APPENDIX 2
HHFDC SUPPLEMENTAL FORMS
1. Applicant & Co-Signor Affidavit (2 pgs.) – must be signed in front of a notary public.
2. Applicant & 1% Co-Mortgagor Affidavit (3 pgs.) – must be signed in front of a notary
public.
3. Acknowledgement of Prior Purchase of Affordable Property
4. Adult Household Member Acknowledgement with Exhibit A – Document Checklist (3
pgs.)
5. Affidavit as to Applicant’s Legal/Physical Custody of Children (2 pgs.) – must
be signed in front of a notary public.
6. Request for Preference
7. Verification of Employment (“VOE”)
8. Note change to the form for the *Co-Applicant Application with Exhibit A – Document
Checklist. *Use the Application Form from the Application Packet and check the “Co-
Applicant” box under the title of the form.
For additional copies of the attached forms, please duplicate as necessary.
HHFDC Resale Program Application No.
APPLICANT & CO-SIGNOR AFFIDAVIT
For HHFDC’s Affordable For-Sale Program
Primary Applicant Name:
Co-Signor Name(s):
The above-named Applicant
1
is applying to purchase a unit in the above, named project in accordance with
the Hawaii Housing Finance and Development Corporation’s (HHFDC) affordable for-sale housing
program.
For purposes of qualifying for a mortgage loan to finance the purchase of a dwelling unit, a “qualified
resident” as defined in section 201H-32, may be assisted by a co-signor, who may own other lands in fee
simple or leasehold suitable for dwelling purposes, who shall not have an interest in the dwelling unit to be
purchased, and who certifies that as the co-signor does not intend to reside in the dwelling unit. The income
and assets of the co-signor shall not be counted in determining eligibility of the qualified resident.
Applicant requests a Co-Signor to financially pre-qualify for a mortgage loan. HHFDC requires that the
Applicant and the Co-Signor(s) comply with the program requirements such as non-occupancy; no ownership
interest in title; and as listed below.
State of Hawaii )
) SS.
County of )
Each of the undersigned Applicant and if applicable, Spouse, Co-Applicant and Co-Applicant
Spouse and the undersigned Co-signor(s), being first duly sworn on oath, deposes and states that:
1. The Applicant submits this Affidavit in accordance with Applicant’s Application to
Purchase Real Property under 201H, HRS for purposes of qualifying for a mortgage loan
to purchase a unit in the above referenced Project, if approved by HHFDC as an Eligible
Purchaser;
2. The Applicant has requested a Co-Signor to assist with financially qualifying for a
mortgage loan to purchase a unit in the above referenced project, if approved by the HHFDC
as an Eligible Purchaser;
3. The Applicant’s selected, preferred lender acknowledges and affirms Applicant and Co-
Signor’s mutual decisions to proceed under this arrangement;
4. Applicant and Co-Signor mutually agree that we are entering into this agreement on our own
accord for Applicant to financially qualify for a mortgage loan to purchase a unit in this project,
if approved by the HHFDC as an Eligible Purchaser;
5. As Co-Signor, I/we will not have an interest in the property, will not be on title to the property
deed, and will not be an occupant or reside in the unit purchased;
6. By signing this affidavit, we authorize the State of Hawaii and the HHFDC, its representatives
and staff to periodically verify compliance with each of the provisions herein;
7. I/We make this affidavit in support of being the Applicant of the above referenced project and
to financially qualify under Chapter 201H, HRS and Title 15, Chapter 300, Hawaii
Administrative Rules of the HHFDC; and
8. I/We have read, understand and accept the foregoing conditions for the subject Project and
acknowledge that knowingly making a false statement in this Affidavit shall also be cause for
HHFDC’s automatic disqualification from this project and future HHFDC projects.
1
Applicant shall mean the Primary Person applying to purchase a property under chapter 201H, HRS and
if applicable, Applicant’s Spouse, Co-Applicant and Co-Applicant’s Spouse.
Applicant & Co-Signor
Affidavit
Page 2
9. I/We understand that the statements made in this Affidavit are made under oath and will be
relied upon by the HHFDC in its review of the application to purchase. Applicant and the Co-
Signor shall be subject to misdemeanor criminal charges under Hawaii Penal Code, Section
710-1061, HRS, which are punishable by a fine and/or imprisonment and forfeiture of the
property purchased, for knowingly making a false statement in this Affidavit.
APPLICANT:
Print Applicant's Name
Applicant's Signature
Date
Print Spouse's Name
Spouse's signature
Date
Print Co-Applicant Name
Co-Applicant Signature
Date
Print Co-Applicant Spouse’s Name
Co-Applicant Spouse’s Signature
Date
This - page Applicant & Co-Signor Affidavit
dated was subscribed and sworn
to before me this day of
, 20 by
Print Name
Notary Public, Judicial Circuit, State of
.
My commission expires:
CO-SIGNOR(S):
Relationship(s) to Applicant:
Print Name
Signature
Date
Street Address, City, State, Zip Code
Best Phone No.
Print Name
Signature
Date
Street Address, City, State, Zip Code
Best Phone No.
This - page Applicant & Co-Signor Affidavit
dated was subscribed and sworn to
before me this day of
, 20 by
Print Name
Notary Public, Judicial Circuit, State of
.
My commission expires:
7.2019
Applicant & Co-Signor Affidavit
HHFDC Resale Program Application No.
APPLICANT & 1% CO-MORTGAGOR AFFIDAVIT
For HHFDC’s Affordable Resale Program
Primary Applicant Name:
1% Co-Mortgagor Name(s):
The above-named Applicant
1
is applying to purchase a unit in the above, named project in accordance with
the Hawaii Housing Finance and Development Corporation’s (HHFDC) affordable for-sale housing
program.
For purposes of qualifying for a mortgage loan to finance the purchase of a dwelling unit, a “qualified
resident” as defined in section 201H-32, may be assisted by a co-mortgagor, who is a family member, as
defined by the HHFDC, who may own other lands in fee simple or leasehold suitable for dwelling purposes,
whose interest in the dwelling unit to be purchased is limited to no more than one percent (1%), and who
certifies that as the co-mortgagor does not intend to reside in the dwelling unit (the “1% Co-Mortgagor”).
The income and assets of the 1% Co-Mortgagor shall not be counted in determining eligibility of the
qualified resident.
Applicant requests a 1% Co-Mortgagor to financially pre-qualify for a mortgage loan. HHFDC requires
that the Applicant and the 1% Co-Mortgagor comply with the program requirements such as non-
occupancy; limited ownership interest in title to 1% only; and as listed below.
State of Hawaii )
) SS.
County of )
Each of the undersigned Applicant and if applicable, Spouse, Co-Applicant and Co-Applicant
Spouse and the undersigned 1% Co-Mortgagor, being first duly sworn on oath, deposes and states
that:
1. I/We, the undersigned Applicant submits this Affidavit in accordance with Applicant’s
Application to Purchase Real Property under 201H, HRS for purposes of qualifying for a
mortgage loan to purchase a unit in the above referenced Project, if approved by HHFDC as
an Eligible Purchaser;
2. The Applicant has requested a 1% Co-Mortgagor to assist with financially qualifying for a
mortgage loan to purchase a unit in the above referenced project, if approved by the HHFDC
as an Eligible Purchaser;
3. The Applicant’s selected, preferred lender acknowledges and affirms Applicant and 1%
Co-Mortgagor’s mutual decision to proceed under this arrangement;
4. Applicant and 1% Co-Mortgagor mutually agree that we are entering into this agreement
on our own accord for Applicant to financially qualify for a mortgage loan to purchase a
unit in the Project, if approved by the HHFDC as an Eligible Purchaser;
5. As 1% Co-Mortgagor, I/we will only have a 1% interest in the property and will not be
an occupant or reside in the unit purchased;
6. Applicant and 1% Co-Mortgagor understand that if the 1% Co-Mortgagor’s ownership
interest in the unit is more than one percent (1%), the HHFDC will have the option to
repurchase the unit during the 10- year Use, Sale and Transfer Restrictions and if the
Applicant decides to sell or transfer the interest in the property, Applicant may not
transfer his/her interest to the 1% co-mortgagor;
7. By signing this affidavit, we authorize the State of Hawaii and the HHFDC, by designating
employees of the HHFDC, to periodically verify compliance with each of the provisions
herein;
1
Applicant shall mean the Primary Person applying to purchase a property under Chapter 201H, HRS and if
applicable, Applicant’s Spouse, Co-Applicant and Co-Applicant Spouse.
7.2019
APPLICANT &
1% CO-MORTGAGOR
AFFIDAVIT
Page 2
8. I/We make this affidavit in support of being the Applicant of the above referenced property
and to financially qualify under Chapter 201H, HRS and applicable Hawaii Administrative
Rules of the HHFDC;
9. I/We have read, understand and accept the foregoing conditions for the subject Project
and acknowledge that knowingly making a false statement in this Affidavit shall also be
cause for HHFDC’s automatic disqualification from this project and future HHFDC
projects.
10. I/We understand that the statements made in this Affidavit are made under oath and will
be relied upon by the HHFDC in its review of the application to purchase. Applicant and
the 1% Co-Mortgagor shall be subject to misdemeanor criminal charges under Hawaii
Penal Code, Section 710-1061, HRS, which are punishable by a fine and/or imprisonment
and forfeiture of the property purchased, for knowingly making a false statement in this
Affidavit.
APPLICANT(S):
Print Applicant's Name
Applicant's Signature
Date
Print Spouse's Name
Spouse's signature
Date
Print Co-Applicant Name
Co-Applicant Signature
Date
Print Co-Applicant Spouse Name
Co-Applicant Spouse Signature
Date
This - page Applicant & 1% Co-Mortgagor Affidavit
dated was subscribed and sworn to
before me this day of ,
20 by
.
Print Name
Notary Public, Judicial Circuit, State of
.
My commission expires:
1% CO-MORTGAGOR(S):
Relationship(s) to Applicant:
Print Name
Signature
Date
Print Name
Signature
Date
1% Co-Mortgagor's Address:
Tel No.
(Res)
(Bus)
(Other)
7.2019
APPLICANT &
1% CO-MORTGAGOR
AFFIDAVIT
Page 3
This - page Applicant & 1% Co-Mortgagor Affidavit
dated was subscribed and sworn to
before me this day of ,
20 by
Print Name
Notary Public, Judicial Circuit, State of
.
My commission expires:
HHFDC Resale Program Application Number:
(To be completed by Sales Staff Only)
ACKNOWLEDGEMENT OF
PRIOR PURCHASE OF AFFORDABLE PROPERTY
Name of Primary Applicant:
Applicant(s) and/or Co-applicant(s) have previously purchased an affordable unit/property sold,
developed by, or developed in partnership with the Hawaii Housing Finance & Development
Corporation (“HHFDC”), Housing Finance & Development Corporation (“HFDC”), Housing
Community Development Corporation of Hawaii (“HCDCH”), Hawaii Housing Authority (“HHA”),
the Hawaii Community Development Authority (“HCDA”) OR one of the county agencies (Kauai,
Maui, Molokai, Hawaii), (the, “Government Sponsor”).
Complete the following:
Project Name:
Type of Project:
Single Family
Multi-Family
Developed or Sponsored by:
HHFDC, HCDCH, HFDC, or HHA (“State Housing Agency”)
(Identify Government Sponsor)
County agency – specify:
HCDA
(Check one below)
The property was repurchased by the Government Sponsor or its designated repurchase
authority, if any. Since then, there has been a significant change in the following. Please explain:
Household size
Explain.
Place of employment
Income
The sale of the property was due to extreme hardship such as family member’s death,
divorce, loss of employment or a disability and the property was repurchased by the
Government Sponsor or its designated repurchase authority, if any.
The previous spouse retained title to the property and it has been more than one year since
the final divorce decree was filed. (Attach copy of certified divorce decree and copy of
deed).
For multi-family units only:
Applicant’s current family size exceeds the maximum household size for the unit based on
the prevailing county building or housing codes.
No. of years at current residence:
The property was not repurchased by the Government Sponsor or its designated
repurchase authority, if any. The property was sold at a restricted price to a qualified
resident/affordable buyer whose income did not exceed the required maximum area median
income in effect at the time and utilized by the respective Government Sponsor or its
designated repurchase authority, if any. Therefore, the property remained affordable
according to the Government Sponsored regulations. (Attach copy of final escrow closing
statement)
The property was sold unrestricted on the open market to a willing buyer and was not
repurchased by the Government Sponsor or its designated repurchase authority, if any.
Print Applicant's Name
Applicant's Signature
Date
Print Spouse's Name
Spouse's signature
Date
Print Co-Applicant's Name
Co-Applicant's Signature
Date
Print Spouse's Name of Co-Applicant
Spouse of Co-Applicant's Signature
Date
Eff.2008_Rev 7.2019
Page 1 of 1
HHFDC Resale Program Application No.
(To be completed by Sales Staff only)
ADULT HOUSEHOLD MEMBER ACKNOWLEDGEMENT*
NAME OF PRIMARY APPLICANT:
*If completed, signed and submitted, this form shall be made a part of the above-named Primary Applicant’s application.
Before this application, (1) were you included as a household member on another person’s application? No / Yes – are
residing with said person? Yes / No – on the back of this page, explain why not; (2) have you applied for any government (
State, Federal) sponsored project? No / Yes – were you approved to purchase a unit? No / Yes – did you sign a contract?
(3) What housing project(s) did you apply for?
you still
County,
No / Yes.
A. HOUSEHOLD MEMBER (“HHM-1”) INFORMATION
HHM-1 SPOUSE (“HHM-2”) INFORMATION
Print Full, Legal Name (no middle initials or nicknames)
First Name:
Print Full Legal Name (no middle initials or nicknames)
First Name:
Middle Name:
Middle Name:
Last Name:
Last Name:
Check one: Male Female
Check one: Male Female
Married or Domestic Partnership (recognized under operation of law)
also check one, if applicable:
Legally Separated by Decree;
Separated (pending divorce);
Separated (living apart)
Refer to Exhibit A – Document Checklist, Section A.1.
Single: also check one ➔ Never Married; Divorced; Widowed;
Refer to Exhibit A – Document Checklist, Section A.2.
Present Address:
Rent
Live w/ Parents
Own*
No. of Yrs. at Address:
Mailing Address (if different from Present Address):
*If own present address, refer to Exhibit “A” – Document Checklist, Section A.3.
B. EMPLOYMENT INFORMATION
(HHM-1): EMPLOYER - Name, Address & Phone #
Position:
Check one:
Full-Time Part-Time Years at this job?
Years in this line of work?
(HHM-2): EMPLOYER - Name, Address & Phone #
Position:
Check one:
Full-Time Part-Time Years at this job?
Years in this line of work?
Self-Employed? N Y - If Yes, effective start date?
• Refer to Exhibit A – Document Checklist, Section H.2.
Self-Employed? N Y - If Yes, effective start date?
• Refer to Exhibit A – Document Checklist, Section H.2.
C. RESERVED
D. HOUSEHOLD INCOME WORKSHEET – ALL INCOME MUST BE REPORTED*
*Household member(s) must complete required sections of the above, named Primary Applicant’s Household Income Worksheet.
HHM-1 | HHM-2
1.
Are you a U.S. citizen?
Y N Y
N
2.
Are you a Resident Alien? If Yes, refer to Exhibit A – Document Checklist, Section E.1
Y N Y
N
3.
(Age)/ Date of Birth:
HHM-1: ( )/mmddyy HHM-2: ( )/mmddyy
4.
Are you a legal resident of Hawaii? Refer to Exhibit A – Document Checklist, Section E.2 Y N Y N
5.
Are you physically residing in Hawaii? Refer to Exhibit A – Document Checklist, Section E.2 Y N Y N
6.
Do you or any additional household member own any leasehold and/or fee simple properties/lands
suitable for dwelling purposes anywhere in the world? If Yes, Refer to Exhibit A – Document Checklist, Sec E.3
7.
Have you ever purchased or owned an affordable unit/property sold or developed by or in
partnership with a government (county, state, federal) agency such as the HHFDC, HFDC, HCDCH,
HHA, or HCDA, in accordance with county ordinance or state laws? If Yes, Refer to Exhibit A –
Document Checklist, Section E.4., and PROVIDE REQUESTED INFORMATION.
Y N Y N
Y N Y N
HOUSEHOLD MEMBER AND SPOUSE, IF ANY, HEREBY DECLARE AND FURTHER ACKNOWLEDGE & AGREE THAT:
a. All information provided herein and as attached are true; are for purposes of supporting Applicant’s application according to
HHFDC’s for sale housing program, such as comprising applicant’s total household size ; shall become the property of HHFDC
for purposes of determining Applicant’s eligibility to purchase; and will not be returned;
b. Applicant understands that making any false statements knowingly in connection with this Application shall constitute perjury
and is a crime punishable under the provision of the Hawaii Penal Code; and is cause for automatic disqualification from
HHFDC’s project and future projects.
Print Household Member
’
s Name Household Member
’
s Signature
Date
Print Household Member Spouse's Name Household Member Spouse's signature
Date
NEW 7-2019 Page 1 of 1
E. HHFDC ELIGIBILITY REQUIREMENTS
F. PREFERENCE DETERMINATION – Applicable only to new projects for applications submitted prior to the
deadline date listed on page 3 of the Application Packet. Refer to Appendix 2 – Preference Form for additional
information and completion if applicable to you or your spouse. Attach completed form to Applicant’s application.
G. DECLARATION & ACKNOWLEDGEMENT OF HOUSEHOLD MEMBER
Exh A - 2 of 2
EXHIBIT A - DOCUMENT CHECKLIST
Review this checklist and attach all applicable supporting documentation as may be required or
applicable to your Acknowledgement form. HHFDC will use your information to verify
Primary Applicant’s eligibility, household income requirements and requested preferences, if
any. HHFDC may request additional information and/or documentation to complete its review
of your acknowledgement form; however, request for additional information only applies after
the application deadline date. Refer to the Information Packet – Appendix 2 for Supplemental
Forms, if required. Important: (R) - means required of all household members.
A. Household member Information & Spouse Information (Application - Section A)
1. If married or legally separated, pending divorce or living apart, the
“Spouse” section of the application, must be completed. If legally
separated, provide of certified separation decree in its entirety.
2. If single due to divorce or widowed, attach the following as applicable.
o Copy of certified final divorce decree in its entirety. One (1) page acknowledgement
is not acceptable.
o Copy of decedent’s death certificate.
3. If currently residing in a property owned by applicant and/or household
member, refer to section E.3., below; and attach copy of requested
supporting document(s) as indicated on the form.
B. Employment Information (Application - Section B)
1. If self-employed, refer to section H.2., below; and attach all required documents.
C. RESERVED.
D. HHFDC Household Income Eligibility Worksheet. Refer to section H below.
E. HHFDC Eligibility Requirements (Application - Section E)
1. Citizenship
o If Permanent Resident Alien, submit copy of valid Permanent Resident Alien card
(front & back).
o Persons with temporary alien cards are ineligible until permanent resident alien
status is received.
2. Legal & Physical Resident in Hawaii
o (R) Submit a signed copy of the most recently filed State of Hawaii
Income Tax Returns & all applicable schedules. If self-employed,
submit last two (2) years with all worksheets.
o (R) Submit a signed copy of the most recently filed Federal Income Tax
Returns & all applicable schedules. If self-employed, submit last two (2)
years with all worksheets, such as Schedules SE/C.
o If a recent resident to Hawaii and no Hawaii state tax returns were
filed at time of application, submit signed copies of your last filed
tax return for the state you lived in prior to moving to Hawaii
together with current pay statement showing Hawaii state
withholdings and one (1) of the following:
•
Valid Hawaii state ID or Driver’s License; or Hawaii Voter Registration
Certificate
o If not required to file taxes, provide tax office transcript affirming not required
to file taxes.
❖ Important: If taxes were filed electronically, provide required tax forms for
submittal, not those marked “Keep for your Files”. Sign where required and
attach. Do not submit signed, one-page acknowledgement of electronic filing
statement. Submit copy the signed tax forms (i.e. Form 1040, HI N-37).
3. Property Ownership
o Complete supplemental form, Real Estate Disclosure Statement; and
attach copy of requested supporting document(s) as indicated on the
form.
Exh A - 2 of 2
❖ IMPORTANT. Applicant and/or household member determined to have
circumvented the rules of homeownership shall be automatically
disqualified from participating in the project and future projects.
4. Prior Purchase of Affordable Property
o Complete supplemental form, Acknowledgment of Prior Purchase of
Affordable Property; and attach copy of requested supporting document(s)
as indicated on the form.
F. *Preference Determination – prior to Public Drawing only; New Projects Only
(Application - Section F)
*If applicable, provide request for preference of Applicant’s application.
Applicants need only request for one (1) of the following. Multiple requests or
approvals constitute only one request. HHFDC will approve or disapprove preference
in its sole discretion.
1. Public Housing & State Subsidized Rental Housing Preference
o Complete supplemental form, Request for Preference; and attach copy of
requested supporting document(s) as indicated on the form, such as a copy
of your rental agreement and certificate of occupancy from HPHA or
HHFDC.
2. Displacement Preference
o Complete supplemental form, Request for Preference; and attach copy of
requested supporting document(s) as indicated on the form, such as a
certified displacement letter from the respective government agency.
G. Household Member’s Signed Declaration & Acknowledgement of Eligibility
1. Household member and Spouse, if any, must sign in ink- original signature
required. No electronic signatures allowed.
H. HHFDC Household Income
(+)
Eligibility Worksheet.
(+)
Income is primarily defined as “money received, especially on a regular basis,
for work or through investments; and shall also include money received from
sources as follows and listed on the HHFDC Household Income Worksheet. Refer
to Appendix 1 of the Information Packet for further explanation. All persons 18
years & older living or intended to live in the purchased unit must disclose all
income, if any. If unemployed or not receiving income, must state $0 and sign.
HHFDC, in its sole and absolute discretion, shall determine TOTAL
HOUSEHOLD INCOME as the sum of the gross monthly income received
from all household members, 18 years and older, from income generating
sources such as, the primary job before taxes, or a compilation of various part-
time jobs comprising 40 hours per week, tips, cost of living allowance (COLA),
basic allowance for housing (BAH), dividends, interest, royalties, pensions or
annuity distribution, Veterans Administration (VA) compensation, net rental
income, business income & investments, alimony, child support, social security
benefits, public assistance, unemployment compensation, sick pay, income from
trusts, distribution from deferred compensation plan, and other income from
sources such as welfare benefits, workers compensation, aid to families with
dependent children, tax-exempt interest income. HHFDC DOES NOT
INCLUDE overtime income, bonuses and other income from part-time
employment if in addition to a primary job; but will include if part of primary job
(i.e. retail or auto sales or service (waiter) industry.
1. Employment Income – for all household members 18 years and older:
o (R) Submit copies of employment pay statements dated within 1-2 months of the
signed application date
as follows:
•
1-month pay statements and complete supplemental form, Verification of
Employment (VOE); or
•
2-month pay statements, if no VOE form
Exh A - 2 of 2
•
Important: One month pay statements means 5 consecutive pay
statements, if paid weekly; 3 consecutive pay statements, if paid
bi-weekly; 2 consecutive pay statements, if paid semi-monthly. If
submitting two months’ pay statements, submit double the amount
of pay statements as described.
o (R) Submit copies of all income reporting statements such as Form W-
2, 1099-Misc, bank statements, etc., submitted with your filed tax
returns.
2. Self-Employment Income:
o Submit signed copies of the most current year’s General Excise Tax (GET)
filing (if none, provide copies of payments received (e.g. copies of checks);
and
o Submit signed copies of the Annual GET filing for the most current two (2) years;
and
o Submit signed copies of last two (2) years Federal and Hawaii state tax returns with
all attached Schedules.
3. Additional monthly and/or Periodic Income, such as financial assistance, supplemental
benefits and the like.:
o Submit copies of the most current benefits letter and bank statement confirming
receipt of payment such as:
•
Copy of certified program notice confirming annual payment.
•
Copy of Form 1099-MISC.
1 of 2
HHFDC Resale Program Application No.
(To be completed by Sales Staff Only)
AFFIDAVIT AS TO
APPLICANT'S LEGAL/PHYSICAL CUSTODY OF CHILDREN
Name of Primary Applicant:
Important: Applicant/Co-applicant (or other member of application required to provide proof of legal/physical custody
of a minor child listed in section C of the application) must complete, sign before a notary public, and attach
this form
to the application as evidence of legal/physical custody of any minor child listed in section C of the application,
if
Applicant/Co-
applicant does not claim the minor child as a dependent on their federal income tax return; is not identified as a
parent on the child’s birth certificate; or, if requested by HHFDC.
List name of person affirming legal/physical custody of minor child(ren):
Applicant or Household Member Name:
Address
Tel. No.
(Res)
(Bus)
(Other)
Name of Other Party:
Address:
Tel. No.
(Res)
(Bus)
(Other)
The above-named person (Applicant/Co-Applicant/Household Member) is applying to purchase a
property in the above referenced project.
State of )
) ss.
City and County of )
The above-named Applicant and Other Party acknowledge and agree that the following listed child(ren) were
born of the unwed or marriage relationship to said above named parties; and that the children named below will
not be listed as a household member on the Other Party’s application for an HHFDC sponsored affordable for-
sale housing development; and in doing so shall cause the HHFDC to automatically disqualify said parties from
participating in any HHFDC sponsored affordable for-sale housing development.
Name of Children
Date of Birth
Social Security No.
1.
2.
3.
Check box, as applicable:
[ ]
Pursuant to the attached separation/final divorce decree dated/filed on , the
Applicant and the Other Party are awarded joint legal and physical custody of the above
referenced children. **Attach complete certified/recorded copy of the final divorce decree
to verify child custody.
[ ]
Applicant was never married to the other party and applicant has legal and physical custody of
the above referenced children. **Attach copies of children’s birth certificates for the
above listed children.
Each person signing below (Applicant and/or Other Party), being first duly sworn on oath, deposes and
says that:
1. The Applicant has joint and/or legal and physical custody of the above listed children;
2. The primary residence of the above listed children shall be with the Applicant;
3. The above listed children are currently physically residing with the Applicant and shall physically reside in
the property purchased under Chapter 201H, HRS;
4. The Applicant will use the above listed children to qualify for a household size requirement to purchase a
property in the above referenced project under Chapter 201H, HRS;
5. The Other Party may not use the above referenced children to qualify for the required household size to
purchase any property under Chapter 201H, HRS.
2 of 2
HHFDC Resale Program Application No.
(To be completed by Sales Staff Only)
6. The Applicant and the Other Party understand that it is a crime punishable by a fine or imprisonment for 30
days or both to knowingly make a false statement concerning the above facts as applicable under the
provision of the Hawaii Penal Code, Part V Section 701-1063, as may be amended; and shall be cause for
automatic disqualification from this and future HHFDC projects.
Applicant:
Applicant's Signature Date
Print Applicant's Name Date
This - page Affidavit as to Applicant’s Legal/
Physical Custody of Children dated
was subscribed and sworn to before me this
day of , 20 by
Print Name
Notary Public, Judicial Circuit,
State of .
My commission expires:
Other Party:
Other Party Name Date
Print Other Party Name Date
This - page Affidavit as to Applicant’s Legal/
Physical Custody of Children dated
was subscribed and sworn to before me this
day of , 20 by
Print Name
Notary Public, Judicial Circuit,
State of .
My commission expires:
Rev.8-2008;6.2016
HHFDC Resale Program Application Number:
(To be completed by Sales Staff)
REQUEST FOR PREFERENCE*
*For use with New Projects only, prior to Public Drawing
Name of Primary Applicant:
Applicant(s)/Co-applicant(s) is/are requesting preference as follows and have attached the
appropriate documentation to support this request.
❖ Important: Applicant need only apply for one (1) type of preference. Multiple types of applicable preferences listed
below will constitute only one (1) request and does not provide an advantage over other applicants who may be
subject to only one type of preference. Request for preference is subject to HHFDC approval, in its sole discretion.
Disability Preference (For Multi-Family Projects Only)
• Applicant/Co-Applicant or household member currently residing and/or shall physically
reside in the home has a disability.
**Attach completed Disability Form & Certification by treating physician or by an
Independent Consultant
Public Housing Preference
I am currently residing in a public housing project:
• administered by the Hawaii Public Housing Authority (HPHA) or
• in a HHFDC subsidized rental project and receiving rental assistance.
**Attach a copy of your rental agreement and approved annual certification letter from
the property manager/agent managing the affordable rental property.
Displacement Preference (check only 1 below)
Hawaii Housing Finance & Development Corporation (HHFDC) Displacement
Certificate due to Home Construction Defect.
• As a homeowner, I was displaced due to HHFDC's purchase of my home because of a
substantial construction defect.
**Attach a copy of the displacement certificate received from HHFDC.
Displaced by Government Action.
• As a homeowner, I was displaced from my home by a governmental agency.
**Attach a copy of the governmental agency’s displacement certificate.
Relocation from Public Housing Preference.
• As a resident in a public housing rental project, I was relocated because I was over
income.
**Attach copy of letter from public housing rental project indicating displacement due
to exceeding the income limits.
Print Applicant's Name
Applicant's Signature
Date
Print Spouse's Name
Spouse's signature
Date
Print Co-Applicant's Name
Co-Applicant's Signature
Date
Print Spouse's Name of Co-Applicant
Spouse of Co-Applicant's Signature
Date
Page 1 of 1
Rev.7.2019
HHFDC Resale Program Application No.
(To be completed by Sales Staff)
HHFDC REQUEST FOR VERIFICATION OF EMPLOYMENT (“VOE”)
Name of Primary Applicant:
Privacy Act Notice: This information shall be used by the Hawaii Housing Finance and Development Corporation (“HHFDC”) to
determine applicant's eligibility as a prospective buyer under Chapter 201H, Hawaii Revised Statutes (“HRS”). You do not have to
give us this information, but if you do not, the applicant’s application for approval as a prospective buyer may be rejected.
Refer to Project Application Packet – Exhibit A – Document Checklist for additional, detailed information. Upon receipt by HHFDC,
the information as required and permitted by the HRS, as amended, will be confidential and used only by the HHFDC.
A. EMPLOYEE (Applicant or Household Member): Complete the following, then give to your employer for
completion.
The employee identified in this section A., (“Employee”), attests and affirms that he/she is employed by the
employer identified in section B., below (“Employer”). Employee is applying to purchase a dwelling in the above-
named project sponsored by HHFDC (“Applicant”); or is being included as a household member of an applicant wanting
to purchase a dwelling in the above-named project (“Household Member”). HHFDC requires Employee’s income
information
to determine if Applicant meets HHFDC’s income eligibility requirements.
By signing below, the undersigned Employee authorizes the Employer to provide the requested/required information to
assist HHFDC with determining Applicant’s household income eligibility to participate in the above referenced project.
Employee:
Name:(Print) (Signature)
Address: Zip
Tel. No.: / Alternate Tel. No. Best time to Contact
B. EMPLOYER verification of present employment. Complete the following, then give to the
above-named Employee for further processing.
Name of Employer:
Employer Address:
NOTICE TO EMPLOYER: The above-named Employee is an Applicant or Household Member required to provide
employment income information for purposes of participating in the above referenced project.
_
Employee’s Present Position Date of Employment Employee Number, if any
Salaried:
[ ] No
[ ] Yes
Commission:
[
] No
[
] Yes
If Yes, is it likely to continue? Frequency?
Overtime:
[ ] No
[ ] Yes
Bonus:
[
] No
[
] Yes
If Yes, is it likely to continue? Frequency?
Is overtime/bonus likely to continue? [ ] Yes [ ] No
Base Earnings, Year-to-Date, As of (Date)
$
Past Year
$
Overtime, Year-to-Date, As of (Date)
$
Past Year
$
Commissions, Year-to-Date, As of (Date)
$
Past Year
$
Tips, Year-to-Date, As of (Date)
$
Past Year
$
Bonuses, Year-to-Date, As of (Date)
$
Past Year
$
NOTE: If paid hourly, please indicate average hours worked each week during current and past year:
a.
Current average hours worked per week:
Hours
b.
Past year average hours worked per week:
Hours
Certification: State statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance or conspiracy
proposed to influence the approval of the HHFDC. The undersigned is a representative of the Employer authorized to provide income
information for the above-named Employee; or is employed by the Employer in the capacity to provide such information (e.g. payroll
department).
Legal Name of Employer:
Signature Title Date
Preparer’s Name (Print): Phone No.
7.2019 EMPLOYER – RETURN COMPLETED FORM TO EMPLOYEE
1 of 1
Current Base Pay:
$
[ ] Annual
[ ] Monthly
[ ] Weekly
[ ] Hourly
[ ] Other
