Homebuyers Application

HOMEBUYERS PROGRAM APPLICATION
P.O. Box 128
Mentor, MN 56736
Phone: (218) 309-0057 | kristi@nwmnhra.org
Section II. INCOME INFORMATION
Income and Employment: Information on employment and ALL SOURCES OF INCOME for you, your spouse, and other residents of your household age 18 and over must be disclosed.

For the purpose of this program, "residents" includes all persons living in a housing unit for at least nine month of the year and who do not pay rent, or who are claimed as dependents for Federal Income Tax purposes.

Verification of your income will be requested before your application may be processed.
Do you or anyone in your household receive a regular paycheck from employment?*

YesNo
How many employments to do you have to add?*

12
Employment #1
Name of household member that is employed*
Name of Employer*
Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Monthly earnings*
Length of employment*
Employer's phone number*
Please enter a valid phone number.
Employment #2
Name of household member that is employed*
Name of Employer*
Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Monthly earnings*
Length of employment*
Employer's phone number*
Please enter a valid phone number.
Do you have any other sources of income to add? (MFIP, GA, Unemployment, Child Support, etc.)*

YesNo
How many other sources of income do you have to add?*

123
Other Source of Income #1
Type of Income (Source)*
Monthly earnings*
Other Source of Income #2
Type of Income (Source)*
Monthly earnings*
Other Source of Income #3
Type of Income (Source)*
Monthly earnings*

HOMEBUYERS PROGRAM APPLICATION
P.O. Box 128
Mentor, MN 56736
Phone: (218) 309-0057 | kristi@nwmnhra.org
Section III. CREDIT INFORMATION
We will be requesting a copy of your credit report. Information needed by the credit company to release the report includes:
Previous address*

Street Address INCLUDING Apt/Unit Number

Street Address Line 2

CityState / Province

Postal / Zip Code
Co-applicant's previous address*

Street Address INCLUDING Apt/Unit Number

Street Address Line 2

CityState / Province

Postal / Zip Code
Section IV. CREDIT INFORMATION
Please provide the name and address of your current landlord and a person who could serve as a reference for you:
Reference #1
Name*
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Reference #2
Name*
Relationship*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Section VI. SIGNATURES
I/we certify that the statements contained in this application are true, accurate, and complete to the best of my/our knowledge and belief.

I/we hereby authorize the release of any information necessary for NW MN Multi-County HRA to obtain a credit report and process this application.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Co-applicant's Signature*

Clear
Date*

MonthDayYear
Date

HOMEBUYERS PROGRAM APPLICATION
P.O. Box 128
Mentor, MN 56736
Phone: (218) 309-0057 | kristi@nwmnhra.org
AUTHORITY TO RELEASE INFORMATION
By signing below your are acknowleding the following:

This is your authority to release information regarding my income, employment, bank accounts, and outstanding debts including mortages, to order a consumer credit report, and to make other inquires, such as a criminal background check, to support my application for housing from NW MN Multi-County HRA HOMEBUYERS PROGRAM.

You may make copies of this letter to distribute to any party with which I have a financial or credit relationship and that part may treat that copy as an original.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Co-applicant's Signature*

Clear
Date*

MonthDayYear
Date
FAIR HOUSING & LEAD BASED PAINT CERTIFICATION
Before continuing, please click the following links and read through the information:
- Fair Housing Act of 1966
- Protect Your Family From Lead in Your Home
Fair Housing

I hereby certify that I have read the information on the Fair Housing Civil Rights Act of 1966 and that I have read and understand the information.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Lead Paint

I hereby certify that I have read the publication entitled Protect Your Family From Lead in Your Home and understand the information.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date

HOMEBUYERS PROGRAM APPLICATION
P.O. Box 128
Mentor, MN 56736
Phone: (218) 309-0057 | kristi@nwmnhra.org

MURL Program Application
Please check the statement that applies to your situation:*

I have never owed a homeI have not owned a home in the last three yearsI owned a home with a spouse and am now divorced
Please answer the following questions:
Are you able to go to a financial institution to secure financing to purchase a home?*

YesNo
Are you enrolled in any other programs that NW MN Multi-County HRA offers?*

YesNo
If yes, which one(s)?*
How did you hear about the HOMEBUYERS PROGRAM?*
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Co-applicant's Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Section I. PERSONAL INFORMATION

Co-Applicant Information

Other Household Member #1

Other Household Member #2

Other Household Member #3

Other Household Member #4

Other Household Member #5

Other Household Member #6

Section II. INCOME INFORMATION

Employment #1

Employment #2

Other Source of Income #1

Other Source of Income #2

Other Source of Income #3

Section III. CREDIT INFORMATION

Section IV. CREDIT INFORMATION

Reference #1

Reference #2

Section VI. SIGNATURES

AUTHORITY TO RELEASE INFORMATION

FAIR HOUSING & LEAD BASED PAINT CERTIFICATION

Please answer the following questions: