• Community Revitalization Fund Program
    (Down Payment Assistance Program)

    Home Owner Application

    To the applicant: The information on this form will be used to determine your eligibility for down payment assistance. Please fill out all information correctly and completely.

  • HOUSEHOLD INFORMATION

  • Applicant Information

  • Birth Date*
     / /
  • Marital Status
  • Format: (000) 000-0000.
  • Do you have a co-applicant?*

  • Co-Applicant Information

    if applicable
  • Birth Date*
     / /
  • Marital Status*
  • Format: (000) 000-0000.

  • Household Occupant Information

    Please provide the following information for all household members NOT previously listed in parts 1 or 2.
  • How many additional household members do you have?*

  • Member #1

  • Birthdate*
     / /

  • Member #2

  • Birthdate*
     / /

  • Member #3

  • Birthdate*
     / /

  • Member #4

  • Birthdate*
     / /

  • Member #5

  • Birthdate*
     / /

  • INCOME INFORMATION

    "INCOME" means any amount received from the following source by an resident age 18 or older living in the household. Please check all that apply.
  • Public Assistance including: MFIP, SSI, GA, Child Support, and Unemployment Compensation*
  • Salaries from employment, including commissions, bonuses, overtime pay, and tips*
  • Estate or Trust Income*
  • Rental Income*
  • Gains from sale of property or securities*
  • Pensions and Annuities including: PERA, Social Security, Railroad Retirement, 401k Disbursements, etc.*
  • Business Profit (for self-employed individuals, including farmers)*
  • Interest and Dividends*
  • Contract for Deed payments received*

  • Including yourself, list all income from the past twelve (12) months for all household members aged 18 years and older.

  • How many income sources do you have to add?*

  • Income #1

  • Income #2

  • Income #3

  • Income #4

  • Income #5

  • Income #6

  • Click on the following links and read through the information before completing the next portion of the application.

    Protect Your Family from Lead in Your Home

    Fair Housing Civil Rights Act of 1966

  • Please read each of the following statements:

    • I am authorizing the photographing of my property
    • I hereby certify that I have received the publication "Protect Your Family from Lead in Your Home" and that I have read and understand this information
    • I hereby certify that I have received information on the Fair Housing Civil Rights Act of 1966 and that I have read and understad this information

    I, the undersigned, certify subject to penalty under law that the above information is true and complete to the best of my knowledge and belief.

  • Date of Application*
     / /
  • Date of Application
     / /

  • Community Revitalization Fund Program Program Questionnaire

  • Loan Officer's Information

  • Format: (000) 000-0000.
  • Have you completed the homebuyer education course?*
  • Where will your residence be located?
  • Which of the following do you anticipate doing?*
  • What type of construction will your new home be made of?*
  • What type of home will it be?*
  • What would you do without this program in place?*

  • I authorize Northwest Minnesota Multi-County HRA to release the information from this application to my lender and members of the Fund Advisory Committee. I certify that the information in this application is complete and accurate to the best of my knowledge and belief.

  • Date*
     / /
  • Date*
     / /

  • The $100.00 application fee should be made payable to:
    Northwest Minnesota Multi-County HRA

    Please remit:

    Northwest Minnesota Multi-County HRA
    Attn: Katelyn
    P.O. Box 128
    Mentor, MN 56736

  • Community Revitalization Fund Program Privacy Act Release Form

    • I hereby consent to permit the release of information contained in my grant and/or loan application file to Northwest Minnesota Multi-County Housing and Redevelopment Authority for the propose of determining my eligibility to participate in the Affordable Housing Program.
    • I understand that this information will be released only to Northwest Minnesota Multi-County Housing and Redevelopment Authority and members of the loan review committee.
    • Any use, other than specified above, or any subsequent release of this information, is expressly forbidden under the Minnesota Date Privacy Act, unless my written consent is obtained.
    • I have been informed of my right to refuse to release the information.
    • I understand that I may revoke this consent upon written notice to Northwest Minnesota Multi-County Housing and Redevelopment Authority at any time.
  • Date*
     / /
  • Date*
     / /

  • Northwest Minnesota Multi-County Housing and Redeveleopmt Authority

    PO Box 128 | 205 Garfield Avenue | Mentor, MN 56736
    Phone: 218-637-2431 | Fax: 218-637-2433

  • Dear Loan Applicant,

     

    If approved, your loan payment will automatically be taken out of your bank account each month, so please complete this form and submit a voided check from the account you wish to use. Please be advised that this payment will automatically come out of your bank account at the beginning of each month.

    If you have questions, please call our office at 218-637-2431 ext. 1121

  • AUTHORIZATION FOR AUTOMATIC WITHDRAWAL

  • Your Information

  • Format: (000) 000-0000.

  • Banking Information

  • Format: (000) 000-0000.

  • Account Information

  • What type of account is this?

  • My signature below certifies that I authorize Northwest Minnesota Multi-County Housing & Redevelopment Authority to withdraw my monthly payment from my checking or savings account. This authorization will remain in effect until I notify the HRA, in writing, to cancel it, or the loan is paid off.

  • Date*
     / /

  • Application Fee Payment

  • Would you like to use the account listed above for the $100.00 application fee?*

  • My signature below certifies that I authorize Northwest Minnesota Multi-County HRA to withdraw the $100.00 application fee for the Down Payment Assistance Program from the bank account listed above once the voided check or verification of banking is received.

  • Date*
     / /
  •  
  • Should be Empty: