PBCI Housing Department Renovation Loan

PBCI Housing Department Renovation Loan

5811 Jack Springs Road, Atmore, AL 36502
Today's Date

Month Day Year
Date
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com

Type a question

	List ALL family members living in the home.	Relation to Head	Date of Birth	Age	Sex	Social Security Number	Tribal Roll Number
1
2
3
4
5
6
7
8
9

Total Family Income

List all earned income and income received by all household members. This includes income from wages, self-employment, child support, contributions, Social Security, disability payments (SSI), Workman’s Compensation, retirement benefits, AFDC, veteran benefits, rental property income, stock dividends, income from bank accounts, alimony, and all other sources.

Type a question

	Household Member	Earned Income	Employer Name and Phone Number	Unearned Income (Amount & Source)	Per Capita Payment	Total Income
1
2
3
4
5
6
7
8

Signatures

All applications are valid for one year. After one year your application well be destroyed, if this occurs you will need to reapply. It is the applicant’s responsibility to update the application. You are responsible for providing all required information. If required information is not provided, the application will be considered incomplete.
Warning and Signatures

Title 18, Section 1001, of the United States Code states that a person is guilty of a felony for knowingly and/or willing making false or fraudulent statements to any department or agency of the United States.

Advised of the above, I hereby swear and attest that all of the information provided on this application is true and correct. I also understand that all changes in the household income and family composition must be reported within ten (10) days in writing to the Housing Department.
Date

Month Day Year
Date
Spouse's E-Signature (If applicable)

First Name Last Name
Date

Month Day Year
Date

Please return required items with the application.

Application will not be processed until all required information is received.
1. Proof of Income of ALL people listed on application
2. Copy of Tribal ID card on ALL Tribal Members listed on application
3. Copy of Social Security Cards for ALL people listed on application
4. Copy of Driver License/ State ID card
5. Copy of Marriage Certificate, if married
6. Copy of your Home Owners Insurance
7. Copy of Deed/Lease (If manufactured home, copy of the Title or other proof of ownership)
8. You are required to pay a Land Restriction fee upon approval of application. Fee depends on State.
9. MUST HAVE A CREDIT SCORE OF 550 OR HIGHER
Proof of Income

Cancel of
Tribal ID Cards, Social Security Cards, & Driver's License

Cancel of
Marriage Certificate (If married)

Cancel of
Copy of Home Owner's Insurance or Copy of Deed/Lease

Cancel of
Should be Empty:

Family Composition