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S OUTHEAST R URAL C OMMUNITY A SSISTANCE (County of Campbell)

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BROWSE COUNTY OF CAMPBELL (VA) FORMS

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S OUTHEAST R URAL C OMMUNITY A SSISTANCE
P ROJECT, INC.
H OUSING L OAN A PPLICATION
LOAN APPLICATION CHECKLIST
Please check the boxes of those requirements which have been fulfilled and enclosed with the application;
if a requirement has not been completed, please explain why in the space below or if the information does
not apply to the project, then please state the reason for its non-application.
o Typed and completed application;
o Check or money order for 1% origination/application fee;
o Resolution to apply which authorizes this application for a Southeast Rural Community Assistance
Project loan;
o Attorney's opinion of the applicant's legal capacity to borrow;
o Architecture/Engineering studies;
o Copy of engineers' or contractors' site development cost estimates;
o Map of project area and/or topography, flood plain or FEMA map of project site;
o Request for Environmental Information [Rural Development Form 1940-20 (if required)];
o Appraisal;
o Purchase contract/option;
o Construction or rehabilitation specifications as advertised for bids;
o Copies of bids received for the project;
o Project schedule;
o Housing project operating Pro Forma;
o Current agency-wide budget;
o Recent audit or financial statements (balance sheets, income statements);
o Copy of funding sources approval or commitment letters
Comments: __________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Southeast Rural Community Assistance Project, Inc 1
APPLICANT INFORMATION
1. Date: _________________________________
2. Borrower______________________________ Contact person: ___________________________
Address: ______________________________ Title:____________________________________
City: _________________________________ Phone #: _________________________________
State: ___________ Zip: _________________ Fax #: ___________________________________
Community name:_______________________ County:__________________________________
3. Type of organization: o Government (city, town, county) o Non-Profit
o Public Service Authority o User Association
4. Date of incorporation:__________ Tax exemption:____________ State: ____________________
Federal identification number: _____________ Statute incorporated under: __________________
5. Outstanding indebtedness: ________________ Debt limit: _______________________________
6. Rural Development District:_______________ Planning District: __________________________
Community Action Agency:__________________________________________________________
GENERAL INFORMATION
1. Loan amount: __________________________ Funds needed by: ___________________________
(Date)
2. Term requested: ________________________ Repayment requested: _______________________
(# of Months/Years) ($ amount per month, quarter, etc.)
3. What type of security will Southeast RCAP have for the loan? If the loan will be secured by
property, what lien position will Southeast RCAP have?
_______________________________________________________________________________
_______________________________________________________________________________
4. How will Southeast RCAP’s loan be repaid (from what source)?
_______________________________________________________________________________
_______________________________________________________________________________
5. What will Southeast RCAP’s loan be used for?
_______________________________________________________________________________
_______________________________________________________________________________
Southeast Rural Community Assistance Project, Inc. 2
GENERAL INFORMATION (Continued)
6. Type of project: o New Construction o Rehabilitation o Other ___________
7. Number of Housing Units Being Developed: _____ Single-Family Units _____ Multi-Family Units
8. Name of Housing Project: __________________________________________________________
9. What is your organization's mission statement (if on a separate form, please attach)?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
10. Please briefly describe your organization's history?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
11. What are the primary services/products your organization provides?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
12. What areas/counties does your organization operate in?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
13. Describe your organization's experience in developing affordable housing projects?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
14. In the past, how many housing units has the organization developed?
_______ Single-Family Units in _______ projects
_______ Multi-Family Units in _______ projects
Southeast Rural Community Assistance Project, Inc. 3
PROJECT INFORMATION
1. Please give a brief description of the project: (If a separate sheet is needed, please attach.)
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
2. What is the condition of the existing housing stock in the area?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
3. Why was the area selected for this housing project?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
4. Describe the infrastructure needs for this project (water, sewer, electricity, etc.):
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
5. Does the city/county government support affordable housing? o Yes o No
If yes, please state how the government does so?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
6. Is the community aware of the proposed project? o Yes o No
7. Is there, or do you expect, community opposition to the project? o Yes o No
8. If so, by whom, and how do you plan to mitigate this opposition?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
9. Date of construction start:_________________ Completion date: __________________________
10. Total project cost: $ _______________________________________________________________
11. What is/was the purchase price for the site or land? $ _____________________________________
12. What is the size of the parcel in acres? ________________________________________________
13. Appraisal value of land/property: "As Is" $_________________ "As Built" $_________________
Southeast Rural Community Assistance Project, Inc. 4
PROJECT INFORMATION (Continued)
14. Please note the key people involved with this project:
Staff/Consultants: Name Title Address Phone/Fax
_________________________________________________________
_________________________________________________________
Legal Counsel:
Name Title Address Phone/Fax
_________________________________________________________
_________________________________________________________
Engineer/Architect: Name Title Address Phone/Fax
_________________________________________________________
_________________________________________________________
15. Please describe the current status of the project:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
16. What are the next steps in developing this project:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
17. Total population for the project area (persons): __________________________________________
Number of low/moderate income persons in the project area:_______________________________
Number of low/moderate income persons the project will serve: ____________________________
18. What are the primary industries in the area:_____________________________________________
19. What is the unemployment rate in the area: _____________________________________________
20. What is the projected annual growth for the area: ________________________________________
21. # of minority persons in the area: _____________________________________________________
# of elderly persons in the area: ______________________________________________________
# of female head of household in the area:______________________________________________
22. US Representative (in project area): __________________________________________________
US Senators (in project area): _______________________________________________________
Southeast Rural Community Assistance Project, Inc. 5
FINANCIAL INFORMATION
Outstanding Indebtedness
Lender’s Name &
Phone #
Original
Amount
Original
Date
Present
Balance
Rate of
Interest
Maturity
Date
Monthly
Payments
Purpose
Security
Curre
nt-
Y/N
Schedule of Collateral
Address
Year
Acquired
Original
Cost
Market Value
Amount of
Lien
Lien Holder Name and Phone #
Other Property & Assets
Address
Year
Acquired
Original
Cost
Market Value
Amount of
Lien
Lien Holder Name and Phone #
Southeast Rural Community Assistance Project, Inc. 6
PROJECT COST INFORMATION
Complete the following line items which apply to the project: for more than three sources, please copy this form.
Source of Source of Source of
Funds Funds Funds
___________ ___________ ___________
(Name) (Name) (Name)
PREDEVELOPMENT COSTS
Land costs/acquisition price $_____________ $____________ $_____________
Preliminary architectural _____________ ____________ _____________
Preliminary engineering _____________ ____________ _____________
Appraisal fee _____________ ____________ _____________
Environmental assessment/report _____________ ____________ _____________
Soil and water testing _____________ ____________ _____________
Legal fees _____________ ____________ _____________
Market study _____________ ____________ _____________
Partnership organizational _____________ ____________ _____________
Soft cost contingency _____________ _____________ _____________
Other studies (list)
______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
Other costs (list):
_______________________________ ______________ _____________ _____________
_______________________________ ______________ _____________ _____________
_______________________________ ______________ _____________ _____________
_______________________________ ______________ _____________ _____________
Total Predevelopment Costs =
Southeast Rural Community Assistance Project, Inc. 7
PROJECT COST INFORMATION (CONTINUED)
Source of Source of Source of
Funds Funds Funds
____________ ___________ ___________
(Name) (Name) (Name)
Construction/Development Costs:
New Construction $_____________ $____________ $_____________
Rehabilitation construction ______________ ____________ _____________
Construction loan fees ______________ ____________ _____________
Construction interest ______________ ____________ _____________
Taxes during construction ______________ ____________ _____________
Developer fee ______________ ____________ _____________
Developer overhead ______________ ____________ _____________
Market study ______________ ____________ _____________
Partnership organizational ______________ ____________ _____________
Other costs (list):
______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
_______________________________ ______________ _____________ ____________
Construction contingency ______________ _____________ ____________
Total Construction/Development Costs =
Source of Source of Source of
Funds Funds Funds
____________ ___________ ___________
(Name) (Name) (Name)
Carrying & Other Costs:
Taxes $______________ _____________ _____________
Tax opinion ______________ _____________ _____________
Title fees ______________ _____________ _____________
Interest on all financing ______________ _____________ _____________
Accounting ______________ _____________ _____________
Tax credit monitoring fees ______________ _____________ _____________
Tax credit reservation fees ______________ _____________ _____________
Marketing ______________ _____________ _____________
SOUTHEAST RURAL COMMUNITY ASSISTANCE PROJECT, INC. 8
PROJECT COST INFORMATION (CONTINUED)
Tax Credit Reserve Fees ______________ ____________ _____________
Marketing ______________ ____________ _____________
Other Costs (list):
____________________________ ______________ ____________ _____________
____________________________ ______________ ____________ _____________
____________________________ ______________ ____________ _____________
Contingency ______________ ____________ _____________
Total Carrying & Other Costs =
SUMMARY:
Total Predevelopment Costs $ _________________
Total Construction/Site Development Costs $ _________________
Total Carrying & Other Costs $ _________________
Total Project Costs =
PROJECT FINANCING INFORMATION
Construction/Interim Financing
Source of Funds Applying or Commitment Amount of Funds
Total Construction/Interim Financing: _______________
Permanent Financing: list loans and grants
Source of Funds Applying or Commitment Amount of Funds
Total Permanent Financing: ________________ Total Project Cost: _______________
Southeast Rural Community Assistance Project, Inc.
9
PROJECT COST INFORMATION (CONTINUED)
Please provide information for all sources of project financing (eg., land acquisition, predevelopment, site development
construction, interim & permanent). If additional space is needed, please copy this form. Also, attach a copy of all
commitment notifications.
SUMMARY:
Construction/Interim Financing
Lender’s Name
& Address
Contact
Person &
Phone #
Purpose
Name of
Program
Amount
Terms
Date
Applied
Current Status
of Application
Conditions
(attach
Commitment
letter)
Permanent Financing
Lender’s Name
& Address
Contact
Person &
Phone #
Purpose
Name of
Program
Amount
Terms
Date
Applied
Current Status
of Application
Conditions
(attach
Commitment
letter)
Southeast Rural Community Assistance Project, Inc. 10
SECURITY OFFERED
Please indicate the security offered for the proposed Southeast Rural Community Assistance Project Loan
o Full Faith and Credit o Rent Revenues
o Building ______________ o Sale of Lots/Houses
o Property ______________ o Other _________________
CERTIFICATION
I (We), the undersigned representative(s) of the above named applicant hereby certify that the
applicant has sought financing from other sources, but the request was refused or the terms offered were
not affordable.
I (We), the undersigned representative(s) of the above named applicant hereby certify that this
application is a duly authorized action of the applicant and that the information contained herein and
attached herewith is true and correct to the best of my (our) knowledge and belief. It is hereby further
agreed and certified that any additional or supplemental information requested in connection with this
application will be submitted as true and correct to the best of my (our) knowledge and belief.
Given under my (our) hand(s) this _________ day of __________________, 20____________
_____________________________________
Signature
_____________________________________
Signature
Below please type or print the name and title of the above parties:
_____________________________________________________________________________________
___________________________________________________________________
Southeast Rural Community Assistance Project, Inc. 11
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S OUTHEAST R URAL C OMMUNITY A SSISTANCE (County of Campbell)

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Completed 5 August 2020

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