Seattle home repair loans and grants

The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein.(4) occupancy of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) if any of my/our circumstances change prior to closing, I/we understand we must provide updated information.; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.

I give the Seattle Office of Housing (City) permission to submit requests or release information to other non-profit organizations or government agencies for the purpose of providing assistance to me. Such information may include but is not limited to my application, income and related documents, results of inspections conducted by the property rehabilitation specialist, the home repair scope of work and completed repairs. Such information may result in my receiving or being denied other City assistance. I authorize the City to enroll me in all City or King County assistance programs for which I am eligible.

You are hereby authorized to release to the City of Seattle, The Office of Housing (OH), and The Department of Human Services (DHS), any information which you may have in your files concerning the undersigned, including, but not limited to, employment records, bank accounts, loan accounts, credit and financial reports, and mortgage and contract amounts.

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. And liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made in this application. I certify I have received and read a copy of “Protect Your Family from Lead Based Paint.”

Applicant's Signature Date Co-Applicant's Signature Date

Homeowner’s Acknowledgement: Please sign demonstrating you understand “Home Repair Loan Program Process — How it Works.”

Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax return requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506 on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.

Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.