The information collected below will be used to determine whether you
potentially qualify as a borrower under the City of Lake Forest Housing
Rehabilitation Program. This document is not a public record. The
information will only be used to process your loan application and to
comply with HUD requirements. After a preliminary review of this
application, you will be required to submit documentation of income,
employment, and other items for verification, as required and
permitted by law.
Applicant’s Name
Co-Applicant’s Name
Address City Zip Code
Home Telephone No.
Work or Cell Telephone No.
Others listed on Title at above Address
Briefly describe the improvements that you wish to be completed. Please
note that any code violations existing on the property must be corrected as
a condition of receiving funding.
Estimate Value of Property Original purchase price $
Year purchased home Remaining loan balance (if any)
Approximate value of ALL assets including, but not limited to: bank
accounts, cars, real estate, stocks, bonds, other property (not including
your residence and designated retirement funds) $
Approximate value of assets in a 401K or other Designated Retirement
Funds $
-Mail Address
Any recent bankruptcies or credit issues? If yes, please explain
Approximate MONTHLY GROSS income from all sources, including but
not limited to: salary, commissions, tips, bonuses, social security, interest,
pensions, business or rental income, disability, unemployment, alimony
and child support: $
Approximate MONTHLY payments including but not limited to: mortgages,
association dues, real estate taxes, credit cards, car payments, space rent
and homeowner’s insurance: $
Do you participate in any type of rent deferment program? If
yes, how much is currently deferred?
List the head of your household and ALL members who live in the home, and their
relationship to the head of the household.
Full Name
Social Security Number
Head of House
Does anyone plan to live with you in the future who is not listed above, and if yes, please
lease list anyone in the household who is handicapped or disabled:
The information provided above is true and complete to the best of my/our
knowledge, under penalty of perjury. I/we consent to the disclosure of income
and financial information from my/our employers and financial references for
purposes of income and asset verification related to my/our application and
understand that nondisclosure of any information can be a basis for denial.
Applicant Signature: Date
Co-Applicant Signature Date
u must return this application to: Theresa Dobbs, Lake Forest City Hall,
100 Civic Center Drive, Lake Forest, California 92630.