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
Estimated Settlement Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Settlement Agency:
Settlement Agency:
Attention:
Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Phone:
Borrower Information
Borrower
Name
Current Address
Email
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Co-Borrower
Name
Current Address
Email
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Social Security
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have you been a homeowner during the past three years?

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
Ethnicity of Head of Household
Non-Hispanic
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
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Co-Participant Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Items Needed To Process Application