Ordinance 94-59 ORDINANCE NUMBER. 94- 59
AN ORDINANCE ADOPTING THE COLLIER COUNTY S.H.I.P. DOWN
PAYMENT/CLOSING ASSISTANCE PROGRAM FOR FIRST TIME
HOMEBUYERS; ESTABLISHING POLICY GUIDELINES AND
ADMINISTRATIVE PROCEDURES; AUTHORIZING FORMS TO BE USED
FOR THIS PROGRAM; PROVIDING FOR CONFLICT AND SEVERABILITY;
AND PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the Florida State Legislature emacted the William
E. Sadowski Affordable Housing Act on July 7, 1992 (the "Act"),
Section 420.907, et seq., Florida Statutes, Chapter 91-37,
Florida Administrative Code, as a comprehensive funding package
for state and local housing programs to better enable
local governments to meet their responsibilities for affordable
housing in accordance with their comprehensive plans; and
WHEREAS, pursuant to the Act, the State has allocated a
portion of new and existing documenting stamp tames on deeds
(the "SHIP" funds) to local governments for development and
maintenance of affordable housing; and
WHEREAS, Collier County has adopted Ordinance No. 93-19
as amended, providing for a Local Housing Assistance Plan; and
WHEREAS, the County desires to adopt a Down Payment/Closing
Cost Assistance Program consistent with the Local Mousing
Assistance Plan.
NOW THEREFORE, be it ordained by the Board of County
Commissioners of Collier County, Florida that:
SECTION I: Title and Citation
This ordinance shall be known and cited as the
"Collier Coun%y S.H.I.P. Down Payment/Closing CoI~ All~l~ance
Program."
SECTION II: Intent and Purpose
A. The intent of this Ordinance is:
1. To adopt the S.H.I.P. Down Payment/Closing Cost Assistance
Program Policy Guidelines and Administrative Procedures for use
in the implementation of the Program.
2. To adopt application forms and other necessary forms for
use in the implementation of the Program. Said forms may be
modified administratively from time to time to conform with
requirements of funding sources.
1
SECTION III: Adoption of a Down Payment/Closing Cost
Assistance Plan
The Collier County Down Payment/Closing Cost Assistance Program
is hereby adopted. A copy said plan including program forms and
contracts is annexed to this Ordinance and adopted and made a
part of this Ordinance by reference.
SECTION IV: Conflict and Severability
In the event this Ordinance conflicts with any other ordinance
of Collier County, the more restrictive shall apply. If any
phrase or portion of this Ordinance , or the particular
application thereof, shall be held invalid or unconstitutional
by any court, administrative agency or other body with
appropriate Jurisdiction, the remaining section, subsection,
sentences, clauses or phrases and their application shall not
be affected thereby.
SECTION IV. Effective Date
This Ordinance shall become effective upon notice from the
Secretary of State that this Ordinance has been filed with the
Secretary oF state.
PASSED AND DULY ADOPTED by the B a of County Commis loners of
Collier County, Florida this ~ day of~-//~._.~ 1994.
-'~TTEST: j~. ARD OF COUNT COMMISSIONERS
A e~:' ~' to form and
legal sufficiency:
~ ~ fll~ wl~ ~
Assistant County Attorney o~ ~k~ ~ ~
fill ~ei ~ Y
COLLIER COUNTY S.H.I.P.
DOWN PAYMENT/CLOSING COST ASSISTANCE PROGRAM
GUIDELINES AND PROCEDURES
I. Introduction
In April of 1993, the Local Housing Assistance
Program,(Collier County Ordinance No. 93-19, as amended by
Ordinance No.93-33) was adopted by the Collier County Board
of Commissioners. This plan was designed for the purpose of
establishing local administration of the State Housing
Initiatives Partnership Program. (S.H.I.P.)
The primary goal of this legislation is to Increase the
availability of affordable housing to very low and low income
persons and families in Collier County.
Very low and Low income persons are defined in Collier
County Ordinance No. 93-19, and further amended by Collier
County Ordinance No. 93-33 as follows:
1)"~OW-incQme Person - means one or more natural
persons or a family, not including students, that
has a total adjusted gross household income that
does not exceed eighty (80%) percent of the median
annual Adjusted Gross Income for households within
the state or 80% of the median Adjusted Gross
Income for households within the ~etropolitan
Statistical Area or, If not within a Metropolitan
Statistical Area, within the County, whichever is
greater .... " (p. 4)
1
2)"VerV-~ow incgme Person - means one or more natural
persons or a family, not including students, that
has a total adjusted gross household income that
does not. exceed fifty (50%) percent of the median
Adjusted Gross Annual Income for households within
the State or fifty (50%) percent of the median
annual Adjusted Gross Income for households within
the Metropolitan Statistical Area or, if not within
a Metropolitan Statistical Area, within the County,
whichever is greater .... "(p.6)
Income data for the Naples Metropolitan Statistical
Area is supplied by the United States Department of Housing
and Urban Development (HUD) and applicable to all of Collier
County. The definition for "Annual Income" is found in 24
CFR, Section 813.106.
Section IV of the Local Housing Assistance Program
states that severs1 different strategies will be employed for
the administration and disbursement of SHIP funds. Strategy
#3, found on page 11 stipulates that a portion of the funds
be distributed through a Down Payment/Closing Cost assistance
'program for very low and low income first time homebuyers.
This strategy is more particularly described in Section VI
C., paragraph a. The Collier County S.H.I.P. Down
Payment/Closing Cost Assistance Program has been designed
2
using this strategy as a framework, and conforms to all rules
and guidelines governing the distribution of these funds.
Assistance provided in conjunction with this program
will be awarded to qualified applicants in the form of two
(2) 0% interest, deferred payment loans of up to $2500 each
for the purpose of down payment/closi.g cost expenses and
rehabilitation or emergency repairs to the subject dwelling
unit, respectively. The two notes, with s combined total of
up to $5,000 will be secured by a second mortgage payable to
the Affordable Housing Trust Fund, Fund 191, payable upon the
sale of the dwelling unit, or loss of homestead.
II. Marketin~/Outreacb
I. At least thirty days prior to the beginning of the
application period, Collier County will advertise this
program in both newspapers of general circulation and
periodicals serving ethnic and diverse neighborhoods. It is
anticipated that the vast majority of referrals for this
program will be generated by non-profit organizations such as
the Collier County Banking Partnership, or through local
mortgage brokers.
B. In order to comply with the Community Reinvestment
Act, local area lending institutions are ~ctively seeking
ways in which to address the credit needs of the entire
community. Ownership programs such as this serve as an
3
k
appropriate vehicle for lenders to demonstrate their
commitment to this legislation. As some participating
institutions may exercise more flexible lending requirements
than others, it is also possible for the partnership to act
as an internal referral source, affording the potential
borrower multiple opportunities at obtaining a first mortgage
loan.
III. Eliaibilitv Criteria - Down Pavment/Closina Cost
Assistance
A. Applicants will be recommended for this program
through participating members of the Collier County Banking
Partnership, and other non-profit organizations committed to
meeting the credit and housing needs of the entire community.
Additionally, S.H.I.P. guidelines stipulate that the program
and availability of funds be advertised in both newspapers of
general circulation and periodicals serving ethnic and
diverse backgrounds.
B. A firm loan commitment from a mortgage lender will be
required before any processing of required documentation can
occur. In so doing, the applicant will be pre-screened in
regards to total annual household income, credit history, and
capacity to repay. Applicants will be asked to sign
4
appropriate releases enabling the financial institution to
provide such mortgage related information to the Collier
County Department of Housing and Urban Improvement. Evidence
of hazard and flood insurance where applicable will also be
required, as well as a copy of the lender's title insurance
policy declaring the Affordable Housing Trust Fund as second
mortgagee.
C. Applicant Eligibility - Applicants will be required to
disclose the number of occupants expected to reside in the
subject dwelling unit, as well as their anticipated gross
annual incomes. Eligibility will be based on the following
set limits for gross annual income based on median figures
established in May of 1994, provided by the U.S. Department
of Housing and Urban Development (HUD):
1 Person $25,050 5 Persons $38,600
2 Persons $28,600 6 Persons $41,500
3 Persons $32,200 7 Persons $44,350
4 Persons $35,750 8 Persons $47,200
The above limits are reflective of the maximum income
allowed, adjusted for family size, under the designation of
low income household. These limits are subject to change on
an annual basis.
5
d) Dvelling Unit Restrictions - This prcxJram is
designed to assist in the purchase of single family
houses, duplexes, or condominium units only. The
maximum sales price allowable will be $83,160 for
existing homes and $95,400 for new construction, or
as amended by the state of Florida. Beneficiaries
must claim the subject dwelling unit as their
homestead.
e) First Time Homebuyer Status - In order to qualify
for the program, applicant(s) must not have
owned a home for a minimum of three consecutive
years. Verification of first time homebuyer status
will be documented in the participant(s) permanent
file.,
IV Administration of Down Pavment/Closina Cost Assistance
~nd Rehabilitation/Emeraencv Repair
A. The Director of the Collier County Department of
Housing and Urban Improvement shall be designated as
the Program Administrator.
B. The Collier County Department of Housing and Urban
Improvement will be responsible for the following
administrative duties:
1) Advertisement in a publication of general
circulation announcing the program and availability
of funds.
2) Accepting applications, Reservation Forms, and the
processing of all supporting documentation.
3) Verification of eligibility requirements for the
program, and approval of applicants.
4) The maintaining of all required documentation and
records of correspondence for each beneficiary in a
permanent file.
5) The preparation of Financial Reports detailing
S.I!.I.P funds used, remaining availability of
funds, and participating local financial
institutions.
6) The coordination of efforts between the Collier
County Housing and Urban Improvement Department,
Purchasing and Finance Departments, with the goal
being timely and efficient processing of all loan
documentation.
REOUIRED DOCUMFRTATION FOR
DOWN PAYMENT/CLOSING COST ASSISTANCE
X. The following documentation will be required of all
beneficiaries of this program. 0ocumentation required
for Rehabilitation/Emergency Repair Assistance will be
detailed in the following section. Packets will be
available through the Collier County Department of
Housing and Urban Improvement.
a) SALES CONTRACT
A copy of the fully executed sales contract and
loan application (Fannie Nee) will be required from
the applicant(s). The sales contract will verify
the listed seller, sales price, and proposed
closing date. The signed application will establish
borrower information that will be further verified
by other supporting loan documentation. A copy of
the sales contract and application will be
maintained in the borrowers permanent file.
b) H~SERVATION FORM
Requests for reservation of funds will be made by
the first mortgage lender through the use of this
8
document. Information contained in the form relates
to the borrower(s), financial institution and
subject dwelling unit. It will be the
responsibility of the first mortgage lender to
provide a completed copy of this form to the
Collier County County Department of Housing and
Urban Improvement in order to initiate the
qualification process. A copy of the Reservation
Form will be maintained in the borrower's permanent
· file.
c) CERTIFICATION OF FINaNCIaL INSTITUTION
The officer of the financial institution
underwriting the first mortgage loan will be
required to execute this combined form before a
Notary Public. The following information will be
verified through the use of this form:
1) Current Annual Family Income
2) That all information regarding the applicant
is true and correct.
3) that processing fees and closing costs paid by
the mortgagor are reasonable and customSty.
4) that all loan funds will be applied to the
required Down Payment/Closing Cost or
Rehabilitation Repair, and that the borrower
not receive any lean funds in cash.
A copy of the combined Certification of
Participant/Certification of Financial Institution
will be maintained in the borrower's permanent
file.
d) MORTGAGOR'S CERTIFICATION AND PAST RESIDENCE
Applicant(s) must not have owned any home for a
minimum of three consecutive years in order to
qualify as first time homebuyers. This document
will be used as verification of residence for the
past three years, as well as providing
information regarding current amount of rent,
and current landlord. A copy of the Mortgagor's
Certification and Past Residence will be
maintained in the borrower's permanent file.
e) 5,B.I.P. INCOME CERTIFICATION
This form is required documentation for any
program utilizing the S.H.I.P. monies as a
funding source. Information contained herein
relates to anticipated household income, assets,
and household data. A copy of the S.H.I.P. Income
Certification form wtll be maintained in the
borrower's permanent file.
10
f) AFFIDAVIT OF NO iNCOME CHANGE
Prior to signing Promissory Notes I and II, the
borrower must execute this form in order to
verify that there has been no increase in
household income since originally qualifying for
buyer assistance through this program.
g) PROMISSORY NOTE I
Promissory Note I will detail the loan
agreement established between the borrower and
the Affordable Housing Trust Fund, relating to
the funds for Down Payment/Closing Cost
Assistance. The Note will include details of the
loan including, but not limited to:
1) Borrower's Promise to Pay
2) Interest & Payments
3) Borrower's Right To Repay
4) Charges
5) Subordination
6) Borrower's Failure to Pay as Requested
7) Obligation of Persons Under This Note
8) Waivers
9) Uniform Secured Note
A copy of Promissory Note I will be maintained
in the borrower's permanent file. The Original
Note is to be maintained on file in the Collier
County Department of Housing and Urban
Improvement, and a copy will be maintained on
file iD the Collier County Finance Department.
h) SECOND MORTGAGE
The Second Mortgage.will be used as the security
instrument for Promissory Notes I and II, and
will be recorded by the Collier County Clerk of
the Circuit Court. Copies of the Second Mortgage
are to be held on file in the Collier County
Finance Department, and maintained in the
borrower's permanent file, respectively. The
original recorded Second Mortgage wtll be held on
file in the Collier County Department of Housing
and Urban Improvement. Payment of fees associated
with the recording of this document will be
the responsibility of the borrower.
t) THIRD PARTY VERIFICATION
Third party verification of will be necessary
whenever the applicant states that any part of
the household income is derived from public
assistance, a government agency, income
generating assets, or for formal verification of
12
identification or employment. The following
sources of income will require formal third party
verification:
1) Military Payment
2) ~Oqt~l Security Benefits
3) Public Assistance
4) Pension and A~Ruities
5) Unemoloyment Benefits
6) yeterans Administration Benefits
7) Educational Assistance
8) IDgome From Business
9) Recurrin~ Cash Contributions
11) Assets on Deposit
While formal, written third party verification is always
preferable, a memorandum to the file documenting the
conversation with the third party will be acceptable. In such
a case it is extremely important to specify the date, contact
person, phone number and address of the third party the
conversation is conducted with.
VI REHABILITATION/EMERGENCY REPAIR-ELIGIBILITY CRITERIA
A. In order to be considered, applicants must meet the
eligibility criteria for the Down Payment/Closing
13
Cost Assistance portion of this program.
B. Only construction, rehabilitation or emergency
repair of affordable housing which meets the
following definition will qualify under this
program:
"Rehabilitation- means repairs or improvements
which are needed for safe or sanitary
habitation, correction of substantial code
violations, or the creation of additional
living space." This definition is found in
Florida Statute 420.9072, and further described
in Chapter 91-37.007(31) of the Florida
Administrative Code.
Homes less than twelve (12) months old will not
qualify for rehabilitation/emergency repair
under this program, but will be eligible for
down payment/closing cost assistance loans of
up to $2,500.
D. Rehabilitation/Emergency Repalr loans will be
limited to $2,500 per borrower.
VII MONITORIN~ OF RE~RBXLITRTIONfEMERGENCY RZFAIR
X. Information regarding the nature of work to
be performed will be obtained through the
use of the preliminary building inspection
required by the first mortgage lender, a
copy of which will be maintained in the
borrower's permanent file. Health and safety
Housing Code violations are to be given
priority by contractors over any cosmetic
rehabilitation work.
B. The borrower will be responsible for the
selection of the licensed contractor who
will perform the rehabilitation/emergency
repair work. The contractor who is selected
must supply a detailed work write-up to the
borrower containing an itemized listing of
material and labor costs. This work write-up
is to be approved by the borrower, first
mortgage lender, and representative of the
Collier County Department of Housing and
Urban Improvement prior to the commencement
of rehabi]itat]on. A copyof the approved
15
work write-up will be maintained in the
borrower's permanent file. The monitoring of
the work will be the responsibility of the
borrower. Contractual agreements made will
be between the borrower and contractor. The
Collier County Department of Housing and
Urban Improvement will be provided with a
copy of the signed contract for
rehabilitation/emergency repair work, which
will ba maintained in the borrowar's
permanent file. Upon completion, any work
performed will be inspected by the Collier
County Permitting and Review Department. No
funds will be disbursed prior to delivery of
a satisfactory inspection report and
itemized contractor's invoice to the Collier
County Housing and Urban Improvement
Department.
VIII REOUIRED DOCUMENTATION FOR
REH~XLITATION/EMERGENCY R~RIR
A. The following documentation will be required of all
participants eligible for rehabilitation/emergency
repair loans:
a) Bebabilitation/Emer~encv Repair Work Write-Up
All work that is to be performed must be listed on
]6
this form detailing costs of-labor and materials.
A copy of the approved work write-up will be
maintained in the borrower's permanent file. This
form must be delivered to a representative of the
Collier County Department of Housing and Urban
Improvement prior to the commencement of any.
rehabilitation/emergency repair work. A signed
copy will be provided to the borrower, and the
Collier County Purchasing and Finance Departments.
Rehabilitation/Emergency Repair loans under this
program will be made up to a maximum of ~2,500.
b) Final lnsoectioq
A copy of the signed final inspection conducted by
the Collier county Permitting and Review
Department will be maintained in the borrower's
permanent file. A copy of the inspection will be
provided to the borrower, and also to the Collier
County Finance Department.
c) Promissory Note IX
This Note is to be utilized specifically for loans
made for the purposes of rehabilitation/emergency
repair work. Terms and cendi=ions will be
identical to those detailed in the description of
Promissory Note I, used for Down Payment/Closing
17
Cost Assistance. A copy of Promissory Note II will
be maintained in the borrower's permanent file,
and a copy will be kept on file in the Collier
County Finance Department. The original executed
Note will be kept on Zlle in the Collier County
Department o~ Housing and Urban Improvement.
d) Second MortasSe
As described in the section detailing
documentation required for Down Payment/Closing
Cost Assistance, the Second Mortgage will be used
to secure Promissory Notes I and II. The second
mortgage will be recorded by the Collier Collier
County Clerk of the Circuit Court. The original
recorded second mortgage wtll be kept on file In
the Collier County Department of Housing and Urban
Improvement. A copy will be maintained in the
borrow~r's permanent file, and a copy wtll be
delivered to the Collier County Finance
Department. Fees associated with the recording
or this document are to be paid by the borrower.
e) Ha~ver or Lien
upon completion oE the Rehabilitation/Emergency
Repair work, the contractor will be required to
execute a Waiver of Lien. No payments w111 be
la
disbursed until the county receives a Waiver of
Lien from the contractor.
IX Prooedure for Loan closinas and the
Disbursement of Funds
The lender underwriting the first mortgage
will make a formal request for the reservation
of S.H.I.P. funds by contacting the Collier
County Department of Housing and Urban
Improvement. Reservation requests should be
made a minimum of thirty days prior to the
contract closing date, and substantiated
through the use of the Reservation Form
detailed in the section describing required
documentation. At this point, funds will be
reserved, and the applicant will be assigned a
f~le number. It will be asked that all
completed Program documentation be provided
for the purposes of verifying the applicant's
eligibility, and to initiate the disbursement
process.
B. The Collier County Purchasing Department will
be notified of the request for funds through a
requisition, and a separate Purchase Order
will be issued for each borrower. Loan funds
19
for Down Payment/Closing Cost Assistance will
be issued in the form of two payee checks,
payable to the borrower/closing agent. Receipt
of these funds will be verified by the closing
agent, and further evidenced on the formal
Settlement Statement, a copy of which will be
maintained in the borrower'$ permanent file.
Anadditional copy will be delivered to the
Collier County Finance Oepartment. Copies of
all checks issued are to be kept in the
borrower's permanent file.
Funds disbursed for Rehabilitation/Emergency
Repair will disbursed in two payee form,
payable to the borrower/contractor only after
submission of the contractor's ~nvoice and a
satisfactory inspection report.
C. A representative of the Col]ier County
Department of Housing and Urban Improvement
will be present at loan closings whenever
possible. The representative will verify that
all mortgage and supporting documents have
been executed properly, and that the second
mortgage be recorded by the Collier County
Clerk of the Circuit Court. The recorded
second mortgage will then be kept on file in
the Collier County Department of Housing and
Urban Improvement. The completed borrower's
file will contain copies of all first mortgage
documentation in addition to'the S.H.I.P.
fumds provided by this program, for the
purposes of establishing a complete audit
trail.
21
DOWN
4) C(X~BINED CERTIFICATION OF PAR?rCIPA~tT
AND FINANCIAL IMBTIT~ION
6) ~)'I~tXPLO~,'DAPI'IDX~rTT
7) AFlrZDAVr? Of NO IN(,"'CD(g CKANO~
9) PRONrBBORY
1o)
COLLIER COblrrl
S,H,I,P, 1301411 PAY~ENT/CLOSZNG COST
ASSISTAHC~ PROGRiN
RESERVATIOM FORM
Financial Instz
Contact Person:
(Addreaa)
(Phone Number)
Appliesnit Age: SSHf
Race: African Am. Am, Indian
Aslan Caucasian
Hispanic
Co-Applicant:. Age:
Race: African Am,.... Am, Indian
Aslan Caucasian
Hispanic
Farm Worker: Yes He
Number or persons intending to reside in home:
Number of Xdultes Number ot Children under
Prooertv
Proper~y To Be Purchased:
(Street Addream)
(City) (State) (Zip Code)
Purchase Pricel New Existin~
Anticipated Closing De:el
Rural Urban
Residence Types Single Family Detached
Condo
Tovnhouse
Duplex
Nanufactured
Other (Please
Target Area: Yes ,,, Nc
Census Tract Number:
First-Time Homebuyer: __ Yes __ Me
(Cannot have had owi~ershlp within the past three years)
!~an Type: __ ~|A VA , _ FHIIA __ CONV __ ~HK PORTFOLIO IX)AN
fe Property in the City of N~tpIof~? Yes NO
"~ Florid. lieuslag F"/nln¢,' Alt~T
St,tie HoesinS fn|fh:fh, fi !'a rfncrship (SH1]~ ProSram
INCOME CERTIfiCATION
~ l} A. HomeOwns. FJtb~q:
~A. Hame(IJ~,lrtnq 29 tteeNk,!Si~ 2D. C"heckene:
~:. B. ~C,
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LI
,; D.
04 I
A.., A,4,fn
B,
C.
D.,, .
4..Tm~ ..A~-~., As~. ~, , ~. S....
~, km bl~,
~ A.f~fplfed Annual
,, ,A,
, ,,
D.
6, T~sI. m f b. c d ·
I) lieled £ffgfMIily, A~ rrel[rmm
Iflil~llwecc~TmnlsKemdcm~,mvmva'No'er'Ve~'d'~m~mnmclmmal,m~,~,~w~mslm~~
Yew IV, Nee A ppfknhle
C') APPL/CAFfr ITAT!:IklrffTx The im'~n,~ekm em ~ ~ m m I~ reed m A-mTmne meleeram mcevee fiN, efifibffky
cc~f)'dsal~m/rmemswelr~amtcxxvq~lewm~l~e~o4'my~owk~xxwkdlen~xlkf~mmt~~~
~IONA~ - ~ (34: HOUSEH(X,D) DATE
ASSET ADDENDUM TO APPLICATION
(for assets less than S5,000)
In order to properly qualily an applicant for SHIP Assistance, the lollowing asset information for all
occupants including minors must be obtained. This information wilt be used rof qualification pmlx~es
Assets Include:
Cash held in savings and/of checking accounts, trust funds, equity in real estate and othe~ capital investments,
stocks, bonds, Treasury bills, certificates of deposit, money market funds, IRA accounts, retirement and
pension funds, lump sum receipts (i.e., iotlery winnings, insurance settlements, etc.), and penanal propeTty
held as an investment (i.e., gem or coin collections, paints, antique cars, etc.).
(Do not include .r~='__~sary personal property such as furniture, automobiles, end clothing.)
A. I(w~)horebynntcthatxlmcombinedvalueofmy(our)aseU__does/__doesnotexceed$5,000.
TOTAL VALUE OF ASSETS: $
TOTAL ANNUAL INCOME EXPECTED TO BE DERIVED FROM ASSETS' $
: B. . I (WE) do not have any assets at this time.
APPHCANT DATE
APPLICANT DATE
COLLIER
S.H.I.P. DO~4 PAYI4ENT/CLOSIMG COST
ASSISTANCE
C~FICATION Or PA~ICTPA~
I, ~LY A~ORIZED AND A~ING OFFICER OF
THE PARTICIPANT ~ICH ~ILL ORIGINATE BOTH THE HORTGAGE ~A~ AND THE
PR~H ~AN ~ HEREBY DENSE AND
SAY, FOR AND ON BEHALF OF THE PARTICIPANT ~AT: (1) TO THE BEST OF
PARTICIPANT'S ~OWLE~E, ~E FOREGOING INFO~ATION IS ~UE AND CORRE~
AND ~AT ~E ~RRENT ANNUA~ FAMILY INCOME OF THE NO~GAGOR{S) IS ~SS
THAN ~E INCOHE LIMIT ESTABLISHED BY ~E
FOR ~E COUntY f ~ City f I IN ~HXCH TH[ RESIDENCE BEING ACQUIRED
~CATED= (2) ~g PARTICIPANT IS N~ AWARE OF A~Y FA~S OR CrRCUHSTANCES
THAT ~OU~ CAUSE IT TO OUESTION THE TRWH O~ COMPLETENESS OF A~Y
OF T~E FOREGOING BORROWER PROFILE~ {~} JH THE COURSE OF PROCESSING THE
~AN ~HENTS CONCERNING THE HORTGACORfS). ~N/~G ~AS CONE TO THE
PARTICIPANT'S A~ENTION ~ECH ~OULD LEAD IT TO 8ELXEVE THAT ANY OF
IWFO~TION SUPPLIED BY T~E HORTCAGOA{S} O~ ANY ~ER PARTY IS FA~E OR
~ISLEADING: (4) EAC~ INVESTIGATION UNDERTAKEN BY T~E PA~ICIPANT HAS
BEEN ~OROUGHLY UNDERTAKEN AND ~AS PROVrOED HO XNFO~ATXON ~HXCH ~OULD
LEAD THE PARTICIPANT TO BELIEVE THAT THE RESULTS OF SUCH XNVESTIGATIO~
A~E IN ANY WAY FA~E OR MISLEADING; ~5) THE PROCESSING FEES AND C~SXNG
COSTS PAID BY THE NORTGAGOR(S) ARE REASONABLE AND ~STO~MY, AND (6) ALL
~AN ~NOS WELL BE APPLIED TO ~E REQUIRED C~SXNG COSTS/~WN PAYMENT AND
THE NORTGAGOR(S) WZL~ N~ RECEIVE ANY ~RTION OF ~E ~AN ~NDS IN CASH.
AUTHORIZED SZGNA~RE (PLEASE TYPE OR PRINT
TIT~ (P~E PRINT OR TYPE) DATE
STA~ OF ~RIDA
~e foregoing lnsC~men~ vas ack.~ledged before Be this ~ day
of , 19.. , by
as
a cor~ra~ion. Me/She Is personally
knovn Co me or has pr~uced a va]ld dr~ver's license es
and did not take an oath,
Notm~ hblJc
Nota~'s printed or typed name
Commission Expiresz
CommimmJ.on Number:
CERTIFZCATION OF FFNANCfAL
l, ~I,Y AUT!IORTZED AND A~ZNG OFFICER OF TIlE A~VE-NAHED FINAPICIAI
ZNSTZ~TZOH, ~ H~HERY CERTIFY T!IAT, TO TIlE REST OF HY KffOWLE~E, THP
FOR~COZNC XHFORHATION fS TRUE AND CORRE~ AND THAT THE ~RRENT AIIIJUAt
FANfLY ZHCONE OF ~IE APPLICA~(S) IS LESS TIIAN ~;
ZNCOHE LZHXT ESTABLISHED BY COLLIER COUNTY IN ~HICH
THE RESIDENCE BEING ACQUIRED IS ~ATED.
AUTHORIZED SIGNA~RE (PI,~ASE PRIHT OR TYPE N~E)
TITLE (PL~SE PRINT OR TYPE) DATE
(For Anency Use only)
IIUD Reservation No. Approved By:
Expiration Date: Date:
Partcipant under the Collier County
Down Payment/Closing Cost Assistance Program
Ladies and Gentlemen:
Z/we understand that ANNUAL rAHZLY INCOH~ includes total income for 811
sources (before taxes and u~thholdtng) of 811 adult persons residing or
intending to reside In the residence to be financed with the proceeds
the NorCgage Loan. The in~ormation Contained in the £oZZowing statement
~s true and correct, end accurately sets forth al1 information relevant
to a determination of my/our ~amily#e Annual Family Zncome ae of the date
hereof, and to the best of my/our knovZedge and belief.
Primary Haas Earner: Secondary Naoe Zarner:
lie dlff~lel, ~18~ll lilt)
Nlme:
Pre.ent Addresez
(Number end Street) {Apt
(C~ty) {County) {State) {Z~p Code)
Current Rent Amountl
Number of Years It Current Addreams
Number of Persons in ramiiys .... Ages oZ such Persons
Current Land]ord:
Address:
(House and Street}
(cZty) (State) (Zip Code)
Principal ResJdences .for Prior Three Years
Relationship of
Ogner tO
{"none" or state
re]etionsh~pby
Dates Occupied Ovner's blood or by
Address from / To Name & Address martleas)
/
41 d/
UNEMPLOYED AFFIDAVIT
Bet'ore me this ...... day ot' 19._, personally appeared
. who, being duly sworn, deposes and says:
I. ! have made application for SHIP assistance from ..
2. Clxzk (a) or (b) as applicable:
· (a) I am not Fesendy employed but anticipate be~ing employed within the
next twelve months.
.... Co) I am not presently employed and do not anticipate becoming employed
within the next twdve months.
3. Based on my past x%~rk experience, skills, and income hisloty as refitclod in my income tax
return for the most rcccnl tax year (copy attachc~ and with adjustments to reflect
circumstances anlicipated within Ihe next Iwclve months, ! expect Io earn $.__ per year
when I become employed.
STATE OF FLORIDA
COUNTY OF
Beror~ me personally appeared who acknowlcd~l Io me II~
he/she/they executed the foregoing instrument Ihis __ day or ,19_.
[NOTARIAL SEAL] Noisy Public
State or Rotida st Large=
My Commission Expires:
COLLIER COD~EY
DO~FN PAYMENT/CLOSING COST ABSIBT~CE PROGR}a4
AFFIDAVIT OF NO INCOME CHRNGE
Homeowner Name:
Co-Owner Name:
Address:
DATE OF AFFIDAVIT:
I am signing this AFFIDAVIT OF NO INCOME CHANGE to certify
that my household income has not changed, since the time of
my original SHIP INCOME CERTIFICATION FORM, dated .
It is my understanding that my eligibility for the use of the
SHIP program funds depends on my household income and that
all of the information recorded on the SHIP INCOME
CERTIFICATION FORM is true, accurate, and current.
INCOME CHANGE: YES NO
SIGNATURE OF APPLICANT DATE
INCOME CHANGE: YES NO
SIGNATURE OF CO-OWNER DATE
' < INCOME CHANGE: YES NO
SIGNATURE OF OTHE]~ DATE
HOUSEHOLD MEMBER
COLLIER COUNTY
S.B.I.P. DOWN PAYMENT/CLOSING COST
ASSISTANCE PROGRAM
WAIVER OF LIEN
COLLIER COUNTY, FLORIDA Date=
LOAN N~MBER
WHEREAS the undersigned has been employed by
to furnish rehabilitation/emergency repair work for the
premises located at:
of which
is the owner(s).
The undersigned, for and in consideration of
(DOLLARS) and other good and valuable
considerations, the receipt whereof is hereby acknowledged,
do(es) hereby waive(s) and release(s) any and all lien or
claim or right of lien under the statues of the State of
Florida, relating to Mechanics liens, on the above described
premises and improvements thereon, and on the monies or other
considerations due or to become due from the owner, on
account of labor or services, material, fixtures or apparatus
heretofore furnished to this date by the undersigned for the
above described premises.
CONTRACTOR ~
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
(date) by (name of person
acknowledging), who is personally known to me or who has
produced (type of identification) )
as identification and who did (did not) take an oath.
Signature of Person Taking Acknowledgment
Name of Acknowledger (Typed, Printed)
Title or Rank
Serial Number. tf any
(NOTARY ' S SEAL)
PROHISSORY NOTE
,
(Property Address) (City) (Stele)
1, IOISi~-YR(S) PRCIOlS( TO PATI I/Ve promise to pay
($ ) (this &~o~nt wilt be
"pri~clpet') to the order el.
to shy other holder ef this Note (the "Lender"), khoSe oddroll
I/vl v~ferstt~cl that the tenclef ~y transfer the Promissory Note. The Larder
enyw so takes this Note by transfer e~d ~e is entitled te receive pey~eentS uMSr
Z. INS[liST; tritereat e~ this Note shall be Sere percent t0X) par eer~a~; escept that
If I/us fell to pay this Note aS reelfed. the Interest rite shall be Suelye pareses
(17~) ;~er erv-&f~ from the dote ~hen passeant ef this Note ia ek~e ~t:t I/ve pay it in
full.
3. ~Av~(Nf$:rr%~Cipal payligHts shall ~ deferred for the term ef the first ~rllsge
or ~tit the dote the lost paint %l ~ ~ reflM~e
or lottery the first ~rt~sge toes. I/Ve agree to I~dlalely ~y the entire I~
~er this Note. Nyl~ tollS paWnS shell h U.S.
&. I~e~e,s tiGHT T0 PR[PAT~ I~e have the right to Mke ~nts of prl~l~ st
tl~ kfore they ere ~. A pe~nt of WI~I~t ~ty is k~ ms e
~e~ l/we rake s We~nt, I/~ will tell the Note Notdee in wrlt(~ that l/m
et~ so,
I~e ~y ~ke · full We~t er ~rtlsl We,ll charts. The wo~e Hater wilt
vie e1% of ~ ~e~file to r~e the ~t el the ;rl~t~l thai I ~ ~r this
NOte. If I~e ~ke a ~rtlll preH~l. Ihere viii ~ ~ Chides le the ~ date
or In the ~t of ~ ~thty pa~nl ~lels the Note Holder sireel In ~rlll~ to
S, L~e CHARC[S: ff s lay, ~lch a~tles to this tos~ s~ ~lch lets · NXlM
C~ergeS. Is fi~tiy interpreted So that the I.terest er ether 1oa~ charles cottect~
or to ~ cottect~ in c~ctt~ v, th this teas ezceed the ~rmitted ilkits; then
why I~h Iol~ cheeSeS Shall ~ riled by the ~t MCelilry 10 f~e the charles
to the ~rmitt~ limit; s~ (lil any s~ airea~ cotlect~ fr~ ~ ~tch e~ce~
~%11~ timits viii k ref~ to ~/~. The Note Notdee ~y ch~le to ake this
ref~ ~ r~l~ the ~l~lpe% that I/W N ~er this Note er ~ ~kl~ I direct
~nt to N/~. If · ref~ r~el ~l~l~l, the re~tl~ wilt N treeill
· ~rttel pre~nt.
&. S~ORDINATI~: L~er e~ loftier eck~tedge a~ agree that this
Initr~nt is s~Jec% e~ i~rdl~te in lit res~ctl to the liens. ter~.
8~ e~itl~l of the first Deed of Trot e~ te all ~v/~es heretofore a~ er ~tch
Ny hereafter ~ ~ ~rswnt to the first Oe~ ef lrdt i~t~l~ eft s~
for the ~r~se ef Is) pretectl~ er further gec~t~ the ties ef the first 0oH of
Trust, curl~ ~flultl ~ the lorr~er ~er the first Oe~ el lr~t or tot e~ ether
~r~se e~prtssty ~rmitted ~ the first 0oH of Trust er (b) C~sfr~t(~.
rt~vetl~9. re, iriS, turntable. fteturl~ or ~1~1~ the Pr~rty. the tern
e~ provist~s of the first Deed of Trust are~r~l e~ c~trottl~. s~ they
s~rl~e l~ other ter~ s~ ~ovlsi~s hereof In c~fllct ther~tth. In the eve~t
of I foreclosure Or de~ in lieu of forecloses ef the firit Deed el fruit.
provltl~% herel~ er I~y preyilia% In I~ ether /otterfret leree~el festrlltl~
~e of t~e Pr~riy to t~ or ~erlte I~ h~seholdl mr etherwise reltrictl~ the
lerr~r's ability to sell the Pearly she(I ha, ~ f~ther force er effect
I~se~ent ~rs er ~cheler% of the Pr~rty. A~ ~r%~, i~l~i~ his I~Cellorl
I~ lieu of forecloses, the ties el this Society InStr~nt shall ~ntiellty
terminate ~ the Senior Lien ~ofder's ic~tSiti~ of title. provi~d that {i) the
te~fr has ~en liven written ~tsce of s ~f~tt ~er the first Oe~ el Trot
(ii) the truer shell Nt have curpd the ~fwl% ~er the firIf Deed of Trot vethis
the 30-day ~ri~ pr~ided in s~h ~tlce sent to the te~er.
7. 8~I~IIS) fAIL~[ TO PAY AS
(A) Oafmutt
If I/we do ~t ~y the full ~l as reWlr~ mn SfClt~ 3 I~ve, I/W will k
deflvt~. If I ~ in dellvii. the Note Nol~r ~y brl~ a~l s~f ICll~e
elapse% e% descried I~ (I)
the right to tx paid back for all ef its costs ore laiNrises, includlq, taut fieflimited
to, renewable itter~ys~ fees.
l. GIVIVG 0f NOTICES: ~lesS i~tlcabte lie rewirf4 I different ~th~, ~ alice that
~st ~ given te ~/~ ~er the lots v111 ~ Ilyon h ~li~ri~ It or ~
it ~ first cllsl Nil le N et the Pretty A~rfll ~ PIle I or at I dirtiest
e~ress If I/w give the Note ~el~r m ~tlce ef ~1~ dlffer~t ~resl.
A~ ~!lce that ~1 H given to the Note eeldee ~er this NOte ultt H IIv~
3(A) or at I dieenfant I~rell if I/d hlva ~en llvan I ~tJce of that different
~rs~ Ii fuily e~ ~rt~etty ~illel~ le keep lit ef the praiSeS Nde in thee
No~e. t~t~l~ Ihe praise te ply I~e full ~t. ~d. A~ ~rl~ ~e Is
lyerafter. surety er e~orser el this Nets Is else eliteted te ~ these thins. A~
~rl~ ~o takes ever these ~illetl~t, I~l~ the ~llletl~ of · ~re~ter,
i~ety or e~orter of this Note, II else ~lilated te keep ell of the ~ilee
In this Note. The Hole Holder Ny e~force its rights ~er this Note attest each
~rs~ I~lvl~elly or efai~st eft el us together. this N~S that ~ ~ ef us
~ r~lrH te ~y eft of the ~ts ~ ~er this Note.
10. VAt~RS: I e~ e~y other ~rs~ ~o has obtlga~i~s ~er this Note ~elve the rfgh~l
of presentN~t 8~ ~tice of dish~r, 'Presentsnil Hens the right te r~ire the
Note Notdee to dwM paint or ~tl ~. "NoisEs of 0ilh~re N~S the rl~t
to r~ire the Note Holder to live NtiCe to other Nrl~s that ~ts ~ hive
II. ~lf~N SE~ED ~1[: this Note is I ~lrerm en~trwnt ulth Ilmit~ verlltl~
Im jvrlsdlcti~s. In e~ltl~ to the ~otecti~ liven to the Note Nelder ~r this
Notes a Herrgage, Oe~ or trdt er Sec~ity Deed (the 'Secttry Insremain), ~tH
the sw date as this Note. ~otects the Note Holder rim ~lslbte tosses ~lch might
result If I/w ~ ~t keep the praises ~lch I/w Nke In this Note. That Sec~lty
Instr~nt describe h~ aM Wee ~$t c~lt(~l I/w Ny ~ r~lrH to Mkl
I~dlate ~nt In full of all ~tS I/w ~ ~er this Note. ~ of those
c~itl~s are ~serl~d as felts:
Transfer of the Pretty or a lentilclot Interest In Iorr~r, If ell er ' e~ ~rt
of the pretty or e~ Interest in It Is sold or tra~ferr~ toe If I ~flclal
interest In IorrMr Is sold er traMf erred A~ lorr~r II Nt · Nt~sL ~rl~)
vlth~t te~r~l ~lor vrltten c~sent. Le~er Ny. It i~l etl~, r~ire i~Jlte
~nt In fvtt er eli e~ secured ~ this faculty Instreat. n~ver, this
shell ~t ~ exercis~ ~ Le~er if enerclse is F~iblted ~ federa( tie as or the
~te of this SK~Ity
If Le~er exercises this etl~, Le~er shell live Iorr~er NIlIv ef acceteretl~.
The ~tice shelf ~ovlde · ~rl~ of Nt less then thirty (30) days fr~ the date the
~tlce Is ~tlver~ er Nile, elibin ~lch Iorr~r ~t ~y all l~ lec~ ~ this
Security Instreat. If IorrNr(I) fell to Ny thelf l~ ~ler to the etplretl~
or this ~rl~, Leer Ny 4~ke a~ r~iel ~rmitted h this Sect try
vl that f~ther Nt Ice er d~ K loreMr.
Notvlthtt/~iq the e~ve, the Legates flints 10 eelleEr ~ 8~ty the
pr~e~s harder shaft H s~ject e~ s~rdiMte to the rights of the Senior
Notdee to collect ~ o~ty t~h FKf~6 I~ accorde~e ~ith the first Oe~ of Tr~l.
VeTHESS THE eA~(S) A~ SEALEg) Of THE ~teSlGNEP.
Egesl)
Iorrover
(fell)
lerre~er
(feet)
leftover
( Sell )
Iorrover
Return tog
Collier County Departmeal ef uovtlhl & Urban I~prevement
)800 North HorSeshoe Drive
Haplet. It
Phcne: (813) 6&3.8330 fax: (81))
(0111
City of Naples
~S 8th Street S~th, t~
NapLes, FL
Attn: S~efi Golden
-Z-
THIS S(CONO NOIITCAGE ("Security Instrumentw) Is glve~ on , 199__. The Sectrod Hortlll~f Ill
(''lotrover"). This Security Instrument Is liven to
(=Lender"), ~tch is organized. and existing under the lays of the Ur~ltnd States of
America, ind ~d~ose actress Is Iofro~er
Le~er the S~ of (U.S. S ).
~4des for ~thty pl~nt&, vnh the lull dtb(, if ~t pagd earl,~', ~ aM p/ylble ~ .
Ibis S~curily Instrine SeCureS to te~cr: Ca) the re~nt of the ~cbl Cvide~td h the NOKC, with interest, I~
results, e~trAs,~$ I~ ~lficll,~&; (hi Ihe p.~l of all Oth~e ~, with triterell ~ ~ee Nragrl~ ? 10
this Security Inltr~nt I~ the Note. for I~li ~se, Iorr~r doe~ h~f~ lec~ Nrtgaee, Irlnt l~ c~ty te
Lt~er the Iolt~l~ descri~ prodtry t~ited In ,C~ty, ft~l~.
As mere plrtlcutarty described off Exhibit NA,' and ~f, lCh has the ecUrels ef
(NProperty A~lress"):
(Street)
(City} (State) {Zip)
TOGETN[It VITN ate the I~mntl ~ or hereafter erect~ ~ the ~rty, I~ lit eas~tS, rights.
or hereafter a part of the ~rty.' All replacenil e~ ~ifi~s shall also ~ Cover~ h the Security leatrifle.
All Of the fore9ot~ is referr~ to in this Security In~tr~nl as the
1. Pe~t of Prl~l~l e~ Interest; Pr~t I~ Late Charges. Iorrher s~all pt~tly Day ~ee
prl~l~l of a~ interest ~ the debt evtde~ed ~ the Note a~ any pre~nt t~ late Charges M ~er the Note.
2. r~s for Taxes ~ IMbibe. At art ti~S that the NOte iS
~tlte~l~, t~e Nortglgor shall winrein inSura~e vith reSHCt to the Praises against S~h risks I~ for IKh
i~l~l~, ~t ~t limited to , all.risk insvra~e protectl~ the 4nlereSts Of the NortlagOr a~ Hortlagee Illicit loss
or dlNge to the Premises h fire. llghtnl~, e~ other catMettles cvst~rity tnsur~ against (l~l~t~ ~Iter
e~ptosl~, 4f a~roprtate}, ulth I ~lform sta~lrd altered coverage e~rlWnt, I~t~l~ ~ls r~vst
$~h Insure~e It eft tins to ~ in an ~t ~t less than the fuel reptacNnt COSt of the Praises, excl~ive
f~tl~s e~
3. A~tiCltim of PB~TI. ~tesl l~liclble tam provides Other,lie. all ~nts rec/lv~ ~ Le~ef Ihl:~
H a~lled; first, tO interest ~; e~, to pri~i~t ~; a~ test, to ~ tale Charges ~ ~r the Hole.
Iorrwer shell pretty f~ntsh to ke~tr Jet ~tictl of ~ts to ~ ~ld ~er this ~ralre~. a~ all receipts
evfde~l~ the ~nts.
!he proceeds to reDdie or restore !he 0re,arty er to ply lugs SeCured by
then ~. Ihe ]O.day Hrl~ ~11 ~ ~en l~e ~l~(f Is ~iled.
~tE~ Ihe ~ dale or Ihe Kn~hty ~a~fit~ referred 10 tn ~ragrl~ t Or
~er paragra~ ~1 the Pearly is aceweed ~ Le~er, Iorr~r'i rwghl Io I~y ,nsurl~e ~1 ictes I~ pr~t~l
resvl~i~ fr~ 4i~e ~ Ihe ~r~rty prior to Ihe ec~lltt~
6. ~c~y, Preservali~, malnl~e ~ Frothlira or the Pr~rly; I~r~r'l i~ A~IIcItI~,
Leal~olds. IOrr~er Shill ~C~. e~r~UIiih, I~ use lhe Pearly ~ Iorr~r'l ~t~ipll resident uilhtn Iixly
ddyi i(l~r Ihe eserullm of Ihtl ~efurily I~!r~t n~ Shall C~lt~ I0 KE~ Ihe Pretty Is leerwares
Iorro~r'l C~Irol. IOrr~er shall ~l U~lroy, d.~g~ or l~ltr Ih~ Pro~rly. Ill~ Ihe Pr~rly Io ~elerl0rlie,
or C~li vlsle ~ the Pr~rly. Iore~r shall ~ in d~flull !1 any fDrleilure ICI6~ 0r Dr~erdl~, ~elher Civil
or crlmi~l, It ~9~ Ihll in Le~er'i g~ rltlh ~9~nl cwld re,vii
NTeri/lly I~,ir Ihe lien Cre/l~ ~ Ih,t Sfcuruy lniir~nl or Le~cr't ~ecurtIy in!lrril. loftier Ny cure
~h I dellut~ I~ reinsTale, as ~rovid~d in Dlrlgra~ 18, ~ C~lq the ~Cll~ Or pr~eedinl I0 ~ O~tmt~ied wll~
a rull~ lhll, in tt~lr'~ g~ f/1lh delrrmlnlll~, Drecl~eS fOrfailure
Iorr~r Shill also ~ in ~fauil if letter, ~r~ Ihe 10an a~llcait~ DrKess, gave mlerially false or
c~ty vith Ill The provision o1 Ihe State. If loftier aCeireS fee
fee lltle shall ~t ~rte ~ttss te~er agrees to Ihe ~rger ,n ~r616~.
a~re~tl c~taz~fd i~ this Security Inherent. or there tS I legal ~eedl~ ~hlt ~y lilnifitlntty affect
te~r's rights ~n the er~rty (s~ I$ I ~oceedtng ~h ~kr~tcy. DroWse. for c~lt~ Or (OrfeITure or Io
the Pretty to Nke repairs. Alth~h te~er Ny take ICti~
r~irel) pr0vldrd by in insurer a~r0ved by Le~er again ~c~S available
9. I~ti~. Le~rr 0r tit a~ent Ny Nke ~eas~able Cntr,es ~ ~ IntOclips of the ~ro~rly.
here~ Illif~d I~ shall N paid to Le~tr.
the ~e~t ~ltipli~ ~ The/ollhi~ fraCti~: {/} the 10lal
tlkl~. dtvld~ h (b) the fair Nek~l vIEW 0f the Pretty iwdtllely ~fore the
~td to Iorr~er.
15. Covemini Lay; Severability. fh,S Seturtly Instrk,ernl ahall be gayfred by federal lay e~ t~e lee ef
~e )vrisdlct~ ~ ~lCh the Pr~rly ss t~e~ed. I~ the tve~f that ahy Drovist~ or cla~e of Ibis Security
I~tr~nt or ~he Mote c~fl icts v~fh e~llcable law, S~h C~lt~CI Ahall ~t affecI other prov~s~s of t~ts
lechery I~tr~nt 0r the Note ~ich can N I,ven effect vlth~t the c~ftt/tl~ ~elt~, t0 this e~ the
preylairs ef this Security InsteRnS I~ the Note ere ~cler~ to ~ severabte,
16. IorrMr*l C~, IorrMr Shell N liven ~ C~forM c~ of the Note I~ of this Security
InsIrene.
1T, tr~&fer of the Pretty er , Iwflciet Interest In BoerMr. If lit er Bay ~rt of the Pretty
a~y Intfresl in :t is sold or transferr~ (or if a ~fictli ;nitreSt tn 10rear tS sold or franlferr~ l~
i~iate ~nt in full of ell I~ lec~ ~ tht~ Security I~slr~nt. N~ver, this ~ti~ shill NI N
eeergtl~ h ke~er If eaerctse is ~tbit~ ~ f~eral law Is of the date of this Sec~Ity Instrine.
If ke~tr exercised this ~tt~, Le~r shall give Iorr~r notice of acCeleratt~. the ~t~ce shall provide
~r:~ of ~t tess thin ]0 days fr~ the date the ~tice is ~ltvrrrd or Riled wlfhlh ~ieh Iorr~r ~t ~y
~r&H, te~er Ny i~oke ~ r~deeS ~rmllttd h this Sec~ety Instrine ~,lh~t I~ther ~t~ce er deN~
18. lorr~r'l eight tO lei~tlte. If loftier ~Cl~ Cfrtlt~ C~tIa~S, lOrr~r skill ~lvf the right
Inttr~nt Shall c~tt~ ~ha~rd. ~ reinStalent ~ loftier, t~ts SeCurely InStrWnt a~ the
SeCur~ hereh shall r~in fully elfactive It 1l ~ accettrati~ hH ~cvrr~. ,waver, this right to relnstlte
Shill ~t i~ty in the case of acceleratt~ ~er ~ragra~ !?.
19. Sale of Note; Cho~e of tm Servitor. the NOte Or ~ ~rttlt talerest tn the Note (together flth ihil
I~ the entity fk~ at Ihe "Loan $rrvicer') thai COlleCtS ethly p/~f~ M ~r the NOte I~ this SeC~ity
juritdlCtt~ ~ere the PeoNely Is I~at~ thal relate to health. safety or envlr~lat Fotectt~.
21. Acceleratl~; I~les. te~er their give ~tice to loftier ~ior To eccelermtl~ fottwiq
parlgra~ 17 ~less e~lIcable tie provides OtherviSe}. Ihe ~tice shall I~ciiy: (I) the ~llvll; (b) the
r;tr~ to Cure the default; {c) I date, ~t less than ~0 days Irm the date Ihe ~tice II given to Iorr~r,
~ich the ~fautt ~t N Cvr~; m~ (d) that eatlure to cure the ~f~tt ~ Or ~fore Ihe date i~ctftN ih the
~e~4~ a~ sale of the Pretty. the Mtice shall I~lhtr inform Iorr~r Of the rill tO ratestile
Net of Ibis Security InsteRnS. tCheck J~ttceble
~ AdJ~teble aate eider ~ ease I~t Rider
~ Gr~lt~ Pa~t eider ~ ~-& f~lly tier
~ Ple~ ~4~ Oevelo~nt Ride, ~ O~hrrfs) (S~CiIy
$1fni. cI, Seated end det l,l.~red tn Ihe if)reafrire off
eorrever
Acidroll:
IIIr~ttres Illfiature~ (Seal)
iorrover
Print lame
Addreset
IIIriture| IIl~tures
lotrover
Print
Acidrill1
Sllnltvre: SIgnature: {Sell)
lorrover
Addresl~
STATE
CCtMTYOf
I hereby certify thlt e~ this day, before me, ,~ officer duly ~tthorlz~l In the S~Bte aforesaid mncl In the
Coultylforellld to like eck~ovt~d~t~sefitS, personally a~lred
· tome knotm to be the person(I) described In ard d~o ezecuted the
foregoing
Instruw~t end ecknovtectged kforl me that executed the cadme for the purpose therein expressed,
VITIIISE my hand :rd official seat In the Cotjnty ,rd Stele aforesaid this clay of , 19 ,
I~/,Cemlflllorl Expireit .
Notlry Pubtlc'l Sitnature
(SIAL)
.. '~. '...
COLLIER COUNTY S,H.I,P,
DOWN PKYMENT/CLOSING COST
ASSISTANCE PROGI~d4
SUPPLEMENTAL DOCUMENTATION
FOR
THIRD PARTY VERIFICATION
1) APPLICANT/TENANT RELEASE AND CONSENT
2) VERIFICATION OF EMp~X)yMENT
3) VERIFICATION OF SOCIAL SECURITY BENEFITS
4) VERIFICATION OF PUBLIC ASSISTANCE
5) .VERIFICATION OF MILITARY PAYMENT
6) VERIFICATION OF VETERANS ADMINISTRATION BENEFITS
7) VERIFICATION OF EDUCATIONAL ASSISTANCE
8) VERIFICATION OF CHILD SUPPORT
9) VERIFICATION OF P~NSX. ON AND ANNUITIE~
10) VERIFICATION OF RECURRING CASH CONTRIBUTIONS
11) VERIFICATION OF INCOME FROM BUSINESS
12) .VERIFICATION OF ASSISTS ON DEPOSITS
'i
COLtIER COUNTY S. II.LP, DOWN PAYMENTICLOSINO COST
ASSISTANCE PROGRAM
APPLICANT/TENANT RELEASE AND CONSENT
!/We . the undersigned hereby eutho~zc
. ;o rclcasc wixhoul liabilily, information
tegarding my/our employment, income, and/or asscts Io
(owner or/gent)
for purposes of veriFying information provided as pan oflhc owners assistance under the SH]P
INFORMATION COVERED
I/We understand Illat previous or current in fom~stion regarding me/us may be needed. Verifications and inquiries thai may be
requested inlcude. but are not limited to: personal identify; employmenl. income, and assets; medical or child care allowances.
I/We understand that Ibis aulhorization cannot be uK.d to obtain any information about me/us that is not !~Ttinenl Io my eligibility
for the SltIP program.
GROUPS OR INDIVIDUALS TIIAT MAY BE ASKED
TIle groups or individuals Ihat may be asked to release tile above information include. but are not limited Io:
Past and Present Employe~ Welfare Agencies Velerans Administralion
Previous Landlords (including State Unemployment Agencies Retirement Systems
Publie llousin8 Agencies) Social Security Administration Banks sad other
Support and Alimony Proriders Financial Institutions
CONDITIONS
I/we agree thai a photocopy of this autlmrialion may be used for the Purpcses stated above. the original of this
autlmr~zalion is one ~le and will stay in effcet for ayear and one month Irons Ihe dale signed. !/We understand !/we have a right
review Illis fik and corrccl any information thai I/we can provide is incorrccl. ,
S/GNATURF..S
i lead of i lousehold (Pri,t Na,,e) Dale
S[~q.~ (l'rinl N:..nc} Dale
Ad,h K4,,'mi,ce II'um N;mwl I)alv
Ad,h Mc,d,,'r (|qml N.msc} II,le
N(III~ 'I'III.~(;I;NI~I(AI.('ON,~I~NTMAYNOI III:.IINI:I) I~,~I{I:¢)III.:.~TACI'H'YI,II-ATAX I{I:IIIHN. IFAI':{.H'YOI:A
'rA X RI.~I'I ||.t N I.~ NI !1 ~1 }|;11. }l.t?,, !-"t )|{ lvt 4~lle.. -t.e I e,,ll q..~ I I '1 )1{ I '1 )!'Y { )F TAX F! 1,1{~,,I- I~¶1 i.~ I III. |'IIF. I'ARFI ) AND
SIt;NFI) NFI'AI(A I I.I Y
~N OF:
COLLIER. COUNTY S.H.I.P. Ernploya Since Occupation ,
DOWN PAYMENT/CLOSING COST
" $sh~. Effcctiv~ Date of Last IncPAse:
· ASSISTANCE PROG RAM B,s¢ Pay Rate:
lit __.; of Wk ; ot Mo
COLLIER. COUNTY DEPARTMENT OF Average HrdWk .t Ihs¢ Pay Rate,: ....Hours
': HOUSING AND URBAN IMPROVEMENT Weeks .. or Mo, lhs worked per r-ar.
:2800 NORTH HORSESHOE DRIVE Ovcdimc Pay Rmt¢: Per !{r. .
:. NAPLES, FLORIDA 33942
Expcclccl average number of hours ovc~irnc worked per week
durinB ncxl 12 momhs __
Any o~hcr compcnsation mX included sbov~ (six:oily for
commissions, bonuses, llps, tic.):
AUTIIORIZATION: State and Federal Regulations FOR S ....
require us to verify Employment Income of all Is pay teceivexl for vaution? __ No. ofdayt/yr. .
members of the household applying ror assistance.
We ask your cooperation in supplying this TouI Base Pay F. aminLgs for pasl 12 mot
inFOrmatiOn. This information will be used only Io
dclcmline the eligibility sialus or Ihc household. Total Ovcni~nc .Earnings for pall 12 mot $.__
Probability & Exrectcd Dale of Any Pay Increase:
Your prompt return of the requested information will
be appreciated. A sclr-addrcsscd return envelope is Does ihc Employee have access to
cnclosed. Rcfircmem Account [Ycs] ['No]
whal smotml S
RELEASE: I hereby authoriz~ the release of the Signature or or
requested inromlation.
Authorized Representative
Title:
(Signature of Appl icanl)
" Date:
=. Date:
i Tclcphonc:
, or;
A copy of Ihc cxcculcd "Release or Information Fom~"
is allachccl which nellhorizoN Ihc rclc:ssc {}f information
· .~...t;-C.{lLeslcd. _,.,.:=.- ..-.:. ........ . ....
VERIFICATION OF: Social Security Benefits
COLLIER COUNTY S.I{.I.P. Stw:ial Security Data
DOWN PAYMENT/CLOSING COST
ASSISTANCE PROGRAM
Date of Birth
COLLIER. COUNTY DEPAP,'~viENT OF
HOUSING AND URIIAN IMPROVEMENT .. Gross Monthly Social Security Beneilt Amount,
2800 NOKTlt !IORSESIIOE DRIVE Type of Bene~t
NAPLES, FLORIDA 33942
Gross Monthly Supplemental Securith Income
Payment Amount (including State Supplement)
Type of Benefit
AUTIIORIZATION: Stale and Federal Regulations
require us to verify Social Security Benefit Income of all
members of the household applying for assisinnce. We ask · J J Am<~nt of Monthly Deductions for Medieare Paid
your cooperation in supplying !his information. This by the Applicant
information will be used only to determine a,,e eligibility
mintus of the household.
Your prompt return of the requested information will be
,appreciated. A self-nddre.'~xl return envelope is enclosed.
RELEASE: ! hereby authoriz~ Ome release of the requested Signature of or
information.
Authorized Representalive
Title:
(Signature of Applicant)
Date:.
Date: ..
Telephone:
A copy oF the executed 'Release of Information Form" is
attaclw.,d which authorizes the telease of information
$,h ') col t~* no.,vln I IrKJ ~
%%'ARNING' 'l'illc 18. Sectinn I(XII c~rlhclJ.S. Ctxk. Slalcslhalapcr.-xwlisg~' )'tl'af~l lyfl k ' BY
wilhnt!lv makin[,, fal~ or rrnl,thllcnl slnlt~nlcnls I{I any dcllar1111elll ,1' Ihc tintaxi Sinlos Govcrnmcnl.
VEW IrZCATION OF: Public Assistance
COLLIER COUNTY S.H.I.P. PUBLIC ASSISTANCE DATA
DOV/N PAY{vIENT/CLOSING COST .
ASSISTANCE PROGRAIvi
Number in Family: , Rate Per ]v{oq~
COLLIER COUNTY DEPARTMENT OF Aid to Families with Dependent
.. HOUSING AND URBAN IMPROVEMENT Children $
:': 2800 NORTH HO!>.SESHOE DRIVE
NAPLES, FLORIDA 33942 C, enernl Assistance
Does this amounl include Courl
AUTIIORIZATION.. State and Fedcr-',{ Regulations Aw-',rded Support Paymeals [:3 Yes f'l No
require us Io verify Public Assis~nnc~ Income efall
members of the household ap{ml)'iniZ for assist,,nce. We ask Amounl Spcci~ca{ly Desiputed
your cooperation in supplying this information. This for Shell. and Utilities
inforrnnlion will bc used only Io determine the eligibility
status of the houscho{d. Other Assistnnce - Type:
$
Your prompt return of the requested information v/ill be
apprccintcd. A self*addressed return envelope is enclosed. Total Monthly Grant $ , _
Othcr Income - Sourre:
" * Maximum Allowance for
Rent and Utilities $
Amount of Public Assistnnce given
dudnit the past 12 months $
RELEASE: ! hereby authorize the release of the Signnlure of or
requested information.
Authorized Rcpresentnlive
Title:
'=' (Signnture of Appl icnnt)
i!~!': Date: ........
j.., Date:
· Tclcphone:
or;
A copy of Ihc cxcct,tcd "Rclcnsc of Infonn;stion Form"
is ;stt:srhrd %vhit'h ;sailsos S/c..; Ihc ~clcn.~c ~f snf~rsn;utit.~
................... -- ..............
X%,'AIININ(; 'l'sll,' IH..Set'Is.., Ill{}l t~flhr tJ .c, ('¢wlc .Sf;lfrs Ih;sl ~s ih.'~-~su s.. !q.h.~ ofa fclonv for knowin~l.~
and xvillisLs|l)· 1113k111!', f;d.,;c ,. I~'nt,dplcnl ,~l;llrlllf3ll|s In ;lll.'k ¢!q~;.'ln,cs~l ofthc I.)nilcd Slalcs
VERIFICATION OF:: Military Payment ,
COLLIER COUNTY S.H.I.P. Years and Monlhs orService for Pay
DOWN PAY M ENT/CLOS ING COST I'ttrpo~s.
ASSISTANCE PROGRAM
Income:
Base Pay and Longevity Pay 5.
COLLIER COUNTY DEPARTMENT OF
lieUSING AND UP, BAN IMPROVEMENT Proficiency Pay
2800 NORTH HORSESHOE DRIVE Sea and Foreign Duty Pay $
NAPLES, FLORIDA 33942
llazardous Duty Pay $
Subsisfance Allowance
AUTIIORIZATION: State and Federal Regulations
reqnire us to verify Military Income of all members of Q,aners Allowance (include only mount
contributed by Governmetal) $ ...
|he household applying for assistance. We ask your
cooperation in supplying this information. This Number of Dependent~ Claimed
information will be used only to determine the
eligibility status of the hot,sehold. hnminent Danger Pays $
Your prompt return of the requested information will Other (explain):
be appreciated. A self-addressed return envelope is
enclosed.
RELEASE: ] hereby authorize the release ofthe Signature of. or
requested information.
Authorized Representative (Military Personnel)
Only:
(Signature of Applicant) Title:
Date: Date:
or; Telephone:
A copy of the executed "Release of Information
[:orm" is attached which authorizes the release of
infin'nlalion requesled. , , , ~ _-
New item since Desert Storm.
~ .VERIF'ICATI.ON.0F: Veterans Administration_ 1
COLUER COUNTY S.II.I.P. Name of Vclcran:
DOWN PAYMENT/CLOSING COST Addms:
ASSI.<rf'ANCE PROGRAM
:. Dale of Birth:
" COLLIER COUNTY DEPARTMENT OF Scrved:
HOUSING AND URI3AN IMPROVEMENT Paid to:
7 2800 NORTH IIORSESIIOE DRIVE
NAPLES. FLOIUDA 33942 I. Curtenl Benefit Amount S
2. Original Start Date
AUTIIORIZATION: Slate and Federal Regulations
require us to verify Veteran Adminislralion Benefils 3. This amounl will increase/
Income of all n~embers of the household applying for decrease to
assislance. We ask your coopera.on in supplying titis
informalion. This informalion will be used only Io Effcclive:
alelorraine the eligibility status of die household.
4. Benefits are for:
Your prompt rctum of lhe requesled informalion will be
apprecialcd. A self-addressed relum envelope is enclosed. I'i GI Bill Training
I"1 Insurance
El Service Connected ComiRm.salion Disability (%)
El Non-Service Pension Death
El Service Connecled Compensation Dealh
RELEASE: I hereby authorize the release oflhe Signature of or
requested information.
" Authorized Representative
Title:
(Signature of Applicanl)
Dale:
Dale:
Telephone:
or;
A copy of Ihe executed "Release of Information
Form" is allached which authorizes the release of
information t,esled.
m
WARNIN(; 'l'ltl,: IN. Nedl,m 1001 ol'lh¢ I.I.S. (7ode SI;ll,'s Ill;, a I~t'L'c~,n ~.., t:.Ilty .fa felony I~r knowlately
;i.i¢l wllh..L:ly tn:ikiiH: f:ilse or li';lllchllt'fll St:Ill'lilt'IllS It);lily drl!:l. tn~ent of the IJnited States
{ ;¢lVt'l'lllllt'llf. "
:'.
VERIFICATION OF: Edu. Catior~al Assistance._
COLLIER COUNTY S.H.I.P. Assistance and Tuition Per Semester
DOWN PAYMENT/CLOSING COST
ASSISTANCE PROGRAM Assistance:
GI Bill $ ..
COLLIER COUNTY DEPARTMENT OF BEOG S
HOUSING AND URBAN IMPROVEMENT NSDL S
2800 NORTH HORSESHOE DRIVE Worksday $
NAPLES. FLORIDA 33942 Other (excluding Higher
Education Act Title IV) S
AUT!I ORI ZATI ON: State and Federal Regulations Expense:
require us to verify Educational Assistance and
Educational Expense Income of all members of the Tuition S ..
household applying for assistance. We ask your Books S .
cooperation in supplying misinformation. This Supplier $
information will be used only to determine the Equipment S
eligibility status of the household. Transportation
Misc. Personal Expense
Your prompt reture~ of the requested information will Materials
be appreciated. A self-addressed return envelope is
enclosed.
RELEASE: ! hereby authorize Ihe release oflhe Signature of or
requested infom~ation.
Authorized Representative
· Title:
(Signnturc of Applicant)
Date:
Date:
Telephone:
· or;
A copy of Ihe executed "Release of Information
Form" is nuachcd which m~lhorizcs Ihc release of
informalinn re( tlt:.qft'(f.
'i',1¢ I1¢. Sect,o, 1001 of the tJ..¢:;. Coclt. Stales tts;tt a I~e:son Is Cullly of a felony for knowintd~'
and .'ilhnl'ly nl:~kinl~ I~dse or (~';tudulent sl;tlt'ntealts to any dep;irtnlenl of the United States
( ;tlVerlllllt'llt.
VERIFICATION OF:
COLLIEK COUNTY S.H.I.P. Benefits
DOWN PAYMENT/CLOSING COST
ASSISTANCE PROGRAM
Arc benefits being paid now D Yes D No
COLLIER COUNTY DEPP, TMENT OF
HOUSING AND URBAN IMPROVEMENT 2. Ifycs, what isGross Weekly
2800 NORTH HORSESHOE DPJVE payment $..
NAPLES, FLORIDA 33942
3. Date of Initial Payment
AUT! [ORIZATION: State and Federal Regulations
require us to vcrify Uncn~ploymcnt Benefits Income of 4, Duration of Benefits: __ wks
all members of the household applying for assistance.
Wc ask your cooperation in supplying this If claimant eligible for future
information. This informalion ~411 bc used only to benefits FI Yes [::] No
dctcrminc the eligibility slatus of the household.
Your prompt return of the requested information will 5. If yes, How many weeks
bc appreciated. A self-addressed return envelope is
enclosed.
6. Ifno, What is tcrrnination
date of benefits
RELEASE: I hcrcby authorize the release of the Signature of or
requested information.
Authorized Rcprcscntative
Title:
(Signature o[' Applicant)
Date:
Date:
Telephone:
or;
copy of the cxccuted "Relcasc of Information Form"
allached which authorizes the rclcasc o1' i,~fonualion
r__cq,,cstcd.
XVARNI N('; 'l'fllc Ig..%eelurn I()(ll oflhc U.S. C:¢~lc .'.;.ads thai a petstin ,s m~ilty ofa I~lonv For knowira. Iv
a,,d ,, ,U,,.,I, ,,,;,k,,,,, n, lse or fi.,,d,,Ic,. s~;,w,nc,,ts ~,~ ;,,~, dc;,;;'m,em or the t l;fitcd States
( ;¢)s'erl!llK'lll
VERIFICATION OF: Pension and Annuities
COLLIER COUNTY S.H.I.P. Current montly gross amount
DOWN PAYMENT/CLOSING COST orpcnsion or annuity
.:' ASSISTANCE PROGRAM
Deductions fron~ gross for
COLLIER COUNTY DEPARTMENT OF medical insurance premiums
HOUSING AND UPj3AN IMPROVEMENT
2800 NORTH HORSESHOE DPJVE
NAPLES, FLORIDA 33942 Date orinitial award
Effcctivc date of currcnt amount
AUT] IORIZATION: State and Federal Regulations
rcquirc us to vcrif'), Pcnsion and Annuities Income or
all mcmbcrs or Ihc household applying for assistance. Contributions to Company
Wc ask your cooperation in supplying this Rctircmcnt/Pcnsion Fund $
information. This information will be used only to
determine the eligibility status or the household.
Amount Received in a Lump Sum $.__
Your prompt rctum or the rcqucstcd information will
be apprcciated. A sc!l'-addrcsscd rctum cnvclopc is
enclosed.
RELEASE: I hcrcby aulhorizc the rclcase or the Signature el'. or
rcqucstcd information.
Authorizccl Representative
Title:
(Signature of Applicant)
:', Date:
Dale:
Tclcpi~nc:'
A copy or thc executed "Release o1' InFormalion Form'
is allnchcd which attlhorizcs the release oF inl'ontqalion
ttcslcd.
i VERIFICATION OF: Rccu~n~, C.sh ConlTibudons j
COLLIER COUNTY S.H.I.P. Purpose or Cash Contribution:
DOWN PAYMENT/CLOSING COST
ASSISTANCE PROGRAM
COLLIER COUNTY DEPARTMENT OF
HOUSING AND URBAN IMPROVEMENT Amount anticipated to bc rccclvcd rot th~ next 12
2800 NORTH HORSESHOE DRIVE months rollowing
NAPLES, FLOPdDA 33942
$.
AUT!IORIZATION: Slalc and Federal Rcgulations (Dale)
rcquirc us to vcriry Recurring Cash Conlribulions or
all mcmbcrs of the bauschold applying for assistance.
We as!~ your cooperation in suppl),ing this
inrom~ation. This inrom~ation will bc used only to
dctcm~ine the eligibility status or the household.
Your prompt return or thc rcqucstcd information will
bc apprccialed. A sclr-addrcsscd return cnvclopc is
cnclosed.
RELEASE: ! hcrcby authorize the rclcasc of the Signature of or
rcqucstcd inrom~ation.
Authorized Rcprcscntativc
Title:
(Signaltire or Applicant)
Dale:
Dale:
Tcicphonc:
or;
A copy or Ihc cxcculcd 'Rclcose or Inrom~alion Form"
is aliacited which authorizes Ihc release of intorotation
tiCSled.
WA!tNINC; I'illc Ig. Scclnm II)01 uflhc U.S. Code SI;iIcs Ih:d a pcrson is guiltyera fclony for knowingly
and u ilhm.l~ m:,l,m, raise or fraudtalent SI;iIc'IttCIIIS tO all)' dcl~arlmcnl or thc United Stales
(;ovcrtlt11c~11
VERIFICATION OF: Income from BusinesL
COLLIER COUNTY S.H.I.P. Based on business transacted during
DOWN PAYMENT/CLOSING COST 19_. to ! 9_
· ASSISTANCE PROGRAM
!. Gross Income $,
COLLIER COUNTY DEPARTMENT OF 2. Expenses:
HOUSING AND URBAN IMPROVEMENT
2800 NORTH HORSESflOE DRIVE (a) Interest on Loans
NAPLES, FLORIDA 33942 (b) Cost of Goods/Materials S
(c) Rent $
(d) Utilities
AUT!!ORIZATION: Slate and Federal Regulations (e) Wages/Salaries S _
require us to verify Business Income ofall members (O Employee Contributions $ .
of the household applying for assistance. Wc ask ~) Federal Withholding Tax
your cooperation in supplying this information. This (h) State Withholding Tax $__
information will be used only tO determine the (i) FICA
eligibility status oflhc household. (j) Sales Tax
(k) Other S
Your prompt return of the requested information will (I) Straight Line Depreciation $__
be appreciated. A self-addressed return envelope is
enclosed. Total Expenses $.
3. Income
RELEASE: I hereby authorize the release orthe Signature of. or
requested inforn~ntion.
Authorized Representative
:.' Title:
(Signature of Applicant)
Date:
Date:
Telephone:
or;
A copy of the execuled "Release or Informalion
Form" is nunchcd which authorizes Ihe release of
inf, rmnfinn requested. . .
%%.'A I( NI N{; r,tc i,'.c..'.;cctt,,~ I(jol nrthc t i..,~. Code .~l;tlcs Ill;it :: pc, So, iS Fudty ofn fclony for knowini:'l~
;rod %villinrly m::k ilH. Ihlst? ol fi;md,lcnt .~.l:llClltcllts tO all)' ¢lcl~:ulmcnt of the United St;tIcS
(
VERIFICATION OF: ASsets On Deposits
~~ ~ S.II.].P.
~ PA~/~INC ~
A~I~CE PR~
~I~ ~ D~~ OF
H~SIN~ ~ ~ ~RO~
2~ NOR~t [[ORS~HOE D~IVE
N~L~, ~RIDA ~942
a~p~y[~ for assistance. We as~ your
i~format~on will be appreciated, A self-
addressed return envelope Is enclosed, ,
RE~SE: I hereby authorize the release of Signature of or
the requested information,
A~horized Representa~e
(Signature of Applicant) ~tle:
Date: Date:
or; Telephone:
A copy of the executed "Release of Information
Form" Is a~achod which authorizes the release
of information requested.
L?RNING: Title 18 S{.,cttc~n t001 of the U.S. Coc~e Slates Ihat a person is guilty of a lelony for
} I lal ~ r}f Iratfdtjlent statement to any deparlmont el
t tew~
STATE OF FLORIDA )
COUNTY OF COLLIER )
I, DWIGHT E. BROCK, Clerk of Courts in and for the
Twentieth Judicial Circuit, Collier County, Florida, do
hereby certify that the foregoing is a true copy of:
Ordinance No. 94-59
which was adopted by the Board of County Commissioners on
the 8th day of November, 1994, during Regular Session.
WITNESS my hand and the official seal of the Board of
County Commissioners of Collier County, Florida, this 8th
day of November, 1994.
DWIGHT E. BROCK
Clerk of Courts and Clerk
Ex-offic]o to Board of .\~,.:~'~
County Commtssione
uoun~;y ~ommls~ .- ,- .
· . .
B:/s/Maureen Kenyon .-