Fillable NDF AUTHORIZATION TO OBTAIN CREDIT REPORT

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NDF AUTHORIZATION TO OBTAIN CREDIT REPORT

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NDF AUTHORIZATION TO OBTAIN CREDIT
REPORT
NAME: DATE OF BIRTH: AGE:
SPOUSE’S NAME: DATE OF BIRTH: AGE:
ADDRESS: CITY: ZIP:
AMOUNT OF RENT: $
TIME AT RESIDENCE: YEARS MONTHS
MARTIAL STATUS: MARRIED SINGLE DIVORCE WIDOWED SEPARATED
SOCIAL SECURITY NUMBER:
EMPLOYER: TITLE:
EMPLOYERS’ ADDRESS:
(Street) (City) (State) (Zip)
ANNUAL GROSS INCOME:
START DATE:
HOW LONG WITH CURRENT EMPLOYER: YEARS
MONTHS
SPOUSE’S SOCIAL SECURITY NUMBER:
SPOUSE’S EMPLOYER: TITLE:
EMPLOYER’S ADDRESS:
(Street) (City) (State) (Zip)
ANNUAL GROSS INCOME:
START DATE:
HOW LONG WITH CURRENT EMPLOYEE: YEARS
MONTHS
NUMBER OF DEPENDENT(S):
HOUSEHOLD SIZE:
NAME OF DEPENDENT:
NAME OF DEPENDENT:
NAME OF DEPENDENT:
AGE:
AGE:
AGE:
SEX:
SEX:
SEX:
I authorize the New Orleans Neighborhood Development Foundation (NDF) to obtain and review my credit report.
I understand that NDF will discuss the report with me and make a copy available to me.
I hereby further authorize NDF to disseminate all of the information I provide to NDF on this Authorization
Form or otherwise to any third party(ies) NDF deems appropriate, in its sole discretion, and I further hereby
indemnify and hold harmless NDF, its officers, directors, employees and agents from and against any and all
claims, liability, actions, damages, demands, suits, judgments costs and expenses, including without limitation
attorney’s fees and court costs arising out of NDF’s dissemination of the above information.
I authorize NDF to obtain all file documents pertaining to my act of sale from closing attorneys, title companies,
real estate agents, lenders, and mortgage companies & to disseminate the information to any third party(ies)
NDF deems appropriated in its sole discretion.
I have furnished NDF with reasonable identification.
I hereby certify that all information provided to NDF has been & will be true, correct & accurate.
DATE:
SIGNATURE:
SPOUSE’S SIGNATURE:
PHONE NUMBERS: Home:
Work:
Spouse’s Work:
E-mail address:
Pager/Cell phone:
Pager/Cell phone:
**ALL DOCUMENTS SIGNED IN BLUE INK**
**CREDIT REPORT FEE MUST BE PAID BY CHECK OR MONEY ORDER. CASH IS NOT ACCEPTED**
FOR NDF OFFICE USE ONLY
CENSUS
TRACT:
COUNCILMATIC
DISTRICT:
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DISCLOSURE STATEMENT
New Orleans Neighborhood Development Foundation (NDF) is providing Homeownership
Counseling, Homebuyer Education, Financial Fitness Education and Credit Counseling for your
benefit, and in this capacity its primary responsibility is to you.
While you may learn about homeownership opportunities from the housing counseling staff, you
are under no obligation to purchase any properties or services as a condition of receiving
counseling service from NDF.
Furthermore, the information provided on this form does not constitute an application for
mortgage financing, mortgage insurance, or for down payment assistance programs. Housing
Counselors will offer objective advice, if requested, about loan products for which your
household may be eligible. Your household is free to select lenders and lending products of your
own choosing.
By signing below you acknowledge that you have read and understand the above disclosures and
have received a copy of NDF’s Privacy Policy and Practices.
Participant
Signature:
Date:
Co-Participant
Signature:
Date:
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COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)
PROGRAM BENEFIT
QUESTIONNAIRE
AGENCY NAME: ___________NEIGHBORHOOD DEVELOPMENT FOUNDATION_________
PROJECT NUMBER: ___________ __________________________________________________
The __NEIGHBORHOOD DEVELOPMENT FOUNDATION _ has received federal funding
assistance from the City of New Orleans, Division of Housing and Neighborhood Development and State
of Louisiana Department of Social Services. City funds are made available by the U.S. Department of
Housing and Neighborhood Development (HUD) through the Community Development Block program.
These organizations primary objective is to make certain eligible services available to persons of very
low, low and moderate income. In order to help us to monitor our progress toward this goal, we request
your assistance in completing the following:
NAME: _____________________________________________________________________________
S.S. #: _______________________________________________________________________________
ADDRESS: __________________________________________________________________________
(Household means all person (s) who occupy a housing unit. The occupants may be single family, one person
living alone, two or more families living together, or any other group of related or unrelated person who share
living arrangement).
Please check the space in each column that most accurately describes your household size and gross income.
FAMILY/HOUSEHOLD SIZE GROSS INCOME
CDBG TANF
__________ 1 ______$ 0.00 - 49,440.00 ______$20,420.00
__________ 2 ______$49,440.00 - 56,520.00 ______$27,380.00
__________ 3 ______$56,520.00 - 63,600.00 ______$34,340.00
__________ 4 ______$63,600.00 - 70,560.00 ______$41,300.00
__________ 5 ______$70,560.00 - 76,320.00 ______$48,260.00
__________ 6 ______$76,320.00 - 81,960.00 ______$55,220.00
__________ 7 ______$81,960.00 - 87,600.00 ______$62,180.00
__________ 8 ______$87,600.00 - 93,240.00 ______$69,140.00
__________ OVER 8 ______$93,240.00 - OVER ______$6,690 Each Add.
(Only Clients 50%)
I certify that all of the information provided herein is true and correct and that all household income is reported. I
understand that this information is subject to verification by the City of New Orleans, State Department of Social
Services and the U.S. Department of Housing and Urban Development (HUD) or its agent for the purpose of
determining my eligibility for participation in the programs funded by these governmental agencies that is
administered by ______
NDF_______. I further understand that deliberate misrepresentation of the required
information may subject me to prosecution under applicable Local, State, and Federal laws.
SIGNATURE _________________________________________ DATE _______________________
NOTE: In addition to this questionnaire, a copy of support documentation such as most recent
check stub, welfare card, current income tax return, etc. will be required.
Census Tract Number (s) ______________________________________________________________
OFFICE USE ONLY
NOTE: Put an "X" next to your selected household size and income below
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NDF AUTHORIZATION TO OBTAIN CREDIT REPORT

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Completed 17 June 2021

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