Household Affidavit Addendum

I, First Name* Last Name* attest that I:

(a) Am a family size of: Size of Family* .
(b) Have a household income of: Household Income* .

Total of Gross Yearly Income:*

(c) Will be moving into the home with Number of people* people.

I, First Name* Last Name* attest that I:

Am currently...*

Married and living with my spouse.Married, living with my spouse, and have not yet filed for a Separation Agreement or Divorce Decree. (I fully understand that documentation will be needed that allows me to acquire henceforth, hold, manage, alienate, lease, and convey property without the spouse's knowledge, further consent, or joinder, following the provisions of North Carolina General Statutes Section 39-13.4, just the same as if had never been married.)Living with someone who WILL be moving into the home.Living with someone who WILL NOT be moving into the home.

I understand that this affidavit will be relied on to determine my eligibility for down payment assistance, a mortgage, and rent. I understand that a material misstatement or fraudulently made statement in this affidavit, or any other statement made by me in connection with the application for down payment assistance and a mortgage and rent amount may constitute a federal violation punishable by fines, by criminal penalties or by revocation of the mortgage and eviction from the rental property.

Applicant Name:*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Applicant Signature:*

Date:*

Date

Co-Applicant Name:

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Co-Applicant Signature:

Date:

Date