CUMBERLAND COUNTY LEASE

Print off the following forms to include w/application (click to view):

Employment Verification

Landlord Verification

Guidelines & Summary

CUMBERLAND COUNTY LEASE-PURCHASE PROGRAM APPLICATION

To be considered for this program this application must be completed in full and the following documentation must accompany this application. Information must be provided for all persons who will be residing in the household.

copies of birth certificates for all persons residing in the household

copies of social security cards for all persons residing in the household

copies of w-2 forms and the most recent income tax return for all persons residing in the household

copies of documentation showing public assistance, child support payments, unemployment benefits, pensions and annuities, Social Security award or benefit letter

You must specify the area or areas within Cumberland County you would be willing to lease/purchase a house: ______________________________________________________________________

Please include information for everyone who will be residing in the household.

1. GENERAL INFORMATION

Head of Household First, Middle, Last, (maiden)

Name: _________________________________________________

Social Security Number: _______________________________________________________

Date of Birth: ____________________________________________

Marital Status: ____ Married ___Separated ___Divorced _____Single

Telephone: Day: __________________________________________

Evening: ________________________________________

Present Address: __________________________________________

________________________________________________________

How long at this address? ________________________________________________________

Currently, I ____rent, ____live with family or friends, ____own my home

Name and address of landlord: ________________________________________________________

________________________________________________________

Do you currently receive Section 8 Rental Assistance? Yes ____ No ____

Do you currently reside in public housing? Yes ____ No _____

List former addresses (last five years):

1._______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

List names and address of former landlords (last five years):

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Spouse or co-applicant's First, Middle, Last, (maiden) Name: _____

________________________________________________________

Social Security Number: _____________________________________

Date of Birth: _____________________________________________

Telephone: Day: ___________________ Evening: _________________

Marital Status: ____ Married ___Separated ___Divorced ___Single

Present Address: ___________________________________________

________________________________________________________

How long at this address? ________________________________________________________

Currently, I____ rent, ____ live with family or friends, ____ own my home

Name and address of landlord: ________________________________

________________________________________________________

Do you currently receive Section 8 Rental Assistance? Yes ____ No ____

Do you currently reside in public housing? Yes ____ No _____

List former addresses (last five years):

1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

List names and address of former landlords (last five years):

1. _______________________________________________________

_________________________________________________________

2. _______________________________________________________

_________________________________________________________

3. _______________________________________________________

_________________________________________________________

C. Dependents Living In The Household:

Name(s) Birth Dates(s) Relationship

_______________________________________________________

2. EDUCATIONAL HISTORY FOR THE HEAD OF HOUSEHOLD

A. Highest grade completed: __________________________ What year? _____

B. Additional educational/vocational training:

_____________________________________________ What year? ____

_____________________________________________ What year? ____

_____________________________________________ What year? ____

C. Do you have any future plans for educational/vocational training? _______

If so, what? __________________________________________________

3. EMPLOYMENT HISTORY FOR THE HEAD OF HOUSEHOLD

A. Present employer: Name: _____________________________________

     Address: _________________________________________________

     ________________________________________________________

     Your job Title: ____________________________________________

How long employed? ________________________________________________

Number of Hours Per Week: ________________________________________________

Duties: ________________________________________________

Additional Employment, please specify:__________________________________________

________________________________________________

B. Do you have health insurance? Yes ____ No _____

If yes, name of provider: ________________________________________

C. Previous employment: (Last five years)

Name Address How long Duties

_______________________________________________________________________

D. What do you see yourself doing five years from now? ____________________________

_______________________________________________________________________

4. EDUCATIONAL HISTORY FOR SPOUSE or CO-APPLICANT

A. Highest grade completed: __________________________ What year? _____

B. Additional educational/vocational training:

_____________________________________________ What year? ____

_____________________________________________ What year? ____

_____________________________________________ What year? ____

Do you have any future plans for educational/vocational training? ___________

If so, what? __________________________________________________

5. EMPLOYMENT HISTORY FOR SPOUSE or CO-APPLICANT

A. Present employer: Name: _______________________________________

    Address: ___________________________________________________

                  ___________________________________________________

    Your job title:________________________________________________

How long employed? ____________________________

Number of Hours Per Week: ______________________

Duties: _______________________________________

Additional employment, please specify: ____________________________________________

____________________________________________

B. Do you have health insurance? Yes ____ No _____

If yes, name of provider: _______________________________________

C. Previous employment: (Last five years)

Name Address How long Duties

_______________________________________________________________________

D. What do you see yourself doing five years from now? ____________________________

_______________________________________________________________________

6. FINANCIAL HISTORY

A. Household GROSS MONTHLY INCOME

Head of Household Spouse or co-applicant

ITEM

Salary/Wages $_____________ $__________________

Dividends/Interest $_____________ $__________________

Pension $_____________ $__________________

Social Security $_____________ $__________________

Alimony/Child Support $_____________ $__________________

Other Income $_____________ $__________________

B. CURRENT ASSETS

Description Cash or Fair Market Value

Checking Account $____________________

Name of Bank ______________________

Address ___________________________

__________________________________

Savings Account $_____________________

Name of Bank _____________________

Address __________________________

_________________________________

Additional Accounts ___________________

___________________________________

___________________________________ $____________________

Life Insurance (Cash Value Only) $____________________

Automobiles (Value of) $____________________

Make: ___________________________

Year: ____________________________ $____________________

Make:____________________________

Year:_____________________________ $____________________

TOTAL ASSETS $____________________

C. MONTHLY BUDGET: Approximate as close as possible.

Rent $ ____________ Heat $ ______________ Electric $ ____________

Gas $ _____________ Sewer $ _____________ Trash $ _____________

Water $ ___________ Phone $ _____________ Food $ ______________

Medical $ __________ Car Payment $ _________ Insurance$__________

Misc. $ ____________ Loans $ _____________ Other $ _____________

          $ ____________           $ _____________           $ _____________

          $ ____________           $ _____________            $ _____________

Student Loans Payments $_______________________________________

D.    CURRENT LIABILITIES

Creditor's Names & Addresses

                                                                                                                  Minimum

                                                   Account                Current                       Monthly

Charge Accounts                         Number                 Balance                      Payments

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Automobile Loans

__________________________________________________________________

__________________________________________________________________

Other Loans

__________________________________________________________________

__________________________________________________________________

Alimony & Child Support which you must pay monthly

__________________________________________________________________

__________________________________________________________________

TOTAL MONTHLY LIABILITIES:_______________________________________________________

All applicants, please answer the following. If a "yes" is given to a question, explain on an attached sheet of paper.

                                                                                          Yes              No

. Have you any outstanding judgments?                            ___ ___      ___ ___

. In the last 7 years have you been declared bankrupt?     ___ ___      ___ ___

. If yes, bankruptcy was discharged on ___________________________________

. Have you had property foreclosed upon                        ___ ___      ___ ___

upon or given title or deed in lieu thereof?                        ___ ___      ___ ___

. Are you a co-signer or endorser on a note?                   ___ ___      ___ ___

. Are you a party in a law suit?                                        ___ ___      ___ ___

. Have you ever been convicted of a crime?                    ___ ___      ___ ___

. If convicted of a crime, state date and circumstances. _______________________

________________________________________________________________

                                                                                            Yes             No

. Have you ever been an owner or co-owner of real-estate: ___ ___   ___   ___

    If yes, when? ____________________________________________________

    If yes, did you own the real-estate with a spouse from a previous marriage?

                                                                                             Yes            No

                                                                                        ___ ___    ___ ___

    Complete the following:

                                                                Yes                No

* Are you a U.S. citizen                        ___ ___        ___ ___

* Are you a permanent resident alien     ___ ___        ___ ___

If you are not a U.S. citizen, documentation regarding your immigration status must be provided with this application.

I FULLY UNDERSTAND IT IS A FEDERAL CRIME PUNISHABLE BY FINE OR IMPRISONMENT, OR BOTH, TO KNOWINGLY MAKE ANY FALSE STATEMENTS CONCERNING ANY OF THE ABOVE FACTS AS APPLICABLE UNDER THE PROVISIONS OF TITLE 18, UNITED STATES, SECTION 1014.

___________________________________            _____________________

Signature                                                                    Date

___________________________________            _____________________

Signature                                                                    Date

FIRST TIME HOMEBUYER STATUS CERTIFICATION

I/ We hereby certify that I/we am/are first-time homebuyer(s)* or that I/we have not owned a home within the last three years.

____________________________________           _____________________

Signature                                                                      Date

____________________________________            _____________________

Signature                                                                      Date

A first-time homebuyer is defined as someone who has never before owned a home, has owned a mobile home but not the land the mobile home was located on, or someone who has lost their home due to a divorce settlement and has not owned a home since (displaced homemaker).

GENERAL RELEASE OF INFORMATION

Date __________________________________

I/We, the undersigned, give the Housing and Redevelopment Authorities of the County of Cumberland written permission to obtain verification of information from any source given in this application. This information is to be used to determine eligibility for participation in the, Lease-Purchase Program.

____________________________ ___________________________

WITNESS APPLICANT

____________________________ ___________________________

WITNESS APPLICANT

NFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of home ownership and housing rehabilitation programs. You are not required to furnish this information, but are encouraged to do so. However, if you choose not to furnish it, under Federal regulations this Authority is required to note race and ethnicity and gender on the basis of visual observation or surname.

Applicant #1

Ethnicity: Are you Hispanic or Latino? __ yes __no

Race : __ American Indian or Alaskan native

__ Black/African American

__ Asian

__ Native Hawaiian/other Pacific Islander

__ White

Gender: __ Female __ Male

__ I do not wish to furnish this information.

Applicant #2

Ethnicity: Are you Hispanic or Latino? __ yes __no

Race: __ American Indian or Alaskan native

__ Black/African American

__ Asian

__ Native Hawaiian/other Pacific Islander

__ White

Gender: __ Female __ Male

__ I do not wish to furnish this information.

Please list ethnicity, race, and gender of all other household members.

NUMBER OF ADDITIONAL MEMBERS IN HOUSEHOLD: ___________

Please identify each household member by: ethnicity: Hispanic or Latino or NOT Hispanic or Latino; race: (use 1 of 5 categories shown above); and gender.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

__ I do not wish to furnish this information.