Lead Investor's Application FY13

2. Property
Property Type*

Single FamilyMulti-Family
How many units are there?*
How many of these units are you enrolling?*
Note: Each unit enrolling requires a corresponding tenant application.
Property to be Rehabilitated*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Contact’s Phone #*
Please enter a valid phone number.
Is this property HISTORIC?

YesNo
Year property was built*
Is this Property under ORDER TO CORRECT?

YesNo
Year property was purchased*

List all owners of record and their addresses:
Owner 1*

Name

Address
Owner 2

Name

Address
Owner 3

Name

Address

Is your monthly mortgage up to date?*

YesNo
What is your monthly mortgage payment?*
Bank holding mortgage*
Address of mortgage holder*
Original mortgage amount*
Unpaid Balance:*
Utilities Per Year : Water & Sewer *
Common Utilities*

Do you have any additional mortgages or any liens on this property?*

YesNo
(List any additional Mortgages or Liens on Property- include any cross collateralization) *
Mortgagee Holder *
Address of Mortgagee Holder*
Monthly Payment:*
Unpaid Balance:*
An application will need to be completed for each tenant in order for your application to be considered complete. You will receive a tenant application upon completion of this application.

RENTAL PROPERTY INFORMATION:

Rows	Apt #	Tenant's Name (Owner's Unit if Applicable)	Household Size	# of Children Under Six Years Old	#of Elderly over 62	# Bedrooms
Choice 1
Choice 2
Choice 3
Choice 4
Choice 5
Choice 6
Choice 7
Choice 8

RENTAL PROPERTY INFORMATION (Continued):

Rows	Apt #	Is The Unit Vacant (Yes or No)	Do You Have a Lease	Total Rent	Utilities Paid by Landlord	Unit 504 ADA H/C accessible
Choice 1
Choice 2
Choice 3
Choice 4
Choice 5
Choice 6
Choice 7
Choice 8

Total Rental Income from dwelling units at full occupancy $*
List any additional monthly income from this property including garage, parking,and storage spaces(specify source) *
Monthly Income from Commercial Rent from this property*

REPRESENTATIONS AND CERTIFICATIONS OF THE PROPERTY OWNER/S
The undersigned hereby represents and certifies under the pains and penalties of perjury respective to the Property located at:*
Lynn, MA

A. CONFLICT OF INTEREST:
Is the Owner or any member of his/her immediate family, or any business associate, employed by the City of Lynn?*

YesNo
If yes, please explain:*

B. DECLARATION OF OTHER REAL ESTATE OWNED:
Are you an owner or part owner of any other real estate in the City of Lynn?*

YesNo
If yes, please explain:*

C. TAX AND CONTRIBUTION COMPLIANCE:

The Owner is in full compliance with all laws of the Commonwealth of Massachusetts and ordinances of the City of Lynn relating to taxes and to contributions and payments in lieu of the contributions
D. NON-DISCRIMINATION COMPLIANCE:

The undersigned agrees that there will be no discrimination on the basis of race, color, national origin, ancestry, age,sex, religion, disability, sexual orientation, presence of children, marital status, source of income or military status, in the sale, lease, rental use,advertisement or occupancy of the property that is rehabilitated with funds provided by the City of Lynn, Lynn Housing Authority and Neighborhood Development. Regulations issued by the U.S. Department of Housing and Urban Development (HUD) and the Mass. Commission Against Discrimination (MCAD) pursuant to Title VIII of the Civil Rights Act of 1968,as amended in 1988, and Massachusetts General Law, Chapter 151B, Section 4,shall apply.
E. OWNERS' PERMISSION TO ENTER AND INSPECT:

I/We hereby give my/our permission for the employees of the City of Lynn, Lynn Housing Authority &Neighborhood Development and their agents to inspect my property including conducting heating system analysis as a condition of applying for assistance through LLAP. Further, I/We relieve the City of Lynn, Lynn Housing Authority &Neighborhood Development its employees and/or agents from any and all claims of damage or liability arising from the performance of property inspections by the City of Lynn.
F. CERTIFICATION:

I/We certify that, under penalty of perjury, all information on this application to the best of my/our knowledge is true. I/We understand that false information given is sufficient grounds for rejection of this application. Furthermore, verification may be obtained from any source herein.
Penalty for False or Fraudulent Statement,U.S.C.

"Title 18, Section 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies...or makes any false fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five (5 years) or both.
All persons whose names appear on the recorded copy of the deed must sign here:
Signature*

Clear
Date*

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
APPLICANT'S RIGHT TO APPEAL

If you believe that you have been discriminated against regarding any decision made on this application because of race, color, national origin, ancestry, age, sex, religion,disability, sexual orientation, presence of children, or marital status, you may appeal that decision. Additionally, if you feel you have been wrongly denied assistance for any reason, you may appeal that decision. Appeals must be made within fifteen days of receiving the denial letter. All appeals must be in writing to the Director of Planning and Development, Lynn Housing Authority & Neighborhood Development, 10 Church Street , Lynn, MA 01902.
Should be Empty:

LYNN LEAD ABATEMENT PROGRAM

1. Applicant

2. Property

List all owners of record and their addresses:

REPRESENTATIONS AND CERTIFICATIONS OF THE PROPERTY OWNER/S

A. CONFLICT OF INTEREST:

B. DECLARATION OF OTHER REAL ESTATE OWNED:

C. TAX AND CONTRIBUTION COMPLIANCE:

D. NON-DISCRIMINATION COMPLIANCE:

E. OWNERS' PERMISSION TO ENTER AND INSPECT:

F. CERTIFICATION:

Penalty for False or Fraudulent Statement,U.S.C.

All persons whose names appear on the recorded copy of the deed must sign here:

APPLICANT'S RIGHT TO APPEAL