request for supporting documents...gary batton, chief bobby l. yandell, jr., executive director jack...
TRANSCRIPT
Gary Batton Chief Bobby L Yandell Jr Executive Director Jack Austin Jr Assistant Chief
REQUEST FOR SUPPORTING DOCUMENTS
List the Name Address and Account (if applicable) for all landlords or mortgage lenders for the last two years 1 2
On application list Borrower as the CDIBlMembership Cardholder and Non-Tribal Member will be listed as Co-Borrower
Copy of most recent pay stub for 30-day period
Copy of award letter for SSI AFDC retirement income etc
W2 s for past two years
Past 2 years signed and dated federal income tax returns
Copy of most recent bank statement must have bank name amp address and your account information
Copy of Social Security card and a picture identification (Valid Drivers License) for all borrowers
Copy of front and back of CDIB and Tribal Membership card
If you are applying as a Borrower only please submit $3000 for the credit report fee If you are applying as a Borrower and Co-Borrower as married please submit $4500 If you are applying as a Borrower and CoshyBorrower as unmarried please submit $6000 ($30 for each borrower)
Please furnish the information listed above with your loan application This information is extremely important to the timely processing ofyour application During the processing ofyour loan you may be asked to furnish other information and letters of explanation for your file
You will need to attend a Homebuyer Education Class in order to receive assistance from the Housing Authority of the Choctaw Nation A Service Coordinator will contact you once we have processed your loan application
MAIL ALL DOCUMENTS TO Housing Authority of the Choctaw Nation of Oklahoma
Attn Home Finance Department PO Box G Hugo OK 74743
Phone 800-235-3087 or 580-326-7521 Fax 580-317-9610
Valerie Powell Senior Director Leah Williams Director
Assistant Director of Operations ext 6317 Assistant Director of Loan Services ext 6320 Loan Processors extensions 6325 amp 6361 Loan Officers extensions 6337 6307 6315 LoanlEscrow Clerks extensions 6326 amp 6332 Loan Closers extensions 6324 amp 6314 Mortgage Support Specialist extensions 6356 amp 6323
PLEASE CALL FOR PROGRAM GUIDELINES THERE ARE CERTAIN PROPERTY GUIDELINES TO FOLLOW DEPENDING ON THE TYPE OF PROGRAM YOU MAY QUALIFY FOR PLEASE CALL WHEN PROPERTY IS A MOBILE HOME
Uniform Residential Loan applicable Co-Borrower InformaJon must also be provided (and the box checked) when (including the Borrowers spouse) will be used as a basis for loan Dr Dthe income or assels of the Bonowers spDuse or ather person who has community property righls pursuant 10 state law will not be used as a basis fDr IDan qualification but his or her liabilities must be considered because the spouse or othor person has community property rights pursuanllo applicable law and Borrower resides In a community property statl the security propsrty Is located In a community properly state or the Borrower is relying on other property located in a ccmmunity property slate as a basiS for repayment 0( the loan
It Ihis Is an application for Joint credit Borrower and Co-Borrower each agree that we intend to apply (or joint credit (sign below)
Mortgage Applled for
Social Secufty
Present Address (street city state ZIPI country)
Olin (a) Present Value of Lot
Purpose of Reflflanre
o Married (includes registered domestic partners)
o Unmarried (Includes single divorced widowed)
DSeparated
Present Address (street city slate ZIPI country)
Residence
(a+b)
o made be made
No Yrs
----_-___---shyMailing if different Irom Present AddressMailing Address If different from Present Address
------------------bull---------------c--l ~--Iho (ollowin
No Yrs Former (street Cily state ZIP) Rent No Yrs
Former Address (street diy stale ZIP) YrsFormer Address (slreet city 31ate ZIP) Rent No Vrs
----1--------__---------shyBorrower
Uniform R08idntlal Loan AppilcoUo Co-Borrow _____ nni M Form 1003 7105 (IOV 1I()9) Frdie Moe Form 65 106 (rv 6109) Paga COl F Ofm Loanapp1JITn (09120 3)
Name amp Address 01 Employer Self Employed Vrs on hIS
Vrs employed In this [jne 01 wOtltlprofesslon
Name amp Address or Employer
Total $ Total
bull $al Employed Borrowatil) may be required 10 provide additional documentallon such aa tax alums and financial utatemenm
Qescribe Other Income Notice Alimony child support or sllpalllle malntell8ncil income need not be revealed If the Borrower fB) or Cosorrower (e) doee not chOose to have it conSklered ror rltlPlt1ylnlllhls loan
Borrower Comiddot Borrower fannia 101 Form 100J 7105 (f1V ellS)
Calyx Formmiddot Loanapp2fnn (0012013) Uniform Roaldntlallo4 Application Fddl Mac Form 66 706 (rey 6109i
LIIJit chocking and Slvings accounts below
Name and address of Bank SampL Dr Credit Union
Ule insurance net cash $
F~ceamol1nt S
Subtotal Liquid Assets
___~
Total Monthly Palmenta
____~___T_o_ta_I_As__se_ta__a_~_$______________~~~~~w~n~~~~~_____middot_gt __ __ ____~$______________-L~T_otal_l~_bili_t~_S b__~_$____________~ Sch~dule 01 Real Estate Owned (if additional properties are owned use continualion sheet) InsuranCB
Sir Mainienance Net -lt~~~~~~~~~~~-~~r----V~~rY-~~~~~~~~l~~I~~~~~~~~+~~~~-+Taxes amp Misc Rentallncome
Ue any additional names unoor which credit has previously been received and IndlcaUgt appropriate creditor namels) and account number(B) Alternate Name Creditor Name Account Number
-~ ~---------------- --~-----
BorTOwer Uniform R bullbull ldenUllon Appllcllo Freddie Mat Form 86 7106 (nlv 8109) Page 3
C80rrower Fannl Moo Form 1003 7106 (v BillS) Calyx formmiddot Loanapp31rm (0912013)
II you answer to any quesllons a through i
_~~~~~~~~~~~~~~~==~==~========~ pleas use continuation sllee far explanation a Are there any outstanding juagments ailaln~t you
5~~~~~g~~~~~~L--middot-------+----------1 b Have you been declarecl bankrupt within the past 7 years
~~~~~I2~J~~~~~~~~E~i~~r~L_L______--l C Have you had property loreclose(l Upolt1 or given tiUe or deed ill lieu thereof In the last 7 years
_~~~t~~~~~~~~~------i--------I d Are you a party to a lawsuit 1)8611 obligated 01 any loan which resulted in
or tite In oflQroclosure or judgmenl (ChJ~ja $cfl klafS 1 no(t) ft-lQ1Jaga f~s SeA tOJfIiI ~m1
manufiKlmiddotIlIolj (mobiol iJOJtl1 loans My m~11Jil~ If C~ pNYlj kHiJlis tnclultJrtf Jfh (UWtl(l
1 ~IY W( (3JSQS fOf (h(j )tcentn )
Are you presentiy aallnquen or in default on any Federal debt or any other loan mortgage finandal abligaliorl bood or loan guarantee It ~Yes 9iv6 d8talls as described in the precodIng qua5~ion
9 Are you obliQaled to pay alimonv child support or separate maintenance
Is any PM of the down paymenl borrowed
I Are you a co-maKer or endorser on a note
Are you aU S clti~en1
K Are you a permsnan resident alien
I Do you Intend to occupy 1M as
DO DO
0 0 DO DO DO DO DO DO DO DO
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
Uniform Residential Loan applicable Co-Borrower InformaJon must also be provided (and the box checked) when (including the Borrowers spouse) will be used as a basis for loan Dr Dthe income or assels of the Bonowers spDuse or ather person who has community property righls pursuant 10 state law will not be used as a basis fDr IDan qualification but his or her liabilities must be considered because the spouse or othor person has community property rights pursuanllo applicable law and Borrower resides In a community property statl the security propsrty Is located In a community properly state or the Borrower is relying on other property located in a ccmmunity property slate as a basiS for repayment 0( the loan
It Ihis Is an application for Joint credit Borrower and Co-Borrower each agree that we intend to apply (or joint credit (sign below)
Mortgage Applled for
Social Secufty
Present Address (street city state ZIPI country)
Olin (a) Present Value of Lot
Purpose of Reflflanre
o Married (includes registered domestic partners)
o Unmarried (Includes single divorced widowed)
DSeparated
Present Address (street city slate ZIPI country)
Residence
(a+b)
o made be made
No Yrs
----_-___---shyMailing if different Irom Present AddressMailing Address If different from Present Address
------------------bull---------------c--l ~--Iho (ollowin
No Yrs Former (street Cily state ZIP) Rent No Yrs
Former Address (street diy stale ZIP) YrsFormer Address (slreet city 31ate ZIP) Rent No Vrs
----1--------__---------shyBorrower
Uniform R08idntlal Loan AppilcoUo Co-Borrow _____ nni M Form 1003 7105 (IOV 1I()9) Frdie Moe Form 65 106 (rv 6109) Paga COl F Ofm Loanapp1JITn (09120 3)
Name amp Address 01 Employer Self Employed Vrs on hIS
Vrs employed In this [jne 01 wOtltlprofesslon
Name amp Address or Employer
Total $ Total
bull $al Employed Borrowatil) may be required 10 provide additional documentallon such aa tax alums and financial utatemenm
Qescribe Other Income Notice Alimony child support or sllpalllle malntell8ncil income need not be revealed If the Borrower fB) or Cosorrower (e) doee not chOose to have it conSklered ror rltlPlt1ylnlllhls loan
Borrower Comiddot Borrower fannia 101 Form 100J 7105 (f1V ellS)
Calyx Formmiddot Loanapp2fnn (0012013) Uniform Roaldntlallo4 Application Fddl Mac Form 66 706 (rey 6109i
LIIJit chocking and Slvings accounts below
Name and address of Bank SampL Dr Credit Union
Ule insurance net cash $
F~ceamol1nt S
Subtotal Liquid Assets
___~
Total Monthly Palmenta
____~___T_o_ta_I_As__se_ta__a_~_$______________~~~~~w~n~~~~~_____middot_gt __ __ ____~$______________-L~T_otal_l~_bili_t~_S b__~_$____________~ Sch~dule 01 Real Estate Owned (if additional properties are owned use continualion sheet) InsuranCB
Sir Mainienance Net -lt~~~~~~~~~~~-~~r----V~~rY-~~~~~~~~l~~I~~~~~~~~+~~~~-+Taxes amp Misc Rentallncome
Ue any additional names unoor which credit has previously been received and IndlcaUgt appropriate creditor namels) and account number(B) Alternate Name Creditor Name Account Number
-~ ~---------------- --~-----
BorTOwer Uniform R bullbull ldenUllon Appllcllo Freddie Mat Form 86 7106 (nlv 8109) Page 3
C80rrower Fannl Moo Form 1003 7106 (v BillS) Calyx formmiddot Loanapp31rm (0912013)
II you answer to any quesllons a through i
_~~~~~~~~~~~~~~~==~==~========~ pleas use continuation sllee far explanation a Are there any outstanding juagments ailaln~t you
5~~~~~g~~~~~~L--middot-------+----------1 b Have you been declarecl bankrupt within the past 7 years
~~~~~I2~J~~~~~~~~E~i~~r~L_L______--l C Have you had property loreclose(l Upolt1 or given tiUe or deed ill lieu thereof In the last 7 years
_~~~t~~~~~~~~~------i--------I d Are you a party to a lawsuit 1)8611 obligated 01 any loan which resulted in
or tite In oflQroclosure or judgmenl (ChJ~ja $cfl klafS 1 no(t) ft-lQ1Jaga f~s SeA tOJfIiI ~m1
manufiKlmiddotIlIolj (mobiol iJOJtl1 loans My m~11Jil~ If C~ pNYlj kHiJlis tnclultJrtf Jfh (UWtl(l
1 ~IY W( (3JSQS fOf (h(j )tcentn )
Are you presentiy aallnquen or in default on any Federal debt or any other loan mortgage finandal abligaliorl bood or loan guarantee It ~Yes 9iv6 d8talls as described in the precodIng qua5~ion
9 Are you obliQaled to pay alimonv child support or separate maintenance
Is any PM of the down paymenl borrowed
I Are you a co-maKer or endorser on a note
Are you aU S clti~en1
K Are you a permsnan resident alien
I Do you Intend to occupy 1M as
DO DO
0 0 DO DO DO DO DO DO DO DO
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
Name amp Address 01 Employer Self Employed Vrs on hIS
Vrs employed In this [jne 01 wOtltlprofesslon
Name amp Address or Employer
Total $ Total
bull $al Employed Borrowatil) may be required 10 provide additional documentallon such aa tax alums and financial utatemenm
Qescribe Other Income Notice Alimony child support or sllpalllle malntell8ncil income need not be revealed If the Borrower fB) or Cosorrower (e) doee not chOose to have it conSklered ror rltlPlt1ylnlllhls loan
Borrower Comiddot Borrower fannia 101 Form 100J 7105 (f1V ellS)
Calyx Formmiddot Loanapp2fnn (0012013) Uniform Roaldntlallo4 Application Fddl Mac Form 66 706 (rey 6109i
LIIJit chocking and Slvings accounts below
Name and address of Bank SampL Dr Credit Union
Ule insurance net cash $
F~ceamol1nt S
Subtotal Liquid Assets
___~
Total Monthly Palmenta
____~___T_o_ta_I_As__se_ta__a_~_$______________~~~~~w~n~~~~~_____middot_gt __ __ ____~$______________-L~T_otal_l~_bili_t~_S b__~_$____________~ Sch~dule 01 Real Estate Owned (if additional properties are owned use continualion sheet) InsuranCB
Sir Mainienance Net -lt~~~~~~~~~~~-~~r----V~~rY-~~~~~~~~l~~I~~~~~~~~+~~~~-+Taxes amp Misc Rentallncome
Ue any additional names unoor which credit has previously been received and IndlcaUgt appropriate creditor namels) and account number(B) Alternate Name Creditor Name Account Number
-~ ~---------------- --~-----
BorTOwer Uniform R bullbull ldenUllon Appllcllo Freddie Mat Form 86 7106 (nlv 8109) Page 3
C80rrower Fannl Moo Form 1003 7106 (v BillS) Calyx formmiddot Loanapp31rm (0912013)
II you answer to any quesllons a through i
_~~~~~~~~~~~~~~~==~==~========~ pleas use continuation sllee far explanation a Are there any outstanding juagments ailaln~t you
5~~~~~g~~~~~~L--middot-------+----------1 b Have you been declarecl bankrupt within the past 7 years
~~~~~I2~J~~~~~~~~E~i~~r~L_L______--l C Have you had property loreclose(l Upolt1 or given tiUe or deed ill lieu thereof In the last 7 years
_~~~t~~~~~~~~~------i--------I d Are you a party to a lawsuit 1)8611 obligated 01 any loan which resulted in
or tite In oflQroclosure or judgmenl (ChJ~ja $cfl klafS 1 no(t) ft-lQ1Jaga f~s SeA tOJfIiI ~m1
manufiKlmiddotIlIolj (mobiol iJOJtl1 loans My m~11Jil~ If C~ pNYlj kHiJlis tnclultJrtf Jfh (UWtl(l
1 ~IY W( (3JSQS fOf (h(j )tcentn )
Are you presentiy aallnquen or in default on any Federal debt or any other loan mortgage finandal abligaliorl bood or loan guarantee It ~Yes 9iv6 d8talls as described in the precodIng qua5~ion
9 Are you obliQaled to pay alimonv child support or separate maintenance
Is any PM of the down paymenl borrowed
I Are you a co-maKer or endorser on a note
Are you aU S clti~en1
K Are you a permsnan resident alien
I Do you Intend to occupy 1M as
DO DO
0 0 DO DO DO DO DO DO DO DO
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
LIIJit chocking and Slvings accounts below
Name and address of Bank SampL Dr Credit Union
Ule insurance net cash $
F~ceamol1nt S
Subtotal Liquid Assets
___~
Total Monthly Palmenta
____~___T_o_ta_I_As__se_ta__a_~_$______________~~~~~w~n~~~~~_____middot_gt __ __ ____~$______________-L~T_otal_l~_bili_t~_S b__~_$____________~ Sch~dule 01 Real Estate Owned (if additional properties are owned use continualion sheet) InsuranCB
Sir Mainienance Net -lt~~~~~~~~~~~-~~r----V~~rY-~~~~~~~~l~~I~~~~~~~~+~~~~-+Taxes amp Misc Rentallncome
Ue any additional names unoor which credit has previously been received and IndlcaUgt appropriate creditor namels) and account number(B) Alternate Name Creditor Name Account Number
-~ ~---------------- --~-----
BorTOwer Uniform R bullbull ldenUllon Appllcllo Freddie Mat Form 86 7106 (nlv 8109) Page 3
C80rrower Fannl Moo Form 1003 7106 (v BillS) Calyx formmiddot Loanapp31rm (0912013)
II you answer to any quesllons a through i
_~~~~~~~~~~~~~~~==~==~========~ pleas use continuation sllee far explanation a Are there any outstanding juagments ailaln~t you
5~~~~~g~~~~~~L--middot-------+----------1 b Have you been declarecl bankrupt within the past 7 years
~~~~~I2~J~~~~~~~~E~i~~r~L_L______--l C Have you had property loreclose(l Upolt1 or given tiUe or deed ill lieu thereof In the last 7 years
_~~~t~~~~~~~~~------i--------I d Are you a party to a lawsuit 1)8611 obligated 01 any loan which resulted in
or tite In oflQroclosure or judgmenl (ChJ~ja $cfl klafS 1 no(t) ft-lQ1Jaga f~s SeA tOJfIiI ~m1
manufiKlmiddotIlIolj (mobiol iJOJtl1 loans My m~11Jil~ If C~ pNYlj kHiJlis tnclultJrtf Jfh (UWtl(l
1 ~IY W( (3JSQS fOf (h(j )tcentn )
Are you presentiy aallnquen or in default on any Federal debt or any other loan mortgage finandal abligaliorl bood or loan guarantee It ~Yes 9iv6 d8talls as described in the precodIng qua5~ion
9 Are you obliQaled to pay alimonv child support or separate maintenance
Is any PM of the down paymenl borrowed
I Are you a co-maKer or endorser on a note
Are you aU S clti~en1
K Are you a permsnan resident alien
I Do you Intend to occupy 1M as
DO DO
0 0 DO DO DO DO DO DO DO DO
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
II you answer to any quesllons a through i
_~~~~~~~~~~~~~~~==~==~========~ pleas use continuation sllee far explanation a Are there any outstanding juagments ailaln~t you
5~~~~~g~~~~~~L--middot-------+----------1 b Have you been declarecl bankrupt within the past 7 years
~~~~~I2~J~~~~~~~~E~i~~r~L_L______--l C Have you had property loreclose(l Upolt1 or given tiUe or deed ill lieu thereof In the last 7 years
_~~~t~~~~~~~~~------i--------I d Are you a party to a lawsuit 1)8611 obligated 01 any loan which resulted in
or tite In oflQroclosure or judgmenl (ChJ~ja $cfl klafS 1 no(t) ft-lQ1Jaga f~s SeA tOJfIiI ~m1
manufiKlmiddotIlIolj (mobiol iJOJtl1 loans My m~11Jil~ If C~ pNYlj kHiJlis tnclultJrtf Jfh (UWtl(l
1 ~IY W( (3JSQS fOf (h(j )tcentn )
Are you presentiy aallnquen or in default on any Federal debt or any other loan mortgage finandal abligaliorl bood or loan guarantee It ~Yes 9iv6 d8talls as described in the precodIng qua5~ion
9 Are you obliQaled to pay alimonv child support or separate maintenance
Is any PM of the down paymenl borrowed
I Are you a co-maKer or endorser on a note
Are you aU S clti~en1
K Are you a permsnan resident alien
I Do you Intend to occupy 1M as
DO DO
0 0 DO DO DO DO DO DO DO DO
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
Authorization
I ~ ~- ~I
I
Loan Number
I hereby authorize the LenderlBroker to verify my past Ino presel1t employment earnings records bank accounts stock and any other asset balances that are needed to process my mortgage loan appUcalion I further authorize
the LenderBroker to order a consumer credit report and verify other credit Ioformation Including past and present mortgage and landlord references It is understood that a copy of this form will also selle as authorization
IThe information the LenderBroker obtains Is only to be used in the processing af TI)i application for a mortgage loan I
I
Borrower
90nowar
To Whom It May Concern
I have applied for a mortgage loan through Choctaw Home Finance Corporation As part of the application
process I hereby authorize Choctaw Home Finance Corporation to release my loan application file to our preferred
outside lenders for the purpose of mortgage loan financing I further authorize the lender to which the loan file i~
sent to provide Choctaw Home Finance Corporation with any information or documentation regarding my
file
Borrower Date
Borrower Date
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
HOUSEHOLD INCOME WORKSHEET
LAST FIRST MIDDLE
STREET CITY STATE ZIP
BORROWER TELEPHONE
HOME WORK CELL
CO-BORROWER TELEPHONE
HOME WORK CELL
BEST TIME TO CONTACT (and best contact
FAMILY STATJS_____________~__
TOTAL IN FAMILY It OF MINOR(S)
CURRENT HOME STATUS
NUMBER OF ROOMS OF CURRENT
DEGREE OF INDIAN BLOOD
middotmiddotANSWERING THE FOllOWING QUESTIONS Will HAVE NO BEARING ON EUGIBILlTV fOR ASSISTANCE
ARE YOU RELATED TO ANY PERSON EMPLOYED BY THE HOUSING AUTHORITY OF THE CHOCTAW NATION OF OKLAHOMA
YES__ NO _____ IF YOU ANSWERED YES TO THE ABOVE QUESTION PLEASE UST WHOM AND HOW YOU
ARE
PLEASE LIST ALL GROSS YEARLY
MU~nULU MEM8ERS RELATIONSHIP SECURITY I INCOME ~_~~~~~~~~~~~~_____~_~c_ _________~________ I~~c~~_~~~~~--r---------middot~
BORROWER DATE CO-BORROWER DATE
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
AI)PJ~YIN(j If()IIIIIJ)) II()(JSIN( lSSISrlN(~I~
TUlr 1u lUOI]1 IIIIS IS 11l1(JD 1rOItIIIII
Do You Realize
If you commit fraud to obtain assisted housing from HUD you could be
bull Evicted from your apartment or house bull Required to repay all overpaid rental assistance you received bull Fined up to $10000 bull Imprisoned for up to five years bull Prohibited from receiving future assistance bull Subject to State and local government penalties
Do You Know
You are committing fraud if you sign a form knOWing that you provided false or misleading information
The information you provide on housing assistance application and recertification forms will be checked The local housing agency HUD or the Office of Inspector General will check the income and asset information you provide with olher Federal State or local governments and with private agencies Certifying false information is fraud
So Be Carefull
When you fill out your application and yearly recertification for assisted housing from H U D make su re your answers to the questions are accurate and honest You must include
All sources of income and changes in income you or any members of your household receive such as wages welfare payments social security and veterans benefits pensions retirement etc
Any money you receive on behalf of your children such as child support AFDC pa yments social security for children etc
form HUDmiddot1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)
III
Any increase in income such as wages from a new job or an expected pay raise or bonus
All assets such as bank accounts savings certificates of deposit stocks real estate etc that are owned by you or any member of your household
All income from assets such as interest from savings and checking accounts dividends etc
Any business or asset your homel that YOll sold in the last two years at less than full value
The nameS of everyone adults or children relatives and non-relatives who are living with you and make up your household
(Important Notice (or Hurricane Katrina and Hurricane Rita Evacuees HUDs reporting may be temporarily waived or suspended because of your circumstances Contact the local housing before you complete the housing assistance application)
Ask Questions
if you dont understand something on the applicalion or recertification forms always ask questions Its better to be than sorry
Watch Out for Hoosing Assistance Scamsl
Dont pay money to have someone fill out housing assistance application and recertification forms for you Dont pay money to move up on a waiting list
Dont pay for anything that is not covered by your lease Get a receipt for any money you pay
bull Get a written explanation if you are required to pay for anything other than rent (maintenance or utility charges
Report Fraud
If you know or anyone who provided false information on a HUD housing assistance application or recertification or if anyone tells you to provide false information report that person to the HU 0 Office of Inspector General Hotline You can call the Hotline toll-free Monday through friday from 1000 am to 430 pm Eastern Time at 1-800-347middot3735 You can fax information to (202) 708-4829 or e-mail it to You can write the Hotline at
HUD OIG Hotline GFI 451 7h Street SW Washington DC 20410
form HUO-1141
(1212005)