HomeMy WebLinkAboutCOM 0530.002 2002-2004Harry Kim
Mayor
April 22, 2004
TRANSMITTAL
contp of *await
OFFICE OF HOUSING AND
COMMUNITY DEVELOPMENT
50 Wailuku Drive • Hilo, Hawai'i 96720-2484
V/TT (808) 961-8379. FAX (808) 961-8685
To: The Honorable James Arakaki, Chairman
The Honorable J. Curtis Tyler, III, Vice Chairman
The Honorable Aaron Chung
The Honorable Leningrad Elarionoff
The Honorable Fred Holschuh
The Honorable Bob Jacobson
The Honorable Gary Safarik
The Honorable Joe Reynolds
The Honorable Michael Tulang
Members, Hawaii County Council
Subject: Residential Emergency Repair Program (REAP)
We are transmitt
Meetinq on April 21, 2
Edwin S. Taira
Housing Administrator
the following As Requested at the Council
Copy Date
1 02/20/04
1 04/21/04
Description
Application Packet
Program Highlights, Example of loan
repayment
Remarks:
Additional application packets are available by calling our
office. Staff is available to meet to discuss any questions you
may have. Please call Tina Whitmarsh at 961-8379 to schedule a
meeting.
Signed:
Edwin S. Taira
Housing Administrator
C: Harry Kim, Mayor w/attach.
4854dt1w
comm, No. 1C 30. Z
Ref. To -
Re O
o:Ref. D
F1111
EQUAL HOUSING OPPORTUNITY
'HAWAI'l COUNTY IS AN EQUAL OPPORTUNITY
PROVIDER AND EMPLOYER"
RESIDENTIAL EMERGENCY REPAIR PROGRAM (RERP)
What is the Residential Emergency Repair Program (RERP)?
The RERP program provides low cost loans to homeowner: to
repair their primary dwelling unit.
Who can qualify for an RERP Loan?
1. Homeowner must be an owner/occupant for a minimum of
one (1) year and the unit must be the principle residence
2. Total adjusted gross income off all household members
must be below 80% of the median income
ADJUSTED INCOME LIMITS
(See attached Schedule)
1 Person 2 Person 3 Person 4 Person 5 Person
$31,000 $35,450 $39,900 $44,300 $47,850
What types of repairs can be made under the RERP program?
1. Connecting or "hook up" to County Sewer System;
2. Construction of new septic system or cesspool;
3. Accessibility Improvements for the Disabled;
4. Plumbing and electrical;
5. Roof repair/replacement;
6. Fumigation;
7. Abatement of Lead-based paint;
8. Energy efficient improvements; and
9. Installation of Solar Water Heater
What types of repairs are ineligible under theprogram?
1. Construction of
2. Any incomplete
3. Room additions
crowding"
4238r=j
any new residential structure;
or unfinished structure; and
not necessary to correct "over-
What are the costs and terms associated with the RERP program?
Application/Processing Fee
Minimum Loan Amount:
Maximum Loan Amount:
Interest Rate:
Terms:
$ 250
$ 2,500
$25,000
3% Simple Interest
(Compounded Annually)
Deferred for 15 years or
transfer of title
Example 41 - RERP Loan without Disability or Elderly Grant
Maximum Loan Amount: $25,000
3% Simple Interest: $11,250 Compounded Annually
Amount Due at Year 15: $36,250
*See attached worksheet
Example #2 - RERP Loan with 30% Disability or Elderly Grant
Maximum Loan Amount:
30% Elderly/Disability Grant
3% Simple Interest:
Amount Due at Year 15:
*See attached worksheet
Status of the RERP Program:
BALANCE AS OF 4/20/04:
$25,000
($7,500)
$ 7,875 Compounded Annually
$25,375
$350,625
The OHCD can generate at least 14 loans at $25,000
4238r=j
LOAN
AMOUNT
30%
ELDERLY/
DISABILITY
GRANT
DIFFERENCE
OF MORTGAGE
AFTER 30%
3% SIMPLE
INTEREST
15 YEAR
TERM
MORTGAGE
$2,500
$750
$1,750
$787.50
$2,537.50
$5,000
$1,500
$3,500
$1,575.00
$5,075.00
$10,000
$3,000
$7,000
$3,150.00
$10,150.00
$12,500
$3,750
$8,750
$3,937.50
$12,687.50
$13,000
$3,900
$9,100
$4,095.00
$1.3,195.00
$13,500
$4,050
$9,450
$4,252.50
$13,702.50
$14,000
$4,200
$9,800
$4,410.00
$14,210.00
$14,500
$4,350
$10,150
$4,567.50
$14,717.50
$15,000
$4,500
$10,500
$4,725.00
$15,225.00
$15,500
$4,650
$10,850
$4,882.50
$15,732.50
$16,000
$4,800
$11,200
$5,040.00
$16,240.00
$16,500
$4,950
$11,550
$5,197.50
$16,747.50
$17,000
$5,100
$11,900
$5,355.00
$17,255.00
$17,500
$5,250
$12,250
$5,512.50
$17,762.50
$18,000
$5,400
$12,600
$5,670.00
$18,270.00
$18,500
$5,550
$12,950
$5,827.50
$18,777.50
$19,000
$5,700
$13,300
$5,985.00
$19,285.00
$19,500
$5,850
$13,650
$6,142.50
$10,792.50
$20,000
$6,000
$14,000
$6,300.00
$20,300.00
$20,500
$6,150
$14,350
$6,457.50
$20,807.50
$21,000
$6,300
$14,700
$6,615.00
$21,315.00
$21,500
$6,450
$15,050
$6,772.50
$21,822.50
$22,000
$6,600
$15,400
$6,930.00
$22,330.00
$22,500
$6,750
$15,750
$7,087.50
$22,837.50
$23,000
$6,900
$16,100
$7,245.00
$23,345.00
$23,500
$7,050
$16,450
$7,402.50
$23,852.50
$24,000
$7,200
$16,800
$7,560.00
$24,360.00
$24,500
$7,350
$17,150
$7,717.50
$24,867.50
$25,000
$7,500
$17,500
$7,875.00
$25,375.00
4/21/2004
LOAN AMOUNT
3% SIMPLE INTEREST
15 YEAR TERM
MORTGAGE
$2,500
$1,125
$3,625
$5,000
$2,250
$7,250
$10,000
$4,500
$14,500
$12,500
$5,625
$18,125
$13,000
$5,850
$18,850
$13,500
$6,075
$19,575
$14,000
$6,300
$20,300
$14,500
$6,525
$21,025
$15,000
$6,750
$21,750
$15,500
$6,975
$22,475
$16,000
$7,200
$23,200
$16,500
$7,425
$23,925
$17,000
$7,650
$24,650
$17,500
$7,875
$25,375
$18,000
$8,100
$26,100
$18,500
$8,325
$26,825
$19,000
$8,550
$27,550
$19,500
$8,775
$28,275
$20,000
$9,000
$29,000
$20,500
$9,225
$29,725
$21,000
$9,450
$30,450
$21,500
$9,675
$31,175
$22,000
$9,900
$31,900
$22,500
$10,125
$32,625
$23,000
$10,350
$33,350
$23,500
$10,575
$34,075
$24,000
$10,800
$34,800
$24,500
$11,025
$35,525
$25,000
$11,250
$36,250
4/21/2004
RESIDENTIAL EMERGENCY REPAIR
PROGRAM
(RERP )
APPLICATION PACKET
List of attachments:
Fact Sheet
Frequently Asked Questions
Preferred Terms
Application Instructions
Loan Application
Care Provider Allowance
Medical Expense Allowance
Authorization for the Release of Information
Certification of Non -Filing of Federal Income Tax Return
Certification of Non -Filing of State Income Tax Return
Income Limits Schedule
Verification of Mortgage or Deed of Trust
Request for Copies of Income Tax Return
Notification -Watch Out For Lead -Based Paint Poisoning
County of Hawaii
Office of Housing and Community Development
50 Wailuku Drive
Hilo, Hawai'i 96720-2484
808/961-8379
2110r.cmy 02/20/04
COUNTY OF HAWAI'I
OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT
50 WAILUKU DRIVE
HILO, HAWAII 96720.2484
Telephone: 808/961-8379
RESIDENTIAL EMERGENCY REPAIR PROGRAM
(RERP)
FACT SHEET
PURPOSE:
To provide low cost loans to benefit low -and moderate -income homeowners in the County
of Hawai'i to repair the dwelling unit that they occupy as their residence.
PROGRAM FUNDING:
U.S. Department of Housing and Urban Development (HUD) Community Development
Block Grant Program.
APPLICANT QUALIFICATION:
Total adjusted gross income of all persons living in the householdnay not
exceed the attached household income limit schedule. (See attached schedule)
2. Applicant must be owner/occupant for at least one year prior to filing a loan
application for proposed repairs to the dwelling.
APPLICATION FEE:
There is a $250.00 processing fee.
DWELLING QUALIFICATIONS:
1. Single family dwelling owned in fee simple.
2. The dwelling must be a completed residence prior to the owner applying.
3. Cost of repairs is not more than 75% of the cost of replacement after repairs.
4. After repairs, the dwelling must be safe, sanitary and decent.
5. Dwelling may not be located in the Flood Hazard Area unless all flood hazards are
mitigated under Executive Order 11988, Flood Plan Management.
LOAN PROGRAM:
Loan Amount: Minimum $2,500 15 year term
Maximum $25,000 15 year term
Interest Rates: 3% Simple Interest
Term and Principal amount of loan due and payable upon transfer of ownership of the property,
for any reason, such as sale, inheritance, condemnation or foreclosure.
2110r.cmy 02/20/04
`A
COUNTY OF HAWAII
OFFICE OF HOUSING AND COMMUNTIY DEVELOPMET
RESIDENTIAL EMERGENCY REPAIR PROGRAM
(RERP)
FREQUENTLY ASKED QUESTIONS
Q. WHAT IS THE RESIDENTIAL EMERGENCY REPAIR PROGRAM?
A. The Residential Emergency Repair Program was established by the County of Hawai'i to
make low-interest loans available to eligible property owners who are interested in repairing
and improving their properties.
Q. WHAT KINDS OF REPAIRS OR IMPROVEMENTS CAN BE MADE WITH THE LOAN?
A. The LOAN can be used to repair and correct deteriorated and hazardous rorditions on the
property such as damage caused by termites or wood rot, leaky roof and drain pipes,
abatement of lead based paint, faulty electrical wiring and plumbing, hook up to County
sewer lines and termite treatment. The LOAN can also be used to accommodate the special
needs of disabled household members.
Q. IS THERE A FEE TO APPLY?
A. Yes, there is a $250.00 processing fee. A personal check, cashier's check or money order
must be submitted with the completed application. Pursuant to Section 2134, as amended,
of the Hawai'i County Code, there shall be a fee charged for a returned check due to
insufficient funds. If you do not qualify you will be refunded your $250.00 processing fee.
Q. WHO IS ELIGIBLE TO APPLY FOR A LOAN?
A. Owner -occupants whose total adjusted gross income of all persons living in the
household is within the income schedule listed below are eligible. The current maximum
income limits for owner -occupants, by number of persons in household, are as follows:
ADJUSTED INCOME LIMITS
1 2 3 4 5 6 7 8
$31,000 $35,450 $39,900 $44,300 $47,850 $51,400 $54,950 $58,500
5. Q. ARE OWNERS OF PROPERTIES WITH RENTAL UNITS ELIGIBLE FOR PLOAN?
A. No. Only owner -occupants whose household income is within the income schedule are
eligible.
6. Q. ARE SINGLE FAMILY DWELLINGS ON LEASE LAND ELIGIBLE FOR A LOAN?
A. No. Only fee simple, owner -occupant dwellings are eligible.
N
A. No. Single family dwellings on Department of Hawai'i Home Lands (DHHL) are not eligible
until a Master Agreement between DHHL and the County has been executed.
2110rcmy 03/12/04
U4 s
A. To insure that the property is safe and sanitary, all deficiencies cited by the
County's RERP inspector must be repaired and corrected.
9. Q. HOW MUCH MONEY CAN A HOMEOWNER BORROW?
A. The minimum LOAN is $2,500 the maximum LOAN is $25,000 for each dwelling
unit for owner occupied properties.
10. Q. CAN I APPLY FOR MORE THAN ONE LOAN?
A. No. Only one LOAN per household.
11. Q. WHAT KIND OF INTEREST RATE WILL BE BORROWER BE PAYING?
A. The interest rate is set at 3%. The LOAN is deferred for 15 years or until first
transfer of title. If the homeowner applies for a mortgage loan or a home equity
loan, the LOAN amount must be repaid in full.
12. Q. WHAT ARE SOME OF THE SERVICES AVAILABLE TO HOMEOWNERS?
A. The County's RERP inspector will inspect your property. The County will prepare a
Priority List of Repairs which will outline the deficiencies cited that must be
corrected.
13. Q. HOW IS THE LOAN SECURED?
A. LOANS will be secured with Security Contract ani Note on the property.
14. Q. WHERE CAN A HOMEOWNER OBTAIN MORE INFORMATION?
A. The County of HawaiTs Office of Housing and Community Development is located
at 50 Wailuku Drive Hilo and the phone number is 961-8379.
*"The term of the LOAN may be exbnded at the end of 15 years if the borrower remains
qualified for such a LOAN.
**Loans are subject to availability of funds
K
2110r.cmy 02/20/04
RESIDENTIAL EMERGENCY REPAIR PROGRAM
(RERP)
PREFERRED TERMS
Preferred terms shall be given to an applicant if he/she or any member of the household is a
member of any one of the following groups:
1. Elderly person 62 years of age or older.
2. Handicapped or disabled person, when the condition is verified by a medical physical
conducted by a physician licensed to pracice in the State of Hawai'i.
The preferred terms shall be as follows:
THIRTY PERCENT (30%) of the principal balance of the LOAN, will be given as a grant.
2. The Terms of the remaining SEVENTY PERCENT (70%) of the principal balance of the
Loan provided to an elderly person 62 years of age or older or to a handicapped or
disabled person, as defined above, shall be consistent with the Loan Specifications of the
RERP program RULES FOR HOMEOWNERS.
All legal owners shall required to sign a Security Contract arra Note and a Grant Agreement that
spells out the terms and conditions of the Loan and Grant.
2110r. cmY 02/20/04
COUNTY OF HAWAII
OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT
RESIDENTIAL EMERGENCY REPAIR PROGRAM
(RERP)
INSTRUCTIONS FOR COMPLETING THE APPLICATION FORM:
- Type or print information using black ink.
- Sign and date the application.
- Fill in all applicable information.
- Complete the "Request for Copies of Income Tax Return", Form
L-72, and mail to the State Tax officeon the back of the form. Be sure to follow the
directions on the back of the form. The State Tax Office will send you acertified copy of
your State tax return. Mail the certified copy to the Office of Housing and Community
Development (OHCD) as soon as you receive it
DOCUMENTS TO BE SUBMITTED WITH THE APPLICATION:
- Your paycheck statements from any employment for the last three (3) months fora//
working members residing in your home.
- Any other documentation of income forall household members (such as: Social
Security, Disability, Pension, etc.)
- Copy of your most recent Federal Tax Return that you have at home.
- If you do not file a Federal Income Tax Return, complete the attached Certification of Nora
Filing of Federal Income Tax Return, have it notarized and submit it with the completed
application.
- Copy of deed.
- Copy of your current Real Property Tax Assessment Card
- A personal check, cashier's check or money order for $250 payable to "Director of
Finance".
- A certified copy of your State tax return is required.Your application can not be processed
for approval without the certified copy.
RETURN THE APPLICATION BY MAIL OR BY PERSON TO:
Office of Housing and Community Development
Attn: Clyde M. Yoshida
50 Wailuku Drive
Hilo, Hawai'i 96720-2484
If you need any other information or assistance regarding the application, please feel free to call
Clyde M. Yoshida of our staff at 961-8379.
2110r.c.y 02/20/04
COUNTY OF HAWAPI
RESIDENTIAL EMERGENCY REPAIR PROGRAM
(RERP)
APPLICATION
APPLICANT (Head
of Household) Date of Birth
Last First Middle
Co -Applicant
(Spouse) Date of Birth
Last First Middle
SS#
SS#
LOAN NO.
Current Address Yrs. Res. Phone•.
Previous address if less than 2 yrs. at above _Yrs.
Mailing address if other than current address Yrs.
Name and ages of all dependents
(See Supplemental Form to list all Non -Dependent Permanent Household Members)
APPLICANT (CURRENT EMPLOYMENT)
Employer Yrs.
Position Held Yrs.
Address
Phone Gross Monthly Inc. $
CO -APPLICANT (CURRENT EMPLOYMENT)
Employer Yrs.
Position Held Yrs.
Address
Phone Gross Monthly Inc. $
If the current employment is for less than 2 years, complete the following:
Previous Employment Years Employed Last Position Held Monthly Income
Applicant _
Co -Applicant
OTHER GROSS MONTHLY INCOME
Recipient Source of Income Address of Source
W
$
$
c
TOTAL $
Gross Amount
2110r.c y 02;20/09
DEPOSITORY ACCOUNTS (BANKS, SAVINGS & LOAN, CREDIT UNIONS, ETC.)
Depository/Branch Name on Account Account No. Account Type Balance
LIST OF ALL REAL ESTATE OWNED (ATTACH ADDITIONAL SHEET IF NECESSARY)
Property Present Mortgage Monthly Mortgage Mortgagee's Name and
Address Value Balance Payment Loan No. Address
LIABILITIES — LIST ALL LOANS, CHARGE
PREVIOUSLY LISTED MORTGAGES
Payable To Address Account
ACCOUNTS, TIME PAYMENT PLANS, ETC. EXCEPT
Type Account Monthly Balance
Number Payment
Explain if you or any household members are disabled, handicapped or have other serious health
problems:
Brief description of repair work:
2110r.cmy 02/20/04
VOLUNTARY INFORMATION FOR GOVERNMENT MONITORING ASSISTANCE:
The following information is required by the Federal Government to monitor compliance
with equal credit opportunity and fair housing laws. You are not required to furnish
this information, but are encouraged to do so. If you choose not to furnish the
information, Federal regulations require the County Government to note race and sex
information based on visual observation or surname. Please initial below if you do
not wish to divulge information.
APPLICANT
I do not wish to divulge information (initial )
01 (
) Hawaiian (Part)
14
( ) Samoan
03 (
) Hawaiian (Full)
15
( ) South East Asian
04 (
) Portuguese
(Vietnamese
05 (
) Puerto Rico
Laotian, etc
06 (
) White
16 (
) American Indian
07 (
) Filipino
or Alaskan Native
08 (
) Korean
17 (
) Hispanic
09 (
) Chinese
18 (
) Black
10 (
) Japanese
19 (
) Other -please
11 (
) Asian Indian
Specify
12 (
) Guamanian
SEX: ( ) Male ( ) Female
Head of Household Head of Household
CO -APPLICANT
I do not wish to divulge information (initial )
01 (
) Hawaiian (Part)
14
( ) Samoan
03 (
) Hawaiian (Full)
15
( ) South East Asian
04 (
) Portuguese
(Vietnamese
05 (
) Puerto Rico
Laotian, etc
06 (
) White
16
( ) American Indian
07 (
) Filipino
or Alaskan Native
08 (
) Korean
17
( ) Hispanic
09 (
) Chinese
18
( ) Black
10 (
) Japanese
19
( ) Other -please
11 (
) Asian Indian
Specify
12 (
) Guamanian
SEX:
( ) Male
( ) Female
Head of Household
Head of Household
I (We), the undersigned, certify that all of the information provided in this
application is true and correct to the best of my (our) knowledge and is
submitted for the purpose of obtaining a County rehabilitation loan. I (We)
authorize the County of Hawaii to verify all information contained herein and
agree that this application and related verification and statements shall
remain the property of the County of Hawaii.
APPLICANT'S SIGNATURE DATE CO -APPLICANT'S SIGNATURE DATE
2110r..y 02120/04
APPLICANT'S NAME (HEAD OF HOUSEHOLD):
Supplemental Information Schedule
Please complete the following information on all non-dependent Permanent
Members of your household:
Name
Relationship to Head Source(s) of
of Household Age Annual Income
As evidence of income, please submit a copy of the most recent Federal tax
return and a certified copy of your State tax return for each individual
listed above.
If there are no non-dependent permanent household members residing with you,
please write none on the first line below NAME above.
I (We) certify that the above information is true and correct to the best of
my (our) knowledge.
APPLICANT'S SIGNATURE DATE
CO -APPLICANT'S SIGNATURE DATE
Please send or drop off Application to:
County of Hawaii
Office of Housing and Community Development
50 Wailuku Drive
Hilo, Hawaii 96720
Phone: 961-8379
2110r. my 02/20/04
EMERGENCY REPAIR PROGRAM
DO NOT APPLY
CARE PROVIDER ALLOWANCE:
If the following items do not apply to your family, please disregard.
Un -reimbursed Child Care Expense
If you pay (and are not reimbursed) for a care provider to care for a
child under the age of 13 who is a member of your family so that an adult
member of your family may work or attend classes, enter the first name of
the person who works or attends classes here and
provide the following information:
Name and Address of Care Provider for Verification:
Name• Address:
City:
State:_ Zip:
Date Child Care Began:
Total Child Care Cost: $
Telephone:
Average Hours Per Week:
Amount you Pay $ (circle one) per hr per wk per bi-wkly per mon
Amount reimbursed by an individual/organization: $
Name or Organization:
Un -reimbursed Disability Assistance Expense
If you pay (and are not reimbursed) for care or equipment for a disabled
member of your family so that either the disabled member or another
member of your family may work, enter the first name of the person who
works here and provide the following
information:
Name and Address of Care or Equipment Provider for Verification:
Name: Address:
City: State: Zip: Telephone:
2110r..y 02/20/04
RESIDENTIAL EMERGENCY REPAIR PROGRAM DO NOT APPLY
MEDICAL EXPENSE ALLOWANCE:
Complete only if the Head of Household, Spouse, or Co -Head is disabled or
age 62 or older.
If you wish to claim an allowance for medical insurance premiums,
medical, dental or optical expenses, or prescription or over-the-counter
drug expenses, please provide the name of any family member claiming each
expense and the name and address of the provider of the service or
product.
YES NO
Expense Claim:
Provider:
$
Address:
[ ] [ ] Do you
have Medicare (Social Security)?
If
YES,
Monthly
Premium
Amount
$ [
[ ] [ ] Do you
have Medicaid (Welfare)?
If
YES,
Monthly
Premium
Amount
$
[ ] [ ] Do you
have other Medical Insurance?
If
yes,
Monthly
Premium
Amount
$
[ ] [ ] Are you
paying on any medical bills?
If
yes,
Monthly
Premium
Amount
$
Balance
Amount:
$
Family Member:
Expense Claim:
Provider:
$
Address:
City:
State:
Zip:
Family Member:
Expense Claim:
Provider:
$
Address:
City:
State:
Zip:
Family Member
Expense Claim:
Provider:
First Name:
$
Address:
City:
State:
Zip:
Family Member
Expense Claim:
Provider:
First Name:
$
Address:
City: State: Zip:
2110r. any 0::/20/09
Authorization for the Release of Information
Hauai'1 County Office of Housing and Community Development
50 Wailuku Drive
Hilo, Hawai'1 96720
Authority: 42 U.S.C. 1437f and 3535(d), implemented at 24 CFR
982.551(b).
Purpose: In signing this consent form, you are authorizing HUD
and the above named HA to request information including but not
limited: to identity and marital status, employment income,
welfare income, assets, residences and rental activity, Medical
or Child Care Allowances, Credit and Criminal Activity. HUD and
the HA need this information to verify your eligibility for
assisted housing benefits and that these benefits are set at the
correct level. HUD and the HA may participate in computer
matching programs with these sources in order to verify your
eligibility and level of benefits.
Failure to Sign Consent Form: Your failure
Sign the consent form may result in the
denial of eligibility or termination of
assisted housing benefits, or both. Denial of
eligibility or termination of benefits is
subject to the HA'S grievance procedures.
Sources of Information: The groups or
individuals that may be asked to release
information include but are not limited to:
Uses of Information to be Obtained: HUD is required to protect the
information it obtains in accordance with the Privacy Act or 1974,
5 U.S.C. 552a. HUD may disclose information (other than tax return
information) for certain routine uses, such as to other government
agencies for law enforcement purposes, to Federal agencies for
employment suitability purposes and to HAS for the purpose of
determining housing assistance. The HA is also required to protect
the information it obtains in accordance with any applicable State
privacy law. HUD and HA employees may be subject to penalties for
unauthorized disclosures or improper uses of the information that is
obtained based on the consent form.
Who Must Sign the Consent Form: Each member of your household who
is 18 years of age or older must sign the consent form. Additional
signatures must be obtained from new adult members joining the
household or whenever members of the household become 18 years of age.
Previous Landlords (including PHAs)
Courts and Post Offices
Schools and Colleges
Law Enforcement Agencies
Support and Alimony Providers
Past and Present Employers
Welfare Agencies
State Unemployment Agencies
Social Security Administration
Medical and Child Care Providers
Veterans Administration
Retirement Systems
Banks and other Financial Institution
Credit Providers and Credit Bureaus
Utility Companies
Consent: I consent to allow HUD or the HA to request and obtain any information from any Federal, State or local
agency, organization, business, or individual for the purpose of verifying my eligibility and level of benefits
under HUD's assisted housing programs. I understand that HAs that receive information under this consent form
cannot use it to deny, reduce or terminate assistance without first independently verifying the information
obtained. In addition, I must be given an opportunity to contest those determinations.
This consent form expires 15 months after signed.
Signatures:
Head of Household Date
Date
Other Family Member over age 18 Date
Penalties for Misusing this Consent:
Social Security No. (if any) of Head of Household
Other Family Member over age 18 Date
Other Family Member over age 18 Date
HUD, the HA and any owner (or any employee of HUD, the HA or the owner) may be subject to penalties for
unauthorized disclosures or improper uses of information collected based on the consent form. Use of the
information collected based on this form is restricted to the purposes cited above. Any person who knowingly or
willfully request, obtains or discloses any information under false pretenses concerning an applicant or
participant may be subject to a misdemeanor and fined not more that $5,000. Any applicant or participant
affected by negligent disclosure of information may bring civil action for damages, and seek other relief, as
may be appropriate, against the officer or employee of HUD, the HA or the owner responsible for the unauthorized
disclosure or improper use.
2/2004 Original is retained by the requesting organization.
2110 r. any 02/20/04
Residential Emergency Repair Program
Certification of Non -Filing of Federal Income Tax Return
Name:
Name:
Address:
STATE OF HAWAII )
SS:
COUNTY OF HAWAI'I )
The undersigned hereby certify that the borrower (s), pursuant to the lays and regulations
as established by the United States Internal Revenue Service (IRS), did not file a Federal
Income Tax Return for the tax year , and that the borrower (s) understand that
misrepresentation of information or failure to disclose information will constitute just cause for the
County to call the loan immediately due and payable.
BORROWER
Subscribed and sworn to before me
this day of '20
Notary Public, State of Hawai'i
My commission expires:
2110x. cmy 02/20/04
Residential Emergency Repair Program
Certification of Non -Filing of State Income Tax Return
STATE OF HAWAI'I
SS:
COUNTY OF HAWAI'I
Name:
Address:
The undersigned hereby certify that the borrower (s), pursuant to the laws and regulations
as established by the State of Hawai'i Department of Taxation, did not file a State
Income Tax Return for the tax year , and that the borrower (s) understand that
misrepresentation of information or failure to disclose information will constitute just cause for the
County to call the loan immediately due and payable.
BORROWER
BORROWER
Subscribed and sworn to before me
this day of '20
Notary Public, State of Hawai'i
My commission expires:
2110x. cmy 02/20/04
COUNTY OF HAWAII
OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT
RESIDENTIAL EMERGENCY REPAIR PROGRAM
EFFECTIVE 03/2004
INCOME GUIDELINES
HOUSEHOLD
SIZE
TOTAL GROSS
INCOME
1
$31,000
2
$35,450
3
$39,900
4
$44,300
5
$47,850
6
$51,400
7
$54,9500
8
$58,500
FAMILY SIZE ADJUSTMENT:
Four each person in excess of eight, 8 percent of the four person base
should be added to the eight -person limit. (For example, the nine -person
limit equals 140 percent [132 + 8] of the relevant four -person income
limit.) All income limits are rounded to the nearest $50 to reduce
administrative burden.
2110rcmy 03/12/04
Office of Housing and Community Development
(OHCD)
50 Wailuku Drive
Hilo, Havai'i 96720
(808)961-8379
Application No.
RESIDENTIAL EMERGENCY REPAIR PROGRAM
VERIFICATION OF MORTGAGE
OR DEED OF TRUST
The client identified below has applied for a housing rehabilitation loan from
the Office of Housing and Community Development (OHCD). The applicant has
authorized the OHCD in writing to obtain verification of the status of
existing mortgages on the property from any source named in the application.
The requested information in this verification of mortgage is for the
confidential use of the OHCD and the U.S. Department of Housing and Urban
Development. Please furnish the information requested below and return this
form using the stamped, addressed envelop provided. If you have any questions
please feel free to contact our office. Thank you for your cooperation.
Clyde M. Yoshida
Housing and Community Dev. Specialist
50 Wailuku Drive
Hilo, Hawai'i 96720
(808)961-8379
PART I. Applicant Information (To be completed by applicant)
Name of Applicant
Address of Applicant
Address of Mortgaged Property
Mortgage Account Number
PART II. Lender Information (To be completed by applicant)
Name of Lender
Address of Lender
2110r. may 02/20/04
Form L-72 STATE OF HAWAII—DEPARTMENT OF TAXATION
(Rev. 1996) REQUEST FOR COPIES OF INCOME TAX RETURN
Date:
IMPORTANT: Before completing this form, please read instructions on the back of Form.
PLEASE PRINT
1. Name of taxpayer(s) as shown on tax form
3.
Your Social Security Number
2. Current Name and Address
4.
Spouse's Social Security Number
5.
Tax form number (Form N-11, N-12, N-13, etc.)
Account Number (For office use only)
(A)
6.
(A)
Tax year (No more than 3)
(B)
(B)
(C)
(C)
Telephone number of Requestor
Business: ( )
- Home: (_)
7.
(Check box) ❑ Request for copies
❑ Request for certification
Please sign here:
Name of Requestor :
Department of Requestor:.
GOVERNMENT AGENCIES ONLY
(Check box)
❑ Photocopy ❑ Review only
(IRS only)
Mailing address, if applicable: Signature of requestor's supervisor
Telephone number:
Date picked
Signature upon pickup
Photocopies
Number of pages:
Number of Certified copies:
Date picked up:
Examiner's initials:
Supervisory Investigator
OFFICE USE ONLY
(For other than government agency requests)
$1.00 =
$1.00 =
Q7FI[�'fp1
INSTRUCTIONS
Use this form to request a copy of an income tax return.
If you are not the taxpayer shown in item 1, you must present documentation reflecting you
to receive the confidential taxpayer information. This will generally be a power of attorney
signed by the taxpayer. If the taxpayer is deceased, you must present enough evidence to
you are authorized to act for the taxpayer's estate.
Joint tax returns may be disclosed to either the husband or the wife. Only one signature is
your name has changed, sign exactly as your name appeared on the return and also your
All requests must be signed by the taxpayer or authorized agent.
Item 3 — For individuals, the social security number is written 000-00-0000.
Item 6 — Enter the year(s) of the tax form you are requesting__Lf-you need more than th
periods, use additional request forms. Returns which were filed before 1986 may not bf
making conies
Fee — There are specific fees related to requests by taxpayers for copies of their returns
certification of returns.
Copies of returns — One dollar for each page reproduced.
Certification — One dollar for each return certified.
authorization
a letter
!stablish that
red. If
it name.
different
for
Where to file. After you have completed this form, send it to the District Tax Office where t e tax return
was filed. You must use a separate form for each District Tax Office from which you are r questing
copies.
Note: Processing of copies of returns normally takes 15 working days. You will be
or you will be billed through the mail when the copies are ready.
OAHU DISTRICT OFFICE
P. O. Box 259
Honolulu, Hawaii 96809-0259
Telephone: (808) 587-1455
MAUI DISTRICT OFFICE
P. O. Box 1169
Wailuku, Hawaii 96793-6169
Telephone: (808) 984-8500
HAWAII DISTRICT
P. O. Box 833
Hilo, Hawaii 96721 -
Telephone: (808) 9
KAUAI DISTRICT OI
P. O. Box 1688
Kauai, Hawaii 96766
Telephone: (808) 27
by telephone
CE
1
CE
Notification
Watch Out For Lead -Based Paint Poisoning
This property was constructed before 1970. There Is a posvbuiry, It contains lean-oasea paint. nesse reau mehouowm�
Information concerning lead-based poisoning.
Sources of Lead Based Paint
The Interiors of older homes and
apartments often have layers of lead-
based paint an Else walls, ceilings,
window sills, doors and door frames.
Lead based paint and prhners may also
have been used on oualde porches,
railings, garages, fire escapes and lamp
posts. When the paint chips, flakes or
peels off, there may be a real danger
for babies and young children.
Children may eac paint chips or chew
on painted rallings, windows sills or
other Items when parents are not
around. Children can also Ingest lead
even If they do not specifically eat
paint chips or dust particles containing
lead, they may get these particles on
their hands, put their hands Into their
mouths, and Ingest a dangerous
amount of lead.
Hazards of Lead -Based Paint
Lead poisoning Is dangerous -especially
to children under the age of seven
(7). It can eventually cause mental
retardation, blindness and even death.
Symptoms of Lead -Based Paint
Poisoning
Has your child been especially cranky
or Irritable? Is he or she easing
normally? Does your child have
stomachaches and vomldng? Does the
or she complain about headaches? Is
your child unwilling to play? These
may be signs of lead poisoning. Many
times though, there are no symptoms
at all. Because there are no symptoms
does not mean that you should not be
concerned If you believe your child
has been exposed to lead-based paint.
Advisability and Availability of Blood
Lead Level Screening
If you suspect that your child has
eaten chips of palnc or someone cold
you this, you should take your child to
the doctor or clinic for testing. If the
rest shows iliac your child has an
elevated blood level, treatment Is
available. Contact your doctor or local
health department for help or more
Information. Lead screening and
treatment are avallable through the
Medicaid Program for those who are
eliglble. If your child Is Idend Red as
having an elevated blood lead level,
you should immediately notify the_
Community Development or other
agency to which you or your landlord
Is applying for rehabillcatlon assistance
so the necessary steps can be taken to
test your unit (or lead-based paint
hazards. If your unit does have lead-
based palm, you may be eligible for
assistance to abare that hazard.
Precautions to Take to Prevent Lead -
Based Paint Poisoning
You can avoid lead-based paint
poisoning by performing some
preventive maintenance. Look at you
walls, callings, door, door frames and
window sills. Are there places where
the pain[ Is peeling, flaking, chipping,
or powdering? If so, there are some
things you can do Immediately to
protect your child:
(a) Cover all furniture and appliances;
(b) Get a broom or stiff brush and
remove all loose pieces of paint from
walls, woodwork, window wells and
ceilings;
(c) Sweep up all pleces of paint and
plaster and put them In a paper bag or
wrap them In news -paper. Put these
packages In the trash can. DO NOT
BURN THEM:
(d) Do not leave paint chips on the
floor In window wells. Damp mop
floors and window sills In and around
the work area to remove all dust and
palm particles. Keeping these areas
clear of paint chips, dust and dirt Is
easy and very Important; and
(e) Do not allow loose paint to remain
within your children's reach since
children may pick loose paint off the
lower part of the walls.
Homeowner Maintenance and
Treatment of Lead -Based Paint
Hazards
As a homeowner, you should take
the necessary steps to keep your home
In good shape. Water leaks from
faulty plumbing, defective roofs and
exterior holes or breaks may admit
rain and dampness Into the Interior of
your home. These conditions damage
walls and ceilings and cause paint to
peel, crack or Rake. These conditions
should be corrected Immediately.
Before repairing, all surfaces that are
peeling, cracking, chipping or loose
should be thoroughly cleaned by
scraping or brushing the loose paint
from the surface, then repainted with
two (2) coats of non-leaded past.
Instead of scraping and repalntng, the
surface may be covered with other
material such as wall board, gypsum,
or paneling. Beware that when lead-
based paint is removed by scraping or
sanding, a dust Is created, whlr.:h may
be hazardous. The dust can enter the
body either by breathing It or
swallowing it. The use of heat paint
removen could create a vapor or
fume which may cause polsoning If
Inhaled over a long period of time.
Whenever possible, die removal of
lead-based paint should take place
when there are no children or
pregnant women on the premises.
Simply painting over defective lead-
based paint surfaces does not eliminate
the hazard. Remember that you as an
adult play a major role In Else
prevention of lead poisoning . Your
actions and awareness about E1,e lead
problem can make a big difference.
Tenant and Homebuyer -- —
Responsibilities
You should Immediately notify the
management office or the agency
through which you are purchasing
your home If the unit has Raking,
chipping, powdering or peeling paint,
water leaks from plumbing, or a
defective roof. You should operate
wish that office's effort to repair the
unit.
[_] I have received a copy of the
Notice entitled "Watch Out for Lead
Paint Poisoning"
ate
Nanhe