I/WE have read and understand the forgoing application and requirements. I/WE further understand that any omission, misrepresentation, misstatements, deletions, falsifications, or other actions that result in MY/OUR not conforming to the requirements of the program will subject MY/OUR application to immediate cancellation and cause any fund given to me to be immediately due and payable and may cause further legal action if warranted. I/WE further certify that our application for this assistance does not result in a conflict of interest as described in the program guidelines.
I/WE further certify that the information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the U.S. Code states and that knowingly and willingly making a false or fraudulent statement to a department of the United States Federal Government is a felony and grounds for termination of assistance.
I/WE certify that this information is complete and accurate and have provided the following supporting documentation as required to determine MY/OUR eligibility for the program:
1. Copy of valid identification for all family members over the age of 18
2. Proof of Residency: copy of a utility bill or space lease or rent statement with the homeowner/applicant's
3. Proof of Ownership: copy of the Grant Deed or Registration or Certificate of Title for the home listed on the application
4. Copy of income documentation for all family members over the age of 18.
- If employed: last 3 months of paystubs, a recent W2, and 3 months of bank statements
- If self-employed: copies of current and last year's taxes, a quarterly profit/loss statement, and 3 months of bank statements
- Unemployed: copies of unemployment checks
- Completed Income Self-Certification Form
5. Copy of Notice of Violation from the enforcement agency
6. Copies of any inspection reports completed by a licensed contractor, engineer, of architect
7. Additional documents may be requested as needed and may include, but are not limited to:
- Copies of child support income, public assistance benefits, retirement and pension benefits