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READ BEFORE SIGNING

All Adult Household Members Must Sign & Date the Application County of Placer, Housing Trust Placer and its representatives will not discriminate against any applicants on the basis of race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, familial status, source of income physical or mental disability, or genetic information. 

I/we certify that this home will be used as my primary residence of occupancy.

I/we have listed all persons in my/our household. I/we have provided each household member’s acceptable verification of current annual income. I/we have also disclosed ALL assets held by each person listed on the application and have provided documentation thereof All statements made in this application form are true and made for the purpose of applying for Placer County’s First-time Homebuyer Loan Program. Verification may be obtained from any source named in this application, or another third party as necessary for approval. I/we fully understand the County and/or Housing Trust Placer may terminate my/our participation in the program at any time if it finds that I/we have provided false, misleading, or inaccurate information. 

Under penalties of perjury, I/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge and belief. The undersigned further understands that providing false representations herein constitutes an act of fraud.

WARNING: Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United State Government.

As part of the application process for Placer County's First Time Homebuyer Program, Placer County, and its authorized representatives (including any agencies, departments, or administrators) may verify information contained in my/our application and in other documents required in connection with this application. 

I/We understand and agree that the County of Placer and its authorized representatives have the right to verify information provided on my/our application. Further, I/we authorize the County and its authorized representatives to collect, and I/we agree to provide, any and all information and documentation the County may request in order to make its determination as to my/our eligibility and qualification. I/we hereby authorize such requests and agree to provide full cooperation with these requests. Such information requested includes but is not limited to:

Income:                History, dates, title, wages, hours, location, other forms of income, etc.
Assets/Liabilities: Bank statements, loan balances, payment amount and history, liens against, etc.
Mortgage:            Application, estimates, submission materials, etc.
Other:                  Any other related matters of credit

Privacy Act Notice Statement: The County of Placer is requiring the collection of the information derived from this form to determine an applicant’s eligibility in the First Time Homebuyer’s Assistance Program. This Information will be used to verify the accuracy of the information furnished. Failure to provide any information may result in a delay or rejection of your eligibility approval.

Authorization: I authorize the County of Placer to obtain information about me and my household that is pertinent to eligibility for participation in the First Time Homebuyer Assistance Program.
I acknowledge that:

As part of the application process for applying for a FTHB loan, the County of Placer, Department of Housing, and its authorized representatives (including any agencies, departments, or administrations) may verify information contained in my/our application and in other documents required in connection with this application. I/We understand and agree that the Department of Housing and its authorized representatives have the right to verify information provided on my/our application. Further, I/we authorize the County and its authorized representatives to collect, and I/we agree to provide, any and all information and documentation the County may request in order to make its determination as to my/our eligibility and qualification. I/we hereby authorize such requests and agree to provide full cooperation with these requests. Such information requested includes but is not limited to employment history and income; bank, money market and similar account balances, credit history, and/or copies of federal income tax returns.

I/We understand and agree that County of Placer, Housing Trust Placer and its administrators reserves the right to verify and exchange information from third parties to determine household program eligibility. Third parties may include but are not limited to employers, financial institutions, loan officers, government agencies, property managers, credit reporting bureaus, etc. The information submitted in this application will be used to determine program eligibility and is not a commitment to lend or any guarantee to purchase.

The household members listed below, hereby authorizes the County of Placer and its authorized representatives (including any agencies, departments, or administrations) to obtain and review my completed application and any additional documentation, including my credit report from any credit reporting agency, for the purpose of determining my eligibility for the FTHB Loan Program. For the credit inquiry, I understand that this will be used solely for the purpose of evaluating my eligibility and that my credit report may be shared with those involved in the decision-making process. I understand that this authorization is voluntary, and I have the right to withdraw consent at any time and prior to the credit pull. I acknowledge that a hard inquiry may be made for my credit report, which could potentially impact my credit score. This authorization is valid for twelve months from the date below or until the County’s determination of eligibility is made.

All adult members listed on the application must consent to this authorization by acknowledging below.

COMPLIANCE ACKNOWLEDGEMENT

The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (providing that the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the FEDERAL TRADE COMMISSION, Consumer Response Center, 600 Pennsylvania Ave. NW, Washington, D.C. 20580

THIS NOTICE TO YOU AS REQUESTED BY THE RIGHT TO FINANCIAL PRIVACY ACT OF 1978 THAT THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT/DEPARTMENT OF VETERANS AFFAIRS HAS A RIGHT OF ACCESS TO THE FINANCIAL RECORDS HELD BY A FINANCIAL INSTITUTION IN CONNECTION WITH THE CONSIDERATION OF ADMINISTRATION OF ASSISTANCE TO YOU. FINANCIAL RECORDS INVOLVING YOUR TRANSACTION WILL BE AVAILABLE TO THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT/DEPARTMENT OF VETERANS AFFAIRS WITHOUT FURTHER NOTICE OR AUTHORIZATION BUT WILL NOT BE DISCLOSED OR RELEASED TO ANOTHER GOVERNMENT AGENCY OR DEPARTMENT WITHOUT YOUR CONSENT EXCEPT AS REQUIRED BY LAW.

TO All applicants for a loan for the purchase, construction, rehabilitation improvements or refinancing for one- to four-unit family residence:

Under the Housing Financial Discrimination Act of 1977, it is unlawful for a financial institution to refuse to make a loan or to offer less favorable terms than normal (such as higher interest rate; large down payment or shorter maturity) based on any of the following considerations:

1. Neighborhood characteristics (such as the average age of the homes or the income level in the neighborhood), except to a limited extent necessary to avoid an unsafe and unsound business practice.


2. Race, sex, color, religion, marital status, national origin, ancestry or physical or mental disability.

It is unlawful to consider, in appraising a residence, the racial, ethnic or religious composition of a particular neighborhood, whether or not such composition is undergoing change or is expected to undergo change.

If you wish to file a complaint, or if you have questions about your rights, contact: