HomeMy WebLinkAboutMAY 2024 I-PAppl
INCOME PROPERTY
APPLICATION INSTRUCTIONS
1) Please fill out the attached Application Form to the best of your ability. If you are unsure of the
appropriate answer to any question, please call our office at (607) 753-1433. Please do not fill
out any places marked for office use only.
2) In addition to the completed Application Form, we also need copies of the following items:
a) Copy of the Deed for the property, including a legal description;
b) Copy of your Homeowner’s Certificate of Insurance;
c) Copy of current executed leases for all units;
d) Documentation of 20% owner contribution such as cash in the bank or proof of line of credit;
e) Copy of paid receipt for current property taxes and school taxes;
f) Copy of most recent mortgage statement (if applicable);
g) Copy of a photo ID for each applicant/property owner;
h) Tenant Information Form(s) - Please have your tenant(s) complete the Tenant Information
Form attached to this application. This form must be completed for each of your apartments,
therefore, feel free to make additional copies as necessary or call our office for additional
copies; and
3) A Conflict of Interest Disclosure is attached. Please read, sign and return the Disclosure with your
application.
4) The Application Form and copies of all information requested above should be returned to:
Thoma Development Consultants
34 Tompkins Street
Cortland, NY 13045
NOTES:
If property has more than one owner, please provide financial information from all owners
Only one copy of your financial information is needed if submitting applications for more than one
property. Additional information may be requested if needed.
A Certificate of Insurance showing municipality added as Mortgagee will be required prior to starting
any work
You will be given Loan Agreements to sign after the total cost of rehabilitation work has been
determined.
We cannot complete a review of your application until all required signatures and documentation is
received. Failure to answer any of the questions will delay processing of your application!
NOTICE TO APPLICANTS: As required by the Right to Financial Privacy Act of 1978, please be advised
that certain government agencies have a right of access to certain financial records held by the municipality
in connection with the provision or administration of assistance to you under this application. Financial
records related to the transaction considered hereunder will be available to the U.S. Inspector General,
the U.S. Department of Housing and Urban Development, the General Accounting Office, the New York
State Housing Trust Fund Corporation, and the New York State Office for Community Renewal without
further notice or authorization. Financial records will NOT be disclosed or released by the municipality to
other government agencies without your consent except as required by law.
INCOME PROPERTY APPLICATION FOR
REHABILITATION ASSISTANCE
PART I – APPLICANT INFORMATION:
Application Number: _____________________________ Date: ___________________
(for office use only)
Name of Applicant(s): _________
Address: _________
Telephone: (home) ____ (work) ______ (cell) ___
Email Address: ____________________
Address of Income Property: _________
Number of Occupied Apartments: ____ Number of Unoccupied Apartments: ___
YES NO
1. Are there any co-owners other than those listed above?
If yes, please explain below. c c
2. Are there any liens or judgments affecting the property other
than the mortgage?
If yes, please explain below. c c
3. Are property taxes and/or mortgage payments in arrears?
If yes, please explain below. c c
4. Do you have any delinquent federal or State government loans,
including Higher Education loans?
(i.e. IRS liens, State tax liens, etc.) If yes, explain below. c c
5. Are there any commercial uses of the property?
If yes, please explain below. c c
6. Are all apartments located on one structure? c c
7. Have you ever received any other assistance from the
Town of Danby for any purpose? c c
Explanations: ___________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
PART II – APARTMENT INFORMATION:
(Please provide the following information for each apartment.)
Apartment #: Number of Bedrooms: Current Rent: $
Please check those utilities/services that are not included in rent.
Please write on the line what type and/or source as applicable (gas, LP, fuel oil, electric, etc):
c Heat: c Hot water:
c Electric: c Municipal water:
c Stove/range: c Garbage disposal:
c Refrigerator: c Water/sewer:
Apartment #: Number of Bedrooms: Current Rent: $
Please check those utilities/services that are not included in rent.
Please write on the line what type and/or source as applicable (gas, LP, fuel oil, electric, etc):
c Heat: c Hot water:
c Electric: c Municipal water:
c Stove/range: c Garbage disposal:
c Refrigerator: c Water/sewer:
Apartment #: Number of Bedrooms: Current Rent: $
Please check those utilities/services that are not included in rent.
Please write on the line what type and/or source as applicable (gas, LP, fuel oil, electric, etc):
c Heat: c Hot water:
c Electric: c Municipal water:
c Stove/range: c Garbage disposal:
c Refrigerator: c Water/sewer:
Apartment #: Number of Bedrooms: Current Rent: $
Please check those utilities/services that are not included in rent.
Please write on the line what type and/or source as applicable (gas, LP, fuel oil, electric, etc):
c Heat: c Hot water:
c Electric: c Municipal water:
c Stove/range: c Garbage disposal:
c Refrigerator: c Water/sewer:
PART III – Applicant’s Financial Information:
Employment:
Name of Applicant’s Employer:
Address:
Position Held: From To
Gross Annual Income:
Mortgage Information:
Address of Property to be Rehabilitated:
Lender:
Lender’s Address:
Date of Mortgage: Original Amount:
Term of Loan:
Monthly Mortgage Payment Excluding Tax and Insurance: $
Present Balance: Assessed Value:
Other Loans Secured by the Property:
Lender:
Lender’s Address:
Date of Mortgage: Original Amount
Term of Loan:
Monthly Mortgage Payment Excluding Tax and Insurance: $
Present Balance: Assessed Value:
Other Property Owned by Applicant in Same Town:
Location(s):
PART IV - INCOME PROPERTY PROFORMA:
INCOME:
Gross Scheduled Rental Income $____________
Additional Income $____________
TOTAL GROSS INCOME: $____________
EXPENSES:
Vacancy Rate (7%) $____________
Real Estate Taxes $____________
Insurance $____________
Utilities - Electric $____________
- Gas $____________
- Sewer/Water $____________
Legal Fees $____________
Maintenance $____________
Miscellaneous $____________
TOTAL EXPENSES: ($____________)
Existing Debt Service (i.e. Mortgage Payment) ($____________)
GROSS PROFIT: $____________
CASH AVAILABLE: $____________
TOWN OF DANBY
CONFLICT OF INTEREST DISCLOSURE
Under certain circumstances, an applicant for CDBG funding may have what is known as a
“conflict of interest” and may need a waiver in order to participate in the Program. For example, a
conflict of interest may be present if the applicant is related to an employee, officer, or elected
official of the Town of Danby. There are other cases where a conflict of interest may also be present.
Please answer the questions below to help the Town or its authorized representative determine if a
conflict may be present. If so, the Town or its authorized representative may undertake the process
necessary to secure a waiver from the funding source, on your behalf. Waivers of conflicts cannot
be guaranteed by the Town but are reviewed and granted by the New York State Office of Community
Renewal.
*DISCLOSURE*
Please answer YES or NO to all questions listed below so that we may make a determination
of whether any conflicts may be applicable to your project. Answer for all applicants if there is more
than one applicant.
Y N 1. Are you now, or have you ever been an employee, agent, consultant, an officer, or
an elected or appointed official of the Town? If so, please provide information
below:
___________________________________________________________________
Y N 2. Are you related to an employee of the Town, an agent of the Town, a consultant
working for the Town, an officer of the Town, or an elected or appointed official
of the Town (i.e.: are you related to the Mayor, or the Town Clerk, or a
Member of any Town Board, or someone that works in the Department of Public
Work/Highway Department, etc.) If so, please indicate to whom you are related
and the relationship below:
___________________________________________________________________
Y N 3. Do you have a business connection to any of the people listed above in #1?
If so, please note the relationship below:
__________________________________________________________________
I/we, the undersigned, certify that the above information is true to the best of my/our knowledge:
Signed: __________________________________ Date: ______________
Signed: __________________________________ Date: ______________
For office use only
There is no conflict of interest
A potential conflict of interest is disclosed (attach determination)
PART V – CERTIFICATIONS:
1) Although the municipality or their representative may or may not have assisted in
soliciting bids for the Property Owner of this structure to be rehabilitated through
the Community Development Block Grant Program, a signature below indicates
that the Property Owner ultimately and willfully selected or will select the
Contractor(s) to perform the work to be done. As long as the selected
Contractor(s) has submitted a fair price and has provided a certificate of insurance
in the amount required by the municipality, the Property Owner and Contractor(s)
may enter into an agreement for the performance of the work to be done.
2) The signature below certifies the above submitted information is true,
understanding that falsification of any item(s) may result in the forfeiture or
reimbursement of all rehabilitation funds as well as the penalties and provisions
of any applicable State and federal laws.
SIGNATURE OF APPLICANT(S):
X DATE:
X DATE:
APPLICATION CHECKLIST
c Application completed and signed
c Conflict of Interest Form completed and signed
c Copy of deed including legal description
c Copy of current executed leases for all units
c Copy of Homeowner’s Certificate of Insurance
c Documentation of 20% owner contribution such as cash in the bank or proof of line of credit
c Completed and signed tenant information forms from all occupied apartments
c Copy of a photo ID for applicant/homeowner
TENANT INFORMATION FORM
This form should be provided to tenants in each apartment for completion.
Name of Tenant(s):
Address: Apartment Number:
Telephone: (Home/Cell) (Work)
Rent Paid Monthly $____________ No. of Bedrooms: _______
Who pays heat? ________ ; Electric? _____ ___; Water/sewer? ____ ____; Hot water? ____ ____
No. of people living in apartment: ________ Is this a female head of household? c YES c NO
List names and ages of all household members, including self, below:
Name: Age: , Name: Age:
Name: Age: , Name: Age:
Name: Age: , Name: Age:
For any children under the age of 7 listed above, have they been tested for Lead? c YES c NO
If yes, please indicate their Lead Blood Level (LBL) below, if known:
Name: LBL: ______ Name: LBL: ___
Is anyone in the household over age 62? c YES c NO (If yes, # of people over age 62? _)
Is anyone in the household frail elderly? c YES c NO (If yes, # of people frail elderly? _)
Is anyone in the household disabled? c YES c NO (If yes, # of people who are disabled? _)
Is anyone in the household a veteran? c YES c NO (If yes, # of people who are veterans? __)
Is anyone in the household a college student? c YES c NO
(If yes, is student(s) emancipated*? c YES c NO (*i.e. (1) student files his/her own tax return, (2)
student is not claimed as a dependent on anyone else’s tax return and (3) student financially supports
his or herself)
*No person or persons shall be denied participation in the program based on race, color,
religion, sex, national origin, handicap, or familial status. For reporting purposes ONLY, please
indicate which racial category best describes your household:
c White c Black/African American c Black/African American and White
c Asian c Asian and White c Native Hawaiian/Other Pacific Islander
c American Indian/Alaskan Native c American Indian/Alaskan Native and White
c American Indian/Alaskan Native and Black/African American c Other Multi-Racial
Is anyone in the household Hispanic? c YES c NO (If yes, # of people who are Hispanic?______)
(CONTINUED ON NEXT PAGE)
yearly monthly
1. Income from Employment; Tenant #1 $ c c
2 Income from Employment; Tenant #2 $ c c
3. Social Security/S.S.I. Benefits; Tenant #1 $ c c
4. Social Security/S.S.I. Benefits; Tenant #2 $ c c
5. Pension/Disability Payments (All persons) $ c c
6. Income of Non Full-Time Student Over 18 $ c c
7. Net Real Estate/Business Income $ c c
8. Child Support/Alimony Payments $ c c
9. Interest and/or Dividends $ c c
10. Public Assistance $ c c
11. Any Other Income $ c c
TOTAL: $
The signature below certifies the above submitted information is true, understanding that
falsification of any item(s) may result in the forfeiture or reimbursement of all rehabilitation funds
as well as the penalties and provisions of any applicable State and federal laws.
Signature of Tenant(s): X DATE:
X DATE:
Complete and return to:
Thoma Development Consultants
34 Tompkins Street
Cortland, NY 13045
(607) 753-1433
FOR OFFICE USE ONLY
Low/Mod (________%) Elderly Frail Elderly Female Minority Unemployed Disabled