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?
HOUSEHOLD COMPOSITION
List the head of your household and ALL members who live in the home, and their
relationship to the head of the household.
Does anyone plan to live with you in the future who is not listed above, and if yes, please
explain.
P
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
Yo
u must return this application to: Theresa Dobbs, Lake Forest City Hall,
100 Civic Center Drive, Lake Forest, California 92630.