HomeMy WebLinkAbout2019 RRP Authorizaion Form
Authorization for the Release of Information
Residential Repair Program
Certification of Non-Filing of Federal Income Tax Return
Name:_______________________________
Name:_______________________________
Address:_____________________________
_____________________________
STATE OF HAWAI'I )
) SS:
COUNTY OF HAWAI'I )
The undersigned hereby certify that the borrower (s), pursuant to the laws 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
___________________________________
BORROWER
Subscribed and sworn to before me
this _______ day of ________________, 20_____
________________________________________
Notary Public, State of Hawai'i
My commission expires:_____________________
Residential Repair Program
Certification of Non-Filing of State Income Tax Return
Name:_______________________________
Name:_______________________________
Address:_____________________________
______________________________
STATE OF HAWAI'I )
) SS:
COUNTY OF HAWAI'I )
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:_____________________
County of Hawai`i
Office of Housing and Community Development
Hilo, Hawai'i 96720
(808) 959-4642
Application No._____
RESIDENTIAL 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 envelope provided.
If you have any questions please feel free to contact our office. Thank you for your cooperation.
County of Hawai`i
Office of Housing and Community Development
Hilo, Hawai'i 96720
(808) 959-4642
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 _____________________________________________________
_____________________________________________________