Loan Fund Program Application

LOAN FUND PROGRAM APPLICATION

NORTHWEST MINNESOTA MULTI-COUNTY HRA
TO THE APPLICANT: The information on this form will be used to determine your eligibility for loan assistance. Please fill out all information correctly. If not applicable, please indicate by N/A.
APPLICANT INFORMATION
First Name*
M.I.
Last Name*
Date of Birth*

MonthDayYear
Social Security Number*
Email
Home Phone Number
Cell Phone Number
Work Phone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Race*

WhiteBlack/African AmericanAsianAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific Islander
Do you have a co-applicant?*

YesNo
CO-APPLICANT INFORMATION
First Name*
M.I.
Last Name*
Birth Date*

MonthDayYear
Social Security Number*
Email
Home Phone Number
Cell Phone Number
Work Phone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Marital Status*

MarriedSingleDivorcedSeparatedWidowed
Race*

WhiteBlack/African AmericanAsianAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific Islander
OTHER HOUSEHOLD OCCUPANTS

Please provide the following information for each member of the household NOT listed under applicant information.
How many household members do you have to add?*
Household Member #1
First Name*
Last Name*
Date of Birth*

MonthDayYear
Race*
Household Member #2
First Name*
Last Name*
Date of Birth*

MonthDayYear
Race*
Household Member #3
First Name*
Last Name*
Date of Birth*

MonthDayYear
Race*
Household Member #4
First Name*
Last Name*
Date of Birth*

MonthDayYear
Race*
Household Member #5
First Name*
Last Name*
Date of Birth*

MonthDayYear
Race*
NOTE: The information regarding marital status and minority group categories are required for statistical purposes only, so the agecny may determine the degree its programs are utilized by minorities.
PROPERTY INFORMATION
What county is the property you intend to rehab or build in?*
Construction Type*

Mobile HomeStick Built
Year Built*
Are you applying for a business loan?*

YesNo
Business Name:*
Tax I.D. Number OR Social Security Number*
INCOME INFORMATION

"Income" means any amount received from the following sources by any member of the household age 18 or over. Please answer yes or no for the following:
Public Assistance including: MFIP, SSI, GA, Child Support, and Unemployment Compensation*

YesNo
Salaries including Wages, Commissions, Bonuses, Tips, and Overtime Pay*

YesNo
Estate or Trust Income*

YesNo
Rental Income*

YesNo
Gains from the Sale of Property or Securities*

YesNo
Pensions and Annuities including: PERA, Social Security, and Railroad Retirement*

YesNo
Business Profit (for self-employed individuals, including farmers)*

YesNo
Interest and Dividends*

YesNo
Contract for Deed Payments Received*

YesNo
Applicant's employer is*
IF NOT EMPLOYED, ENTER NOT APPLICABLE/NOT EMPLOYED
Co-applicant's employer is*
IF NOT EMPLOYED, ENTER NOT APPLICABLE/NOT EMPLOYED
List all income sources for any member of the household age 18 or over for the past twelve (12) months.
Not applicable for business loan applicants.

Proof/copies of each income must be attached with the application. Proof/copies include, but are not limited to: Paystubs, Social Security Award Letter, Printout from Social Services for Public Assistance, Printout of Child Support payments, Annuity/Pension payments, Retirement payments, etc.
How many income sources do you have to include?*
Income #1
Name of Household Member*
Annual Income Amount*
Source of Income*
Attach proof/copies of income
Income #2
Name of Household Member*
Annual Income Amount*
Source of Income*
Attach proof/copies of income
Income #3
Name of Household Member*
Annual Income Amount*
Source of Income*
Attach proof/copies of income
Income #4
Name of Household Member*
Annual Income Amount*
Source of Income*
Attach proof/copies of income
Income #5
Name of Household Member*
Annual Income Amount*
Source of Income*
Attach proof/copies of income
Do you currently have any other loans with the HRA?*

YesNo
Explain:*
MONTHLY EXPENSES
Select ALL monthly expenses that apply:*

Mortgage PaymentProperty Tax PaymentHomeowner's Insurance PaymentCredit CardsCar Loan(s)Other #1Student Loan(s)Other #2Alimony/Child Support
Monthly Mortgage Payment:*
Monthly Property Tax Payment:*
Monthly Homeowner's Insurance Payment:*
Monthly Credit Card Payment(s): (monthly average)*
Monthly Car Loan(s) Payment(s):*
Monthly Student Loan(s) Payment(s):*
Monthly Alimony/Child Support Payment:*
Other Expense Type:*
Monthly Amount for Other Expense:*
Other Expense Type:*
Monthly Amount for Other Expense:*
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
Type a question*

By checking this box, I certify that I have read the information in the links provided above.
Please read and initial by each of the following statements:
I am authorizing the photographing of my property.
Applicant's Initials*
Co-Applicant's Initials*
I have received, read, and understand the information in the publication "Protect Your Family from Lead in Your Home" and I:
Select one of the following:*

Choose to have a Lead-Based Paint Risk Assessment done on my home. If lead-based paint is hound in the home, and if those substrates found to contain lead are disturbed as a result of the construction, a Lead-Based Paint Clearance Test will be required once the construction is completed. Both the Risk Assessment and the Clearance Test will be paid by me, as part of my construction loan.Choose NOT to have a Lead-Based Paint Risk Assessment done on my home. By exercising this option, I will in no way hold Northwest Minnesota Multi-County Housing & Redevelopment Authority responsible for any lead-based paint issues before, during, or after the construction has taken place.
Applicant's Initials*
Co-Applicant's Initials*
I have received, read, and understand the information provided on the Fair Housing Civil Rights Act of 1966.
Applicant's Initials*
Co-Applicant's Initials*
I consent to the release of information contained in my grant/loan application file to Northwest Minnesota Multi-County Housing HRA to determine my eligibility to participate in the Loan Fund Program. This information will be released only to Northwest Minnesota Multi-County HRA, and members of the loan review committee. Any use, other than that specified above, or any subsequent relase of this information, is expressly forbidden under the Minnesota Data Privacy Act, unless written consent is obtained. I have been informed of my right to refuse to release the information and undersand that this consent may be revoked upon written notice to Northwest Minnesota Multi-County HRA.
Applicant's Initials*
Co-Applicant's Initials*
Applicant Signature*

Clear
Date of Application *

MonthDayYear
Co-Applicant Signature*

Clear
Date of Application *

MonthDayYear
AUTHORIZATION FOR AUTOMATIC PAYMENT
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 question, please call our office at 218-637-2431 ext. 1121
YOUR INFORMATION
First Name*
M.I.
Last Name*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
BANK INFORMATION
Name of Bank*
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
ACCOUNT INFORMATION
Account Type*

Checking AccountSavings Account
Routing Number *
9 DIGITS
Account Number *
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 unit I notify the HRA, in writing, to cancel it, oe the loan is paid off.
Signature*

Clear
Date*

MonthDayYear
Date
DOCUMENT SUBMISSION
Please attach the following items below. If you do not have access to these items right now, please submit the application and email Kristi at kristi@nwmnhra.org with the attached documents.

Your application will not be processed until we have all required documentation.
Last three paystubs/last filed income tax

Cancelof
Proofs/copies of income*

Cancelof
Copy of insurance declaration page

Cancelof
Copy of mortgage or satisfied mortgage document

Cancelof
Copy & proof of current property taxes

Cancelof
Commitment of matching funds

Cancelof
Should be Empty:

LOAN FUND PROGRAM APPLICATION

APPLICANT INFORMATION

CO-APPLICANT INFORMATION

OTHER HOUSEHOLD OCCUPANTS

Household Member #1

Household Member #2

Household Member #3

Household Member #4

Household Member #5

PROPERTY INFORMATION

INCOME INFORMATION

Income #1

Income #2

Income #3

Income #4

Income #5

MONTHLY EXPENSES

Please read and initial by each of the following statements:

AUTHORIZATION FOR AUTOMATIC PAYMENT

YOUR INFORMATION

BANK INFORMATION

ACCOUNT INFORMATION

DOCUMENT SUBMISSION