First Time Home Owner Program Summary Sheet

PURCHASE ASSISTANCE PROGRAM Single Family Residence or Multi-Family Housing APPLICATION

PLEASE PRINT OR TYPE NAME ______SS# ______SPOUSE'S NAME ______SS# ______PRESENT ADDRESS ______YEARS AT THIS ADDRESS______CITY, STATE ZIP ______HOME PHONE ______PRESENT EMPLOYER ______SALARY ______ADDRESS ______YEARS EMPLOYED ______WORK PHONE ______PREVIOUS EMPLOYER ______SALARY ______ADDRESS ______YEARS EMPLOYED ______SPOUSE EMPLOYER ______SALARY ______ADDRESS ______YEARS EMPLOYED ______WORK PHONE ______PREVIOUS EMPLOYER ______SALARY ______ADDRESS ______YEARS EMPLOYED ______

ANNUAL FAMILY INCOME $______NUMBER IN FAMILY

______

LENDER NAME &

ADDRESS______

REALTY AGENCY &

AGENT______

PROPERTY ADDRESS

______

SELLERS ASKING PRICE $ ______REQUIRED FOR APPROVAL OF LOAN INFORMATION NEEDED FOR AUTOMATIC PURCHASE PRICE. $ ______WITHDRAWAL OF PAYMENTS:

BANK LOAN/MORTGAGE $ ______Bank Name: ______DOWN PAYMENT FROM BUYER $ ______Routing Number: ______

WCEDD MATCHING FUNDS $ ______Account Number: ______

I (we) attest that this information and data on this form is correct and true to the best of my (our) knowledge. By signing this application form, I (we) understand that I (we) grant unconditional approval for WCEDD to check my (our) credit, personal finances

2014 Page 1 and employment records at my (our) expense, so a complete evaluation of this application can be made. I (we) also understand that if the property is sold full payment of the loan will be due immediately.

DATE ______SIGNATURE ______

SPOUSE ______

Return to: Wright County Economic Development, First Time Home Owner Program, P.O. Box 214, Clarion, Iowa 50525

PERSONAL FINANCIAL INFORMATION

List all current assets and liabilities.

Current Personal Assets

Cash/Checking acct (Bank ______) $ ______

Savings Account(s) (Bank______) $ ______

Stocks/Bonds/Securities $ ______

Accounts/Notes Receivable $ ______

Autos/Other vehicles (Model & Yr ______) $ ______

Real Estate Value $ ______

Household Furniture, etc. $ ______

Other Assets: (list) ______$ ______

TOTAL ASSETS $ ______

Current personal Liabilities

Balance on car (Holder of first lien______) $ ______

Balance on property (Bank ______) $ ______

Credit Card Liability (Company______) $ ______

Other Liabilities (list creditor and amount) $ ______

TOTAL LIABILITIES $ ______

TOTAL ASSETS $ ______

LESS TOTAL LIABILITIES $ ______

NET WORTH $ ______

I attest that this information, and data on the attached financial statements, are correct and true to the best of my knowledge.

Signature______

2014 Page 2 Date ______Spouse______

Return to: Wright County Economic Development Department, First Time Home Owners Program, P.O. Box 214, Clarion, Iowa 50525

BUDGET WORKSHEET

Return with application

Name ______

Current Projected INCOME, GROSS, Monthly Average Payroll Deductions: Taxes (Federal, State, etc.) Savings Plan (401k, credit union, etc.) Other (medical, dental, etc.) Total Payroll Deductions INCOME, NET (Gross minus Deductions)

Expenses: Personal Savings Housing Utilities Home Maintenance (laundry, toiletries, upkeep) Transportation (monthly payments) Auto Upkeep (gas, insurance, license, etc.) Food (groceries + dining out) Clothes Books, Periodicals, Online Services Entertainment (TV, movies, CD’s, vacation) Debt Repayment (credit cards, school, etc.) Other Expenses Total Expenses INCOME, NET minus all expenses

2014 Page 3