, handicap, or source of income.

This information is requested for demographic and statistical purposes only. It is not used in determining your eligibility

Date

Loan Originator's Phone Number (including are code

Borrower's Signature Co-Borrower's Signature

55 N IH-35 #240 Austin, TX 78702

4 of 4 Income Eligibility Application (Rev 04/15/2013)

Borrower's Certification & Authorization

Certification

The undersigned certify the following:

1. I/We have applied for a mortgage loan from ____________________________, herein referred to as the

“Lender”. In applying for the loan, I/We completed a loan application containing various information on the

purpose of the loan, the amount and source of the down payment, employment and income information, and

assets and liabilities. I/We certify that all of the information is true and complete. I/We made no

misrepresentations in the loan application or other documents, nor did I/We omit any pertinent information.

2. I/We understand and agree that the Lender reserves the right to change the mortgage loan review process to a

full documentation program. This may include verifying the information provided on the application with the

employer and/or the financial institution.

3. 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 mortgage, as applicable under the provisions of Title 18, United

States Code, Section 1014.

AUTHORIZATION TO RELEASE INFORMATION

To Whom It May Concern:

1. I/We have applied for a mortgage loan from, ____________________________, herein referred to as the

“Lender”. As part of the application process, the Lender may verify information contained in my/our loan

application and in other documents required in connection with the loan, either before the loan is closed or as

part of its quality control program.

2. I/We authorize you to provide the Lender and to any investor to whom the Lender may sell my/our mortgage,

any and all information and documentation that they request. Such information includes, but is not limited to,

employment history and income; bank, money market, and similar account balances; credit history; and copies

of income tax returns.

3. The Lender or any investor that purchases the mortgage may address this authorization to any party named in

the loan application.

4. A copy of this authorization may be accepted as an original.

5. Your prompt reply to the Lender or the investor that purchased the mortgage is appreciated.

______________________________________________________ ____________________

Borrower Date SSN

______________________________________________________ ____________________

Borrower Date SSN

______________________________________________________ ____________________

Borrower Date SSN