Certifications and Acknowledgments
Under penalties of perjury, I/we certify that the information presented on this form is true and accurate to the best of my/our knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result in the denial of application or recapture of assistance provided.
I/we specifically acknowledge and agree that: (1) all statements made in this form are made for the purpose of demonstrating my/our eligibility for the Whole Home Repair Program; (2) verification of any information contained in the form may be made at any time prior to or after closing by Pike County and/or its agents, either directly from any source named in this form or through a credit reporting agency, and I/we shall provide any documentation requested for this purpose; (3) the original copy of this form will be retained by Pike County, even if I/we do not qualify for the program; (4) I/we must supplement the information provided in this form if any of the material facts which I/we have represented herein should change prior to settlement.
I/we certify that the information provided in this application form, including any and all attachments, is true and correct as of the date set forth opposite my/our signature(s) on this form and acknowledge my/our understanding that the provision of any false, fictitious or fraudulent information contained in this form or any and all attachments may result in the immediate acceleration of recapture of any financing that might have been provided.
This certification is made in accordance with my/our understanding that, in order to be eligible for Pike County Whole Home Repair Program:
a. The household income does not exceed 80% of the total area median income (AMI) as defined by the U.S. Department of Housing and Urban Developments Income Limits.
i. For households where the AMI is greater than 300% of the U.S. Department of Health and Human Services Federal Poverty Income Guidelines or 65% of the AMI, there will need to be proof of Covid Impact as described in the SLFRF Final Rule Overview.
b. It is owned by a homeowner who meets any of the following criteria:
i. An owner of record evidenced by a publicly recorded deed.
ii. An owner-occupant of a manufactured home who leases a space in a manufactured home community.
iii. An equitable owner who can demonstrate an ownership interest in a property as provided by law, including:
1. A person who has inherited an interest in a property
2. A person who has entered a contract to purchase the property.
3. A person who was the owner of record before a fraudulent conveyance of the property.
4. A person who is a trust beneficiary and a person holding a partial ownership interest in a property such as tenancy by the entirety, joint tenancy, tenancy in a common and life estate.
Methods of Proof for Homeowners
i. Homeowners are required to complete and sign a self-[NO1] certification/ self-attestation of annual income form disclosing the total annual household income and all sources of income for all occupants. Earned income or unemployment compensation for minors under the age of 18 (or full-time high school students) may be omitted from this form.
ii. Homeowners are required to provide at least one of the following:
1. A statement from all current employers stating wages or rate of compensation (if applicable, statement should address hours worked per week and take into consideration overtime pay), or at least two-months of current pay statements from all current employers and/or evidence of participation in public benefit programs. Earned income or unemployment compensation for minors under the age of 18 (or full-time high school students) may be excluded from this process.
a. Any public benefit program received by any member of the household should be considered and properly documented. It’s understood that in some instances, the household’s total income may derive solely from public benefit programs.
2. Proof that the household’s income has been verified through another federal, state, or local program within six-months prior to the WHR application submittal date.
a. For the purposes of other federal, state, or local programs used for income verification, the WHR client must clearly identify the program, date of verification, verification criteria used (e.g., 80% AMI, 300% FPL, etc.), and provide proper documentation that the results of the verification process resulted in a verified household income not to exceed 80% AMI.
I/We understand that any provision of false, fictitious or fraudulent information to Pike County and/or its agents regarding this form may result in the immediate acceleration of full payment of any financing that might have been provided under the Program,
I/we also specifically acknowledge and agree that: (1) all statements made regarding this form are made for the purpose of demonstrating my/our eligibility for the Program; (2) verification or reverification of any information regarding this form may be made at any time prior to or after settlement by Pike County and/or its agents, and the original copy of this form will be retained by Pike County (3) Pike County and/or its agents will rely on the information regarding this form, and I/we have a continuing obligation to amend and/or supplement the information regarding this form if any of the material facts which I/we have represented herein should change prior to settlement.