Personal Information

Eligibility Determination Application
Personal Information
Full Name:

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status:
No. of Dependent:
Former Address (if less than 3 years):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Items Needed To Process Application
Items Needed To Process Application

A Completed and Signed ApplicationA Copy of Certificate from Homebuyers WorkshopInformation Release FormPre-Approval Letter from LenderLast Two Months Bank Statements (Assets)Copy of Sales Agreement and AddendaCopy of Last Two Pay Stubs &Prior Year Federal Tax ReturnAppraisal of Property &Legal Description of Property
Estimated Settlement Date:

MonthDayYear
Date
Settlement Agency:
Settlement Agency:
Attention:
Phone:
Please enter a valid phone number.
Phone:
Borrower Information
Borrower
Name
Current Address
Email
example@example.com
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Social Security
Date of Birth

MonthDayYear
Date
Co-Borrower
Name
Current Address
Email
example@example.com
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Social Security
Date of Birth

MonthDayYear
Date
Have you been a homeowner during the past three years?

YesNo

Please list the names and ages of all members of your household: [Including above applicant(s)]

Income Details

Show amount and type of ALL income including salaries, wages, overtime, child support, alimony and any other type of income into the household.

Note: As per Federal regulations, we are required to ask ethnic/racial data of you for this application. (Information will be confidential and is used for the sole purpose of statistical reporting.)
Race of Head of Household

WhiteAsianNative Hawaiian/Other Pacific IslanderBlack/African American and WhiteAmerican Indian/Alaska Native and Black/AfricanAmericanOther multi-racialBlack/African AmericanAmerican Indian/Alaska NativeAsian and WhiteAmerican Indian/Alaska Native and White
Ethnicity of Head of Household

Hispanic – A person of Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Terms such as “Latino” or “Spanish Origin” apply to this category
Non-Hispanic

A person not of Mexican, Cuban, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race
Information Release
I/We, the undersigned, do hereby give Tri-County Housing authority to have the Realtor, Bank, Mortgage Company, or any entity associated with my first mortgage, release any documents to Tri-County Housing to assist them in the processing and underwriting of my/our 2nd or subordinated mortgage.
Participant Signature*

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Date*

MonthDayYear
Date
Co-Participant Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Items Needed To Process Application