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Housing Counseling/Down Payment Assistance Application 

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A
Type of Income
B
Customer (Monthly Amount)
C
Co-Applicant (Monthly Amount)
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[Total][Total]

Please list any debts you have, including credit cards, auto loans, student loans, and child-care expenses.  Do NOT include rent or utilities

Last Column:  (Who's Debt?)

C = CUSOTMER

A = CO-APPLICANT

B = BOTH

A
Paid To
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Current Balance
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Monthly Payment
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Who's Debt
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Type
B
Name/Place
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Amount
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Type
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Customer
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Co-Applicant
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I authorize the Housing Counseling Agency to:  

(a) pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property;  

(b) pull my/our credit report and review my/our credit file for informational inquiry purposes; and  

(c) obtain a copy of the HUD-1 Settlement Statement, Appraisal, and Real Estate Note(s) when I purchase a home, from the lender who made me/us a loan and/or the title company that closed the loan. 

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.

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