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RDA Resolution 1989-11 RESOLUTION NO. RDA 89-11 A RESOLUTION OF THE LA QUINTA REDEVELOPMENT AGENCY APPROVING THE EXPANSION OF A PROGRAM FOR THE FURNISHING OF ASSISTANCE FOR AFFORDABLE HOUSING AND AUTHORIZING THE EXPENDITURE OF AGENCY FUNDS PURSUANT TO SUCH PROGRAM WHEREAS, the La Quinta Redevelopment Agency the Agency") is in the process of implementing the Redevelopment Plan for Redevelopment Project Area No.1 as adapted by City of La Quinta Ordinance No.34 the Project); and WHEREAS, the Redevelopment Plan the Redevelopment Plan") for the Project provides that certain funds are to be made available to improve and expand the supply of low-and moderate-income housing, in conformity with the provisions of Section 33334.2 of the California Health and Safety Code; and WHEREAS, the Redevelopment Plan provides for the provision by the Agency of certain public improvements; and WHEREAS, the City of La Quinta the City") has established and implemented an Assessment District Assessment District 88-1), which will provide certain sewer and related infrastructure improvements the Improvements") of benefit to residents of the Project Area of the Prolect; and WHEREAS, Hook-Up Fees will be levied against property owners wishing to have their property connected to the sewer improvements; and WHEREAS, although the Improvements will be of benefit once completed, the imposition of an Assessment and Hook-Up Fee to defray the cost of such Improvements would create a burden for certain residents of the affected area, particularly those of limited means; and WHEREAS, the Agency currently implements an Assessment Subsidy Program which provides assistance to defray the cost of the assessment by the District for the benefit of persons who qualify due to income or who covenant to provide affordable housing for a fifteen-year period the Minimum Period"); and WHEREAS, it is proposed that the Program be augmented for the expansion of the Assessment Subsidy Program to include a provision for Hook-Up Fee Subsidies; and WHEREAS, extending the Program to an additional Assessment District Assessment District 89-2) within Project Area No. 2 would allow for continuing Improvements" to be made available to a greater portion of the City's population; and WHEREAS, the Program for the provision of such assistance the Program") and the inclusion of a subsidy for Hook-Up Fees, is described in the Statement of the La Quinta Redevelopment Agency Assessment/Hook-Up Fee Subsidy Program the Statement"), which is attached hereto as Exhibit A", and which, together with all attachments thereto, is incorporated herein by reference; and BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION 110. RA 89-11 WHEREAS, the provision of the Improvements will benefit the Project Area and Project Area No.2 the quoted Project Areas); and WHEREAS, there is no other reasonable means available to the community to finance the improvements; and WHEREAS, the implementation of the Program benefits the Project Areas and the community and the proposed expansion of the Program wZll provide further benefits. NOW, THEREFORE, the La auinta Redevelopment Agency does resolve as follows: 1. The Agency finds and determines that: a) the provision of the Improvements will benefit the Project Areas; b) there is available to the community no other reasonable means of financing the Improvements than that set forth in the Statement, and c) the Assessment Subsidy Program is currently being implemented. 2. The Agency approves the ProgramZ' to include a Hook-Up Fee Subsidy as described in the Statement and to extend the Program' to an additional Assessment District Assessment District 8g-2). The Chairman and Executive Director are authorized to execute on behalf of the Agency all documents necessary and proper to effectuate the provisions of the Program, as described in the Statement. PASSED, APPROVED AND ADOPTED this 6th day of June 1989 by the following vote: AYES: Council Members Bohnenberger, Bosworth, Rushworth, Sniff, Mayor Pena NOES: None ABSENT: None ABSTAIN: None ChairmZj$Z Z 1Z AZST: 1 Z SecretaryZ \IaquinZa\agnassis 2 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO RA 89-11 STATEMENT OF THE LA QUINTA REDEVELOPMENT AGENCY ASSESSMENT/HOOK-Up FEE SUBSIDY PROGRAM PROGRAM PURPOSE The La Quinta Redevelopment Agency acknowledges that the Cove community lacks and/or is in need of infrastructure improvements, and that these deficiencies adversely affect housing conditions. Additionally, the Agency has determined that it is vital that such infrastructure improvements be made to enable the Agency and the City of La Quinta to increase and improve the supply of affordable Very Low, Low and Moderate Income housing that is located in the area. Therefore, the Agency and the City will jointly institute and finance a public improvements program utilizing an Assessment District with improvements funded by 1915 Act Improvement Bonds. Although the contemplated infrastructure improvements will benefit those persons of Very Low, Low or Moderate Income living in the area, the imposition of the assessments may create financial difficulties. In an effort to achieve needed public improvements to increase and improve the community's supply of affordable housing and to alleviate any financial hardship, the Agency is establishing the following Assessment/HookZUp Fee Subsidy Program to maintain the affordability of the community's housing stock. The Assessment/Hook-Up Fee Subsidy Program for Low and Moderate Income Households will provide the funding mechanism to enable the Agency and the City to utilize the 1915 Act Improvement Bonds to pay for needed infrastructure improvements while maintaining affordable housing for Very Low, Low and Moderate Income residents. In addition to providing financial assistance to eligible property owners for funding infrastructure improvements which include a new sewer system, the Assessment/Hook-Up Fee Subsidy Program will also fund payment of Hook-Up Fees which are required to collapse or fill the property owner's septic tank and connect the property to the new sewer system. The Program was initially limited to qualified property owners within Assessment District 88-1 and provided for Assessment Subsidies only. The expanded Program encompasses Assessment District 88-1 and the proposed Assessment District 89-2 and provides subsidies for both Assessment and Hook-Up Fee Payments. If continued to be successful, the Assessment/Hook-Up Fee Subsidy Program may be made available to other qualifying areas of the community; however, no commitment has been made to extend the availability of the Program beyond the scope described in this Statement. DEFINITIONS The meaning of the various terms, as used herein, shall be as follows: Assessment Subsidy Definitions Annual Assessment Payment" means the annual levy of pnncipal and interest that would be charged against the property through the enactment of the Assessment District. Assessment Pavment" means the total of the annual installments of principal and interest that would be levied against the property through the enactment of the Assessment District. \IaquinZa\ass-sub 1 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO RA 89-11 Assessment Subsidv" means the financial assistance the Agency provides towards Assessment Payment. Hock-Up Fee Subsidy Definitions Hook-Up Fee" means the payment required to be made to an unrelated third party in order to collapse or fill the property owner's septic tank and connect the property to the new sewer system. Hook-Up Fee Pavment" means the one-time charge for the Hook-Up Fee. Hook-Up Fee SubsZdy" means the financial assistance the Agency provides toward Hock-Up Fee Payments The amount is determined by the Assessor Engineer pursuant to the Program. Assessment/HookZUp Fee Subsidy Definitions Affordable Housing Cost" means that total housing cost shall not exceed 25% of the person's or household's Gross Income except that in the case of a Very Low Income Person or Household, Affordable Housing Cost shall mean not less than 15% and no greater than 25% of their Gross Income. Total housing cost includes: 1) the principal and interest on a Mortgage loan including any rehabilitation loans and any loan insurance fees associated therewith, 2) property rental payments, 3) property taxes and assessments, 4) fire and casualty insurance covering replacement value of property/improvements, 5) property maintenance and repairs, 6) a reasonable allowance for utilities, 7) homeowner association fees, and 7) space rent if the housing unit is situated on rented land. Affordable Unit" means a dwelling unit maintained by an Owner whose Affordable Housing Cost" is within the Program guidelines previously defined. Additionally, the Gross Income of the qualified household shail not exceed 120% of the median income during the period of program participation. Applicable Anniversary Date" means the second anniversary of the provision of the Initial Agency Assistance and each second anniversary date thereafter during the Minimum Period. Assessment District" means the district formed under the Improvement Act of 1915 through which bonds are issued to fund the construction of public improvements. This program is applicable to Assessment Districts aa-i and a9-2. Certification of Eligibility" means an affidavit, to be provided by the Owner and Renter upon application to the Program and biannually during the Minimum Period, which states that the participant qualifies for the Assessment/Hook-up Fee Subsidy Program Conditions to Assistance" means all of the following, which must be satisfied on a continuous basis throughout the Minimum Period: i) the Unit is maintained as an Affordable Unit; ii) Certification(s) of Eligibility are provided in accordance with the Program: iii) the Covenant of Affordability is recorded and remains in full force and effect; iv) the use of the property subject to the Covenant of Affordability conforms to the Redevelopment Plan; and v) the use of the property conforms to the nondiscrimination limitation set forth in Section 33436 of the California Health and Safety Code. \Iaquinta\ass-sub 2 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO. RA 89-11 Covenant of Affordabilit,"' or covenant means a document recorded against the participating property that stipulates that the housing unit shall remain available at an Affordable Housing Cost to persons or families of Very Low, Low or Moderate Income for a Minimum Period of fifteen years. Over the life of the covenant, household incomes will be allowed to rise to a level of 120% of median income, adjusted annually, and remain in compliance with the Covenant of Affordability. Elderlv Household" means a household in which the head of household or spouse is 62 years or older. Gross Income" means the total of all annual income of any nature from any source derived, including, but not limited to, salaries, wages, dividends, interest, capital gains, rents, income from operation of a farm or business, income from the sale or exchange of property, gifts, inheritances, Social Security payments, other retirement benefits, welfare benefits, alimony and support payments and any other thing of economic value of the entire household less the following: 1. 10% of the total income for an Elderly Household, and/or 2. recurring, extraordinary medical expenses that exceed 3% of Gross Income, and are not compensated for or covered by insurance or other sources, such as public assistance or tort recovery. Household" means a person, persons or family residing in a dwelling unit. Initial Aaencv Assistance" means the initial payment of Agency Assistance to a Participant pursuant to the Program. Minimum Period" means the continuous time period commencing with the recording of the Covenant of Affordability and ending on the fifteenth thereafter, in which the program participant maintains an Affordable Unit as defined by the definitions of the Program. Mortgage" means a mortgage deed, a deed of trust, or any other instrument which constitutes a lien on real property. Net Assets" means all real and personal property of any character which an Owner or Rental Household owns or has an interest in, including stocks, bonds, and savings accounts. For Owner Occupants this excludes the real property within the Assessment District. Owner" means persons or families owning and/or occupying real property which is included in the Assessment District and successors in interest or the legally appointed representatives of such person or persons. Participant" means an Owner of a dwelling which participates in the Program. Program" mean the Assessment/Hook-Up Fee Subsidy Program as set forth in this Statement of the La Quinta Redevelopment Agency Assessment/Hook-up Fee Subsidy Program Assessment Districts No.88-i and 89-2). Rental Household" means a person, persons or family that occupies a dwelling unit for which they compensate a landlord or Owner for use of the dwelling. \IaquintaZass-si,b 3 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO. RA 89-11 Repavment Amount" means the pro-rata share of the Assessment and Hook-Up Fee Payments calculated by diViding the total Assessment and Hook-Up Fee Payments plus interest expense by the number of years as originally set forth in the Covenant of Affordability multiplied by the number of years remaining to run on the Covenant of Affordability as of the time payment becomes due to the Agency. Example; Assessment Payment $1,300.00 + Interest Expense* Hook-Up Fee Payment $1,700.00 Number of years set forth in the Covenant 15 Property has been in program for 5 years 10 years remain under the Covenant Expense* $1300 + Interest Exnense* + $1700) X 10 $2,000 + Interest 15 * The amount of interest expense shall be the lesser of: i) 12% simple interest per annum or ii) the highest interest rate that may lawfully be charged by a redevelopment agency Very Low Income Person or Household Affordabre Housing Cost" means that total Housing Cost shall not be less than 15% and no greater than 25% of a person's or Household's Gross Income. Very Low. Low and Moderate Income Households" means persons or families whose Gross Incomes are respectively defined as not exceeding 50%, 80% and 100% of area median income the median income of a geographic area of the State, as annually estimated by the United States Department of Housing and Urban Development HUD) pursuant to Section 8 of the United States Housing Act of 1937, adjusted for family size). DESCRIPTION The Agency pursuant to Section Z3334.2 of the California Health and Safety Code, a portion of the Community Redevelopment Law) will utilize tax increment funds to provide subsidies to, or for the benefit of, Very Low, Low and Moderate Income Households residing in the Cove community and are part of the Assessment Districts see map for District boundaries). Upon the establishment of the Assessment District, the Agency will disseminate information on the Assessment/Hook-up Fee Subsidy Program to Owner Occupied and/or rental single family housing occupied by Very Low, Low and Moderate Income persons. Households interested in assistance are required to make application to the Agency through the Executive Director). Agency staff will review the applications and determine eligibility based upon established criteria. If an application is approved, the Agency staff will facilitate the payment of the determined Assessment Subsidy amount from the Agency to the fiscal agent responsible for the collection of the Assessment Payments. The Assessment Subsidy will be made in the form of a one time lump sum payment that will equal the applicant's total Assessment Payments. The Hook-Up Fee Subsidy will also be made in the form of a one-time lump sum payment that will equal the applicant's total Hook-Up Fee Payment. The Hook-Up Fee Payment will be to the Coachella Valley Water District and plumbing contractor. Property owners who have already qualified for the Assessment Subsidy Program which did not include Hook-Up Fee Subsidies must submit a Request for Hook-Up Fee Subsidy form. iaquLnZa\assZstjb 4 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO. RA 89-11 ELIGIBILITY The Assessment/Hook.up Fee Subsidy Program is available to all qualified Very Low, Law and Moderate income Households who are within the boundaries of the Assessment District. The provision of subsidies is also subject to the availability of funds. Applying Owners must meet the following requirements in order to qualify for a. The real property for which Assessment/Hook-Up Fee Subsidy is sought must be developed with a housing unit or a housing unit that is under construction. Only one property per Owner is eligible to receive a subsidy. b. The Household's Gross Income must meet the requirements for Very Low, Low and Moderate Income Households. The City of La Quinta's median income for a family of four, as established by the United States Department of Housing and Urban Development HUD) for 1989, is $32,200. CFhe median income for the City is taken from HUD's established median income for the Riverside/San Bernardino Primary Metropolitan Statistical Area which is adjusted for family size and is update annually). Based upon this median income, the following table depicts the eligible income levels for the Assessment/Hook-up Fee Subsidy Program. Income Category 1 Person 2 Persons 3 Persons 4 Persons VeryLow $11,250 $12,900 $14,500 $16,100 Low 18,050 20,600 23,150 25,750 Moderate 27,048 30,912 34,776 38,640 Income Cateciory 5 Persons 6 Persons 7 Persons 8 Persons Very Low $17,400 $18,700 $19,950 $21,254 Low 27,350 28,950 30,600 32,200 Moderate 41,056 43,470 45,886 48,300 C. The Household's Total Housing Cost, when combined with the Annual Assessment Payment and Hook-Up Fee Payment, exceeds the established Affordable Housing Cost for the Household's Gross Income. d. The value of the Household's Net Assets may not exceed $225,000, excluding the value of the property being assessed and two automobiles. e. The Owner must record a Covenant of Affordability. f. In the case of a Rental Household, the Owner must agree to record a Covenant of Affordability that maintains affordable rents for the duration of the Covenant. The Agency will monitor rent levels from time to time. AMOUNT OF SUBSIDY For qualifying Households, the Agency will subsidize the full amount of the Assessment Payment and Hook-up Fee Payment. \raquinta\,,s-sub 5 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO RA 89-11 COVENANT OF AFFORDABILITY The Assessment/Hook-up Fee Subsidy Program will be funded from the La Quinta Redevelopment Agency's Low and Moderate Income Housing fund. The Redevelopment Law, which governs the use of this fund, requires the recordation of deed covenants against properties that benefit from the expenditure of these funds. The covenants are to ensure the continued affordability of the housing unit. The recordation of a deed restriction in the form of a Covenant of Affordability will be required. This Covenant of Affordability will require that the housing unit shall remain affordable to Very Low, Low or Moderate Income Households for fifteen 15) years for both owner-occupied units and rental units. Over the life of the covenant, household incomes will be allowed to rise to a level of 120% of median income, adjusted annually, and remain in compliance with the Covenant of Affordability. Acceleration of the Covenant of Affordabilitv In the event the housing unit is to be sold, payment shall be due in the amount equal to the Repayment Amount. Provided that the housing unit and property) have been operated on a continuous basis with all of the Conditions of Assistance, the Agency will agree to defer receipt of the Repayment Amount in the event the prospective buyer executes and records or otherwise agrees to be bound by and remain subject to the Covenant of Affordability for the remainder of the Minimum Period. Subordination of the Covenant of Affordability The Covenant of Affordability shall contain a lien upon the participating property: such lien in favor of the Agency shall be subordinate to all deeds of trust or similar instruments recorded in favor of a bank, savings and loan association or other similar institutional lender securing repayment of the Participant. ASSESSMENT/HOOKZUp FEE SUBSIDY REPAYMENT The Assessment/Hook-up Fee Subsidy may require repayment if one on the following occurs during the period the covenant is in effect: 1. The housing unit is sold or rented at a cost that is no longer affordable to Very Low, Low or Moderate Income Households; or 2. The housing unit is sold; or 3. The income level of the qualified Household exceeds 120% of median income, annually. The Repayment Amount will become due and payable should any of the three circumstances described above occur. The repayment period i.e., the period during which repayment shall be made) shall be no longer than immediately for rental properties and five 5) years for Owner- occupied residences. The Repayment Amount shall be all due and payable upon the first to occur of: i) any failure of one or more of the Conditions to Assistance; or ii) the sale for assignment of the property; the date upon which either such event shall first occur shall constitute the Due Date." \Iaqu,nta\as,,-stjb 6 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION 110. RA 89-11 UPON FULL PAYMENT THE COVENANT OF AFFORDABILITY SHALL BE RESCINDED. MONITORING OF ELIGIBILITY Program Participants will be required to complete a Certification of Eligibility form on a biannual basis. Owner-occupants will be required to state that their Gross Income does not exceed 120% of the median Gross Income for the Riverside/San Bernardino Primary Metropolitan Statistical area. Certification of Eligibility for Owners of rental property will include notification to the Agency when there is a change in tenancy. The Gross Income of the original and subsequent tenants shall not exceed 120% of the median Gross Income for the Riverside/San Bernardino Primary Metropolitan Statistical Area. Additionally, the rental unit must remain at an Affordable Housing Cost to the tenant. APPLICATION AND APPLICATION PROCESS All interested Owners are required to submit the following: 1) A completed application along with Federal tax returns for the two previous years, the name and address of any dependent's employer, a most recent pay stub, a monthly mortgage stub, a most recent property tax bill and most recent utility bill and 2) A completed Certification of Eligibility Form. Applications for Owner Occupied and Renter Households are enclosed. Owners who qualified for the Assessment Subsidv which did not include Hopk-UO Fees need only submit a Request for Hook-Up Fee Subsidy form. Upon approval of the application, the Owner and Renter Households are required to execute the Covenant of Affordability. Please send completed applications and written inquiries to: CiZ Managers Office ityofLaQuinta 78-105 Calle Estado La Quinta, California 92253 ZIaquIntaZanZub 7 BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUZION NO. RA 89-11 PROPOSED BOUNDARIES OF ASSESSMENT DISTRICT NO. 89-2 CITY OF LA QUINTA RIVERSIDE COUNTY, CZLIZORNIA Sc S, SN Sit up Ct OF lilt S,r,ZtZSNItNOEnION SINlESS HIS Zt'. flAt ON Z 511j,y;j11 Z Z tj ttiGiZZZtCA ON OS,' 11(0 5" ISIt Of! ICC ON 114 Cl ST Ct Rn ON Sit CI CUSNIA ISIS) S55.OAI ONJAarZ. Z C I? CCCRnZON t$IZCIlIZON*tAZCuIN!A Cast twirhata lINt Pr C Null!! SEAT S HI U Elfin MAP 5,90w 51.1 TIlt PNONOSCD OUNCIANSES 0! ASSCSSMCNT OISIRICS NO. *IZ2 Cl IT ON LA OUINIA. COUNIT Cr RSAENSIOC, STAll OF CALINOANIA, utS AN- M0L Z Z railS IjZ.jr rNOTtO ST I'll CIII Council Or LA OUlNIA AJZ A SECULAR HICISNI Hf ON NItO On INC A TAr Z Ir SHE ZlsOturlanZZZ 0, lZ( CTZiZOfZtA oZitIAZ 11(0 INTS OAT Of AIAl T,!J Al I'Ll'' lZt HOUR era..............CtOZN I S. IN SOON Of riAps Or ASSCSSMENI OlSIPICiS. PACE IN INC ONNICE ON Tnt CO IrsIRunEni NO yZZZtLANZCTNOCR Z CCbNIr *TN ZIvlNSSoC tnt-SZ Z *1A Jf 7< Z J(ZZ4'. I 4$ Z Z 41 i.ZJZ7(777Z Z ZLLZ \\ ZL 7ZZjZq r j Z jZ4 ZZjSZj\;pi SCtA( if slaet *Qt,NOanrr AtZi VCIZTY MAP BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO RA 89-11 CITY OF LA OUINTA ASSESSMENT SUBSIDY PROGflAM APPLICANT'S flEQUEST FOZ HOOK-UP FEE SUBSIDY I, qualified for the AsZessment Subsidy Program on I am now requesting additional subsidy for the HookZUp Fees levied for property owners of Assessment District 88-i Signature Date BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLliTION NO. RA 89-11 LA QUINTA REDEVELOPMENT AGENCY ASSESSMENT SUBSIDY/HOOK-UP FEE PROGRAM APPLICATION OWNER OCCUPIED UNIT Property Owner's Name: last first middle Address: street city zip Phone: home work Please indicate if there are additional co-owners Yes No If Yes please list names, addresses and phone numbers on tl)e back of this application 2. How many individuals reside in your home Please list each individual including children) Name Age Estimated Annual Income Name of Employer Address Number Name Age Fstimated Annual Income Name of Employer Address Number Name Name Name Name Use back of application for additional names 3. Monthly House Payment $_____________ include all liens that are secured by the property and require monthly or annual payments) 4. Annual Property Tax $_____________ BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO RA 89-11 5. Annual Property Insurance $_____________ if not included in monthly mortgage payment) 6. Average Monthly Utilities $_____________ gas, water and electric charges) 7. Please list all assets valued at $5,000 or greater THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS APPLICATION: ba) Federal tax returns for 1987-88 and 1988-89. Name and address of employer of each household member who is not a full time student and is still claimed as a dependent). c) Most recent pay stub from above. d) Copy of monthly mortgage stub from above. e) Copy of most recent property tax bill. 1) Copy of most recent property insurance bill. g) Copy of most recent utility bills outlined in item 6. I hereby swear by penalty of perjury that the information provided above is to my best knowledge truthful and accurate. DZte Signature BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTIOZ NO. RA 89-11 LA QUINTA REDEVELOPMENT AGENCY ASSESSMENT SUBSIDY/HOOK-UP FEE PROGRAM APPLICATION RENTER OCCUPIED UNIT Property Owner's Name: last first middle Address: street city zip Phone: home work Please indicate if there are additional co-owners Yes No If Yes please list names, addresses and phone numbers on tile back of this application 2. How many individuals reside in your home Please list each individual including children) Name Age Estimated Annual Income Name of Employer Address Number Name Age Estimated Annual Income Name of Employer Address Number Name Age Estimated Annual Income Name of Employer Address Number Name Name Name Name Use bZrk of ZnnlirZtinn for ZdditinnZI BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02 RESOLUTION NO. RA S9-11 3. Monthly House Payment $_____________ include all liens that are secured by the property and require monthly or annual payments) 4. Annual Prnperty Tax $_____________ 5. Annual Property Insurance $_____________ if not included in monthly mortgage payment) 6. Average Monthly Utilities $ gas, water and electric charges) 7. Please list all assets valued at $5,000 or greater THE FOLLOWING INFORMATION MUST BE SUBMIUED WITH THIS APPLICATION: a) Federal tax returns for 1987-88 and 1988-89. b) Name and address of employer of each household member who is not a full time student and Is still claimed as a dependent). c) Most recent pay stub from above. d) Copy of monthly mortgage stub from above. e) Copy of most recent property tax bill. f) Copy of most recent property insurance bill. g) Copy of most recent utility bills outlined in item 6. I hereby swear by penalty of perjury that the information provided above is to my best knowledge truthful and accurate. Date Signature BIB] 03-04-1997-U01 02:04:36PM-U01 RDARES-U02 89-U02 11-U02