New Mexico Homeowner Assistance Fund
Request for Continued Assistance
Case ID:
I would like to request continued assistance from the New Mexico
Homeowner Assistance Fund. I understand that I am eligible to receive a total of $10,000 of housing cost
assistance depending on actual housing costs and availability of funding. I certify that my monthly housing
cost payment is now due and that my financial hardship circumstances due to COVID-19 have not changed
since my initial application. I certify that I am not able to receive, and have not received, other federal or non-
federal benefits or assistance for the same housing costs for the same period of time for which assistance is
being requested, and that if I do receive such assistance, I will repay any duplicated funds to MFA.
I understand that submission of this form and the eligibility to apply for additional assistance does not
guarantee approval.
I understand that requests are processed in the order received and must be received before the pilot program
end date of November 5, 2021.
I understand that requests are funded in the order received depending on the availability of funding.
The information provided on this form is subject to verification by MFA, the Department of Finance and Administration (DFA) or the Treasury at
any time, and any employee of MFA, DFA, or Treasury may be subject to penalties for unauthorized disclosures or improper use of information
collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above.
Any person who knowingly or willingly requests, obtains or discloses any information under false pretenses concerning an applicant or participant
may result in legal action. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages, and seek
other relief, as may be appropriate.
Signature, Printed Name and Date of all Adult Household Members
Signature
Printed Name
Date
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Printed Name
Date
Signature
Printed Name
Date
Signature
Printed Name
Date
Signature
Printed Name
Date
Signature
Printed Name
Date
Attach: Evidence of total balance due.