City of Thief River Falls SCDP Landlord Application

Small Cities Development Program
RENTAL REHABILITATION APPLICATION
CITY OF THIEF RIVER FALLS

Northwest Minnesota Multi-County HRA
PO Box 128 | Mentor, MN 56736 | Phone: 218-309-0057

The information on this application will be used to determine your eligibility for a Rehabiliation Loan. All fields must be completed.
APPLICANT INFORMATION
Owner Name:*

First NameMiddle InitialLast Name
Will you be using a Federal ID Number or Social Security Number?*

Federal ID NumberSocial Security Number
Federal ID Number:*
Social Security Number:*
Do you have a co-applicant to add to the application?*

YesNo
Co-Applicant Name:*

First NameMiddle InitialLast Name
Will you be using a Federal ID Number or Social Security Number for the co-applicant?*

Federal ID NumberSocial Security Number
Federal ID Number:*
Social Security Number:*
Owner's Address*

Street

Apt/Unit

CityState

Zip Code
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Work Phone:
Please enter a valid phone number.
Email:
example@example.com
Contact Person:*
Contact Phone Number:*
Please enter a valid phone number.
PROPERTY INFORMATION
Address of Building to be Rehabilitated:*

Street

Street Address Line 2

CityState

Zip Code
Estimated Age of Building:*
Estimated Market Value:*
Current Annual Property Taxes:*
Gross Area of Building in Square Feet (Exclude non-habitable space such as attics, basements, etc.)*
Gross Area of Non-Residential Space in Square Feet (Include commercial, office, owner-occupied unit, etc.)*
Exiting Use of Building:*
Proposed Use of Building:*
Is this building within a correct zoning classification?*

YesNo
Current Zoning:*
Variances/Special Use Permits?*
If none, put none or N/A
Is the building a Historic District?*

YesNo
Is this building in a flood plain?*

YesNo
Legal Description:*
Number of Units:*
Number of Stories:*
Structure Type:*

ElevatorRow/TownhouseWalk-upDetached
Parking Spaces:*

SurfaceCovered
Ownership Interest in the Property to be Improved:*

Contract for DeedLessee: Specify Terms of Lease BelowFree and ClearOther: Specify BelowMortgage
Lessee: Specify Terms of Lease:*
Other: Specify:*
Name on Title - Specify ownership interest of each name on the title:*
Amount of outstanding principal owed on the building:*
*NOTE: a copy of the most recent property tax statement from the County Assessor's Office (indicating that taxes have been paid), Copy of the Deed, and Proof of Insurance on the building (declaration page) must be submitted with your application.
ESTIMATED REHABILIATION COSTS AND REQUESTED LOAN INFORMATION
Please describe the proposed improvements:
Exterior:*
If not applicable, put "not applicable" or "N/A"
Mechanical:*
If not applicable, put "not applicable" or "N/A"
Interior:*
If not applicable, put "not applicable" or "N/A"
Estimated total cost of proposed rehabilitation work:*
Requested loan amount from the program:*
Matching amount:*
Source of match:*

Personal SavingsMortgagePrivate LoanOther
Before continuing, please click the following links and read through the information:
- Protect Your Family From Lead in Your Home
- Fair Housing Act of 1966
CERTIFICATION - Please read and check each box by the following statements:
I have read and understand the information in the publication "PROTECT YOUR FAMILY FROM LEAD IN YOUR HOME" linked on the online application. I also understand that I had the option to download the files at the end of the application and can request a copy be mailed to me at any time.
I have read and understand the information in the publication "FAIR HOUSING ACT OF 1966" linked on the online application. I also understand that I had the option to download the files at the end of the application and can request a copy be mailed to me at any time.
I understand the rehabilitation staff or an authorized representative shall have the right to inspect the property to be improved and meet with tenants at any time from the date of application upon giving notice to the owner and occupants.
I understand and agree that upon rehabilitation at least 51 percent of units must be occupied by low-income households and that rental rates will be affordable as defined by the Pennington County Income Limits, FY 2023.
I certify that all statements on this application are true and correct to the best of my knowledge. I also understand that any intentional misstatements will be grounds for disqualification.
I authorize program representatives with the right to access the property to be improved for the purpose of the deferred loan program and to take pictures of the structure before and after rehabilitation.
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Co-Applicant Signature*

Clear
Date*

MonthDayYear
Date
In accordance with Federal Law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating based on race, color, national origin, sex, age, or disability.

To file a complaint of discrimiation, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue SW, Washington, D.C. 20250-8410, or call 800-295-2372 (voice) or 202-720-6382 (TDD).

This institution is an equal opportunity provider and employer.
FILE UPLOAD

The following items MUST be submitted with the application. You can either submit them below or email them to kristi@nwmnhra.org.
Copy of insurance declaration page

Cancelof
Copy of mortgage or satisfied mortgage document

Cancelof
Proof of current property taxes & copy of property tax statement

Cancelof
Should be Empty:

APPLICANT INFORMATION

PROPERTY INFORMATION

ESTIMATED REHABILIATION COSTS AND REQUESTED LOAN INFORMATION

CERTIFICATION - Please read and check each box by the following statements:

FILE UPLOAD