Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer Revised 6-2019 Homebuyer Application Welcome to the Urban League of Rochester dba The Home Store! The Home Store provides: - Individualized counseling for potential buyers ready to buy now or in the near future. - Grant program education, enrollment, and 1-on-1 counseling. - Empowerment to make good decisions before and after the home buying process. - Assistance in locating grants, closing cost or down payment assistance. - Credit and budget counseling We look forward to helping you reach the dream of home ownership! Please return application to: *We WILL NOT ACCEPT original documents* Attn: The Home Store 265 N Clinton Ave Rochester NY 14605 If coming into the office is a hardship, or if you require special meeting accommodations, please call or email us prior to your appointment so that we can best serve you. Meeting accommodations may include: - Phone appointments - Language interpretation - Accommodations for physical disabilities • REMOVE THIS PAGE • IT PROVIDES PROGRAM & CONTACT INFORMATION
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Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
Homebuyer Application
Welcome to the Urban League of Rochester dba The Home Store!
The Home Store provides:
- Individualized counseling for potential buyers ready to buy now or in the near future.
- Grant program education, enrollment, and 1-on-1 counseling.
- Empowerment to make good decisions before and after the home buying process.
- Assistance in locating grants, closing cost or down payment assistance.
- Credit and budget counseling
We look forward to helping you reach the dream of home ownership!
Please return application to:
*We WILL NOT ACCEPT original documents*
Attn: The Home Store
265 N Clinton Ave
Rochester NY 14605
If coming into the office is a hardship, or if you require special meeting accommodations,
please call or email us prior to your appointment so that we can best serve you.
Meeting accommodations may include:
- Phone appointments
- Language interpretation
- Accommodations for physical disabilities
• REMOVE THIS PAGE • IT PROVIDES PROGRAM & CONTACT INFORMATION
HOMEBUYERS DOCUMENT CHECKLIST
Complete the application and include photocopies of all documents requested below. Sign and Date application. We cannot make copies for you.
Paystubs: 1 month (4 current-consecutive pay stubs) for all persons in household over 18years.
Tax Returns: Last (2) years Taxes & 1099’s for all persons in the household over 18years.
*If you cannot locate or did not file a return, please contact the IRS Office at 1-800-829-1040 or
www.irs.gov to request a Tax Return Transcript.
W2s: Last (2) years W2s for all persons in the household over 18years.
*If you cannot locate or did not file a return, please contact the IRS Office at 1-800-829-1040 or
www.irs.gov to request a Wage & Income Transcript.
Other income or Award letter(s): Pension, Disability, Child Support, SSI, SSD, Alimony
Bank Statements: Most recent 2 months for all checking and savings, include all pages.
Picture I.D. and Social Security Card: For all household members OVER the age of 18.
Birth Certificate and Social Security Card: For all household members UNDER the age of 18.
$10 Check/ Money Order: For Credit Report Soft Inquiry Fee ONLY
*Your Credit Report may be pulled up to 1 Business Day before your scheduled appointment time.
Bankruptcy paperwork, Divorce or Separation Agreement (if applicable)
*You will be notified by phone and/ or mail within 7 – 10 Business Days*
• APPLICATION AND DOCUMENTS WILL NOT BE RETURNED •
If you have problems filling out this application, please feel free to call us at (585)325-4663 and a representative will be able to assist you.
Credit Report Access Options: Soft Inquiry ($10 fee per applicant) - Transunion Credit Report + Credit Score - Counts as a review and shouldn’t affect credit score
I will Supply my own credit report - Credit Report must be pulled within 90 days - Must be a full credit report*
*CreditKarma or credit card company reports are not acceptable
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
_______________________________________________________ _______________________ Title Hire Date _______________________________________________________________________________________________________________________ Street City State Zip Code
Phone: (_________) _________ - _____________ Part-Time Full- Time
Gross Income (before taxes): $___________________ Is this amount paid: Hourly Weekly Every 2 Weeks Twice a Month Monthly
CO-APPLICANT EMPLOYMENT – Last 2 years Please Print Clearly
_______________________________________________________ _______________________ Title Hire Date _______________________________________________________________________________________________________________________ Street City State Zip Code
Phone: (_________) _________ - _____________ Part-Time Full- Time
Gross Income (before taxes): $___________________ Is this amount paid: Hourly Weekly Every 2 Weeks Twice a Month Monthly
_______________________________________________________ _______________________ Title Hire Date
Phone: (_________) _________ - _____________ Part-Time Full- Time Gross Income (before taxes): $___________________ Is this amount paid: Hourly Weekly Every 2 Weeks Twice a Month Monthly
_______________________________________________________ _______________________ Title Hire Date _______________________________________________________________________________________________________________________ Street City State Zip Code
Phone: (_________) _________ - _____________ Part-Time Full- Time
Gross Income (before taxes): $___________________ Is this amount paid: Hourly Weekly Every 2 Weeks Twice a Month Monthly
*Please list the approximate value APPLICANT CO-APPLICANT
Checking Account
Saving Account
Cash
CDs/ Liquid Funds
Securities (stocks, bonds, etc.)
Retirement Account
INCOME Please Print Clearly
TYPE OF INCOME APPLICANT
Monthly Amount
CO-APPLICANT Monthly Amount
Salary
Alimony/ Child Support
Rental Income
Social Security
Pension Income
Public Assistance
Self-Employment Income
Dependent SSI Income
Disability Income
APPLICANT CO-APPLICANT Can you document your child support/alimony income? Yes No Yes No *If yes, how long will it continue?_______________
If your child or family member receives SSI, how many more years will the payments continue? _____________________
If you receive disability income, is it for a permanent disability? Yes No Yes No
Regarding other employment, have you worked in the field for Yes No Yes No two years or more?
LIABILITIES & DEBT
*Do NOT include rent, utilities
Paid To
Current Balance
Monthly Payment
A= Applicant C= Co-App
B= Both
1. Auto Loan
2. Student Loan
3. Credit Card (minimum payment)
4.
5.
6.
7.
8.
9.
10.
APPLICANT CO-APPLICANT Have your payments been made on time? Yes No Yes No
Are you currently in Chapter 13 bankruptcy? Yes No Yes No
If yes, when did it begin? _______________________
If yes, when will it be paid out? __________________
If yes, how much is the payment? ________________
Have you had a Chapter 7 bankruptcy? Yes No Yes No
If yes, when was is discharged? __________________
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
LIVING EXPENSES APPLICANT CO-APPLICANT
Monthly Rent/ Mortgage
Electric/ Gas
Cell/ Phone Bill
Cable/ Satellite TV
Internet
Car Insurance
Gas/ Parking/ Tolls
Groceries
Restaurants/ Dining
Daycare/ Childcare
Entertainment Are you about to receive additional funds (e.g. tax refunds, property sale etc.)? Yes No If yes, how much? $_________________________
ADDITIONAL INFORMATION APPLICANT CO-APPLICANT
Have you owned a home in the last three (3) years? Yes No Yes No Are you a Veteran? Yes No Yes No *If yes, are you in Active Duty? Yes No Do you have a contract on a house at this time? Yes No Are you currently working with a real-estate agent? Yes No Are you participating in Section 8’s Self-Sufficiency Program? Yes No Do you live in a Rural area? Yes No Do not know Are you proficient in English? Yes No *If no, your preferred language __________________________ Most convenient time for an individual appointment Morning Afternoon
ACKNOWLEDGEMENT I (We) as a Urban League of Rochester dba The Home Store Program applicant(s) acknowledge that the information provided accurately describes me (our) household and identifies all of my (our) household over the past 12 months. I (We) understand that this application information that I (we) provide will be used to determine program(s) and/or subsidy(ies) eligibility and may also be used to estimate lending eligibility. This information will not be shared with other organizations beyond those involved with the program(s) without the applicant(s) prior approval. Verification requests will occur on an as needed basis, to named income sources, only after approval by the applicant(s). Additional information and/or documentation may be requested from the applicant(s) to determine eligibility for this program or other specific programs and/or subsidies. I (we) authorize the Home Store to check our credit history by requesting a credit report to assist in estimating lending eligibility and in developing corrective strategies as needed. The information I (we) have provided is complete, accurate and true.
I (we) understand that any intentional or negligent representation(s) of the information contained on this form may result in civil liability and/or criminal liability under the provisions of Title 18, United States Code, Section 1001.
____________________________________________ ____________ Applicant Signature Date
____________________________________________ ____________ Co-Applicant Signature Date
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
CLIENT CONFLICT OF INTEREST
It is your right and responsibility to decide whether to engage in any course of counseling with the Urban League of
Rochester dba The Home Store and to determine whether the counseling and/or education is suitable for you. Please
understand that you are free to choose any lender, residence or lending or financial product, from any entity regardless
of the recommendations made by the Urban League of Rochester dba The Home Store representative and still
participate in our counseling and/or education program.
The individualized action plan and direction of our counseling sessions will be based on the case management plan that
the housing counselor and client will develop together. In order to accomplish the outcomes and goals of your action
plan, the action plan will be reviewed regularly during the progression in counseling. Additionally, you are under no
obligation to obtain a mortgage or purchase a home and have the option to terminate the counseling program at any
time and for any reason.
I______________________________________________________ (please print name) certify that I have read and
understand the above statement. Any questions I may have had were previously discussed with my counselor and
answered to my satisfaction. I have been provided with a copy of the Client Conflict of Interest Disclosure.
________________________________________________________ ___________________ Applicant Signature Date
________________________________________________________ ___________________ Co-Applicant Signature Date
________________________________________________________ ___________________ Counselor Signature Date
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
Counseling Services Disclosure Statement
The Urban League of Rochester, NY, Inc. provides the following housing counseling services: Pre-Purchase counseling and education; Foreclosure prevention counseling and education; Non-Default Post-purchase counseling and education; Financial Education and counseling; and Rental Referral Services. I/We understand that it is my/our right and responsibility to decide whether to engage in any course of housing counseling with the Urban League of Rochester, NY, Inc. dba The Home Store and to determine whether counseling is suitable for my/our housing problem. I/We understand that the Urban League of Rochester, NY, Inc. dba The Home Store has the discretion to charge reasonable fees for some counseling services, and that these fees will be explained to me prior to any counseling. I further understand that fees will not be charged if they create a financial hardship and that I will not be denied counseling if I cannot pay the fees. I/We understand that the Urban League of Rochester, NY, Inc. dba The Home Store provides information on a broad range of housing programs and products and that the housing counseling I receive from the Urban League of Rochester, NY, Inc. dba The Home Store in no way obligates me to choose any particular loan product or housing program discussed in my counseling sessions. I/We understand that the Urban League of Rochester, NY, Inc. dba The Home Store does not guarantee that I/We will receive mortgage financing from any lender and/or other mortgage financing entity. I/We may be referred to other housing services of the organization or to another agency or agencies as appropriate that may be able to assist with particular concerns that have been identified. I understand that I am not obligated to use any of the services offered to me. I/We understand that a counselor may answer questions and provide information but cannot give legal advice. If I want legal advice, I will be referred for appropriate assistance. I/We understand that I/we are not obligated to receive any other services offered by the Urban League of Rochester, NY, Inc. or its exclusive partners. The Urban League of Rochester, NY, Inc. offers programs and services in the areas of Education and Youth Services, Employment Services, Family and Children Services, Developmental Disabilities, Business Development and Housing Services. Financial Support for the Urban League of Rochester, NY, Inc. dba The Home Store Counseling Programs is currently being provided by the following industry partners:
National Urban League, City Of Rochester, Wells Fargo, Citizens Bank, Bank of America, Five Star Bank
I have reviewed and understand the above Counseling Services Disclosure Statement.
____________________________________________ ____________ Applicant Signature Date
____________________________________________ ____________ Co-Applicant Signature Date
____________________________________________ ____________ Counselor Signature Date
*Telephone counseling: Disclosure Statement Read to Client? _______Yes _______No
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
Privacy Policy
The Urban League of Rochester, NY, Inc. dba The Home Store is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization and signature on the Counseling Services Disclosure Statement. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.
Information We Collect: Information we receive from you orally, on applications or other forms, such as your name, address,
social security number, assets, and income; Information about your transactions with us, your creditors, or others, such as your account balance,
payment history, parties to transactions and credit card usage; and Information we receive from a credit reporting agency, such as your credit history.
Release of Information to Third Parties: So long as you have not opted-out, we may disclose some or all of the information that we collect, as
described above, to your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling you, or is a requirement of grant awards which make our services possible.
We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process).
Within the organization, we restrict access to nonpublic personal information about you to those employees who need to know that information to provide services to you. We maintain physical, electronic and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.
Opt-out of certain disclosures: 1. You have the opportunity to “opt-out” of disclosures of your nonpublic personal information to third
parties (such as your creditors), that is, direct us not to make those disclosures. 2. If you choose to “opt-out”, we will not be able to answer questions from your creditors. If at any time,
you wish to change your decision with regard to your “opt-out”, you may call us at 585-325-6530 and do so.
By signing below, I certify that I have reviewed and understand the above Privacy Policy Statement.
____________________________________________ ____________ Applicant Signature Date
____________________________________________ ____________ Co-Applicant Signature Date
Affiliations: National Urban League, Inc., New York, New York Member: United Way of Greater Rochester An Equal Opportunity Employer
Revised 6-2019
Authorization to Pull Credit Report Form
APPLICANT Please Print Clearly
Name: _________________________________________________________________________________ First MI Last
_____________________________________________________________________ Street
_____________________________________________________________________ City State Zip Code
_______-_______-_____________ ________/________/__________ Social Security Number Date of Birth (M/D/Y)
Choose one option:
Soft Inquiry ($10 fee per applicant) - Transunion Credit Report + Credit Score - Counts as a review and shouldn’t affect credit score
I will Supply my own credit report - Credit Report must be pulled within 90 days - Must be a full credit report*
*CreditKarma or credit card company reports are not acceptable
By signing this document I give the Urban League of Rochester or an agent working on the League’s behalf permission to acquire a credit report for myself.
I understand that credit inquiries have the potential to impact my credit score. *Please make $10 check or money order out to ‘Urban League of Rochester, NY’*
_______________________________________________ ____________ Applicant Signature Date
_______________________________________________ ____________ Co-Applicant Signature Date
Office Use Only: Please do not write below this line
Amount: ______________________ Date Received: ______________________________
