Homeownership Emergency Loan Program COVID-19 HELP Loan

MAYOR’S OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT

CITY AND COUNTY OF SAN FRANCISCO

LONDON N. BREED

MAYOR

ERIC D. SHAW

DIRECTOR

Homeownership Emergency Loan Program

COVID-19 HELP Loan Addendum

Version January 2021 Page 1 of 3

(Effective immediately)

In response to the current COVID-19 pandemic and until further notice, the Mayor’s Office of Housing and

Community Development (MOHCD) is implementing the following changes (this “Addendum”) to the

Homeowner Emergency Loan Program (HELP) to assist low- to moderate-income San Francisco homeowners

(up to 120% AMI) who are struggling to make housing payments due to financial hardship caused by COVID-19.

Please see the complete December 2019 HELP Operating and Procedures Manual (the “HELP Manual”) for more

information.

Changes to HELP: Loans Addressing Financial Hardship Due to DOVID-19 (COVID-19 HELP Loan)

Eligible Uses of a COVID-19 HELP Loan:

COVID-19 HELP loans can be used to cover: (a) delinquent HOA dues; (b) current and future HOA dues for up to

12 months; (c) delinquent and current special assessments; (d) mortgage forbearance deferred payments that

are due in one lump sum when an affordable repayment option is not available (this does not apply to federally

backed mortgage loans such as Fannie Mae, Freddie Mac, U.S. Department of Veteran Affairs (VA), and Federal

Housing Administration (FHA) loans); and (e) delinquent non-escrowed property taxes.

Eligibility for a COVID-19 HELP Loan:

1. Borrowers must have experienced a financial hardship due to the COVID-19 pandemic. A financial hardship

includes reduced income due to factors such as reduced work hours, temporary business closure or slowdown,

layoffs, and/or increased out-of-pocket medical expenses related to COVID-19. Homeowners experiencing a

financial hardship unrelated to COVID-19 may be eligible for HELP under the regular program guidelines.

2. Borrowers must have been current or less than 30 days past due on their mortgage loan account, property

tax account, and/or HOA account as of April 1, 2020. Borrowers with an account delinquency prior to March

1, 2020 are not eligible for a COVID-19 HELP loan, but may be eligible for a regular HELP loan.

3. To demonstrate financial hardship as a result of COVID-19, borrowers are required to submit the “Affidavit of

Financial Hardship Due to COVID-19” form along with its supporting documentation. See the form for details.

Version January 2021 Page 2 of 3

4. Borrowers do not need to provide documentation to verify inability to secure financing from traditional

lenders and/or ineligibility for other financial options prior to applying for COVID-19 HELP.

5. Borrowers are not required to attend a one-on-one foreclosure intervention counseling session but can reach

out to a MOHCD-approved and HUD-certified housing counseling agency if assistance is needed in applying.

Please go to www.homeownershipsf.org for a list of agencies.

COVID-19 HELP Loan Terms:

1. There are no monthly payments. The COVID-19 HELP loan principal balance plus 1% annual simple interest is

due upon the sale, transfer of title, failure of the property owner to occupy the property as the property

owner’s Principal Residence, or other non-compliance with the terms of the loan.

2. Maximum Loan Amount: The maximum amount used to pay for advance HOA dues may not exceed $12,000,

including non-recurring closing costs. Non-recurring closing costs vary by loan but the average costs are

around $1,000 which can be rolled into the loan. When combined with other COVID-19 HELP permissible uses,

the maximum total loan amount may not exceed $25,000.

3. Minimum Loan Amount: $5,000 not including non-recurring closing costs.

4. Current front-end or housing ratio can be greater than 40% but must be no less than 28%.

5. Maximum Combined Loan-to-Value (CLTV) ratio cannot exceed 100%. The property value will be determined

in the following ways: (a) for a Below Market Rate unit, the property value will be determined by the restricted

resale price calculated by MOHCD; and (b) for a Market Rate unit, the property value will be determined based

on the estimated value derived from the average of three reputable online property value websites. An

appraisal is not required.

Notes:

1. This COVID-19 HELP Loan Addendum is in effect until further notice. If there is any conflict between this

Addendum and the HELP Manual related to a COVID-19 HELP loan, this Addendum will temporarily control

and supersede the conflicting requirements in the HELP Manual. All other requirements contained in the HELP

Manual will remain in effect and apply to a COVID-19 HELP Loan.

2. The COVID-19 HELP application package must be submitted electronically via the ShareFile link on the MOHCD

website https://sfmohcd.org/COVID19HELP.

3. Below is an estimated timeline for closing a COVID-19 HELP loan. The entire process takes about 4 weeks from

the day a complete application package is received to the date that the loan is disbursed. The processing time

can vary depending on the number of applications received, complexity of applications, and additional

information required to determine an applicant’s eligibility.

Version January 2021 Page 3 of 3

COVIDCOVID-19 HELP Timeline

Steps

Time Estimate

Complete Application Submittal to Issuance of Approval Letter

7-10 business days

Buyer Signing

2-3 business days

HELP Loan Funding

5 business days

Closing

2-3 business days

Total Business Days

16-21 business days

QUESTIONS:

All program and application information can be found online: https://sfmohcd.org/COVID19HELP.

If you have any further questions or need assistance in applying, we encourage you to contact a housing

counselor: www.homeownershipsf.org.

Additional program inquiries can be sent to [email protected]. Please allow 5 business days for a response.

Version January 2021

MAYOR’S OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT

CITY AND COUNTY OF SAN FRANCISCO

AFFIDAVIT OF FINANCIAL HARDSHIP DUE TO COVID-19

Homeowner Name(s): ___________________________________________________________________________

Property Address: ___________________________________________San Francisco, CA ____________________

I (We)

_________________________________________________, have experienced financial hardship caused by

the COVID-19 pandemic, and my (our) household is unable to meet the financial obligations of my (our) housing

expenses.

The amount that is currently due or will be due is $ _________________.

My (Our) ability to pay the above amount has been negatively affected by the COVID-19 virus for the following

reasons* (check all that apply):

☐ Reduction in work hours as follows: ___________________________________________________________

☐ Temporary business shut down as follows: ______________________________________________________

☐ Layoffs or terminations due to COVID-19 as follows: _____________________________________________

☐ Increase in out-of-pocket medical expenses as follows: ___________________________________________

☐ Other (explain): ___________________________________________________________________________

*Homeowner(s) must provide written documentation in support of the claim of financial hardship related to

COVID-19. The types of documentation that are acceptable include, but are not limited to, a letter or notice from

employer, establishing proof of reduction in work hours or proof of employer/ business shut down due to COVID-

19, medical bills, etc. If homeowner(s) is self-employed, homeowner(s) shall provide proof of self-employment

including federal income tax returns and a signed explanation of the hardship.

Contact information for employer is as follows:

Name of Employer: _________________________ Address: ___________________________________________

Contact Name: ____________________ Phone: ____________________ Email: __________________________

I swear or affirm that the answers are true and reflect my current finances and status regarding COVID-19. I

understand that a material misstatement fraudulently or negligently made in this affidavit or any other statement made

by me (us) in connection with an application for a Homeowner Emergency Loan Program (HELP) loan may constitute a

federal violation punishable by a fine and/or denial of my (our) application for a HELP loan, or, if HELP loan funds have

been released prior to discovery of the false statement, immediate recalling of the HELP loan, which may be in addition

to any criminal penalty imposed by law. I authorize the City to obtain records of information pertaining to my

financial or employment status from any source in order to verify the information provided by me.

Dated this day of , 2021

Applicant’s Signature: _________________________________ _______________________________________

Given the current exigency, Homeowner(s) agrees that Homeowner(s) may self-authenticate their sworn statement

herein and no notary shall be required.

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 2 of 14

TODAY’S DATE:

DUE TO COVID-19, YOU NEED ASSISTANCE WITH (PLEASE CHOOSE ALL THAT APPLY):

☐ PAST DUE HOA DUES ☐ CURRENT/FUTURE HOA DUES ☐ PAST DUE NON-ESCROW PROPERTY TAXES ☐ HOA

SPECIAL ASSESSMENTS ☐ DUE MORTGAGE FORBEARANCE PAYMENTS

PROPERTY INFORMATION

Street No. Street Name Street Type Unit #

City State Zip Code

Year Built: Year Purchased: ______

Total # of Units: __________

How many units are tenant-occupied: _____

How many units are vacant: _____

MOHCD-assisted property?  Yes  No

Head of Household (Household Member 1):

HOUSEHOLD

MEMBER

Head of

Household

LEGAL NAME

First Middle Last

DATE OF BIRTH

Month Day Year

OCCUPATION:

DEPENDENT?

Yes No

MARRIED OR DOMESTIC

PARTNERED? Yes No

Household Member 2

HOUSEHOLD

MEMBER

LEGAL NAME

First Middle Last

DATE OF BIRTH

Month Day Year

OCCUPATION:

DEPENDENT?

Yes No

MARRIED OR DOMESTIC

PARTNERED? Yes No

RELATIONSHIP TO HEAD OF HOUSEHOLD:

Household Member 3

HOUSEHOLD

MEMBER

LEGAL NAME

First Middle Last

DATE OF BIRTH

Month Day Year

OCCUPATION:

DEPENDENT?

Yes No

MARRIED OR DOMESTIC

PARTNERED? Yes No

RELATIONSHIP TO HEAD OF HOUSEHOLD:

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 3 of 14

Household Member 4

HOUSEHOLD

MEMBER

LEGAL NAME

First Middle Last

DATE OF BIRTH

Month Day Year

OCCUPATION:

DEPENDENT?

Yes No

MARRIED OR DOMESTIC

PARTNERED? Yes No

RELATIONSHIP TO HEAD OF HOUSEHOLD:

(if you need to add more household members, please attach a separate sheet to this application)

Total Household Size

Including Dependents:

CONTACT INFORMATION FOR HEAD OF HOUSEHOLD

RESIDENCE ADDRESS

 Mark if same as property address

We cannot accept a PO box here.

Street No. Street Name Street Type Unit

City State Zip Code

MAILING ADDRESS - you may use a PO box

 Mark if same as property address

(if different from residence address)

Street No. Street Name Street Type Unit

City State Zip Code

PRIMARY PHONE # SECOND PHONE # EMAIL

 Home  Work  Cell  Home  Work  Cell (leave blank if you don’t have one)

Area Code Phone Number Area Code Phone Number

SOMEONE WE MAY CONTACT IF WE CANNOT REACH YOU? (optional) PHONE NUMBER

__________________ ___________________ _____________________

First Name Last Name (Area Code) Phone Number

HOW DO YOU KNOW THIS PERSON?

Family Member  Friend  Other: ____________________________________________________________________

Social Worker or Housing Counselor Name of Agency _______________________________________________________

Counselor Name:_______________________ Email:_________________________________ Phone:____________________

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 4 of 14

BORROWER DISCLOSURES

You must complete this form as a part of your application.

See application instructions for more information and examples.

THE FOLLOWING QUESTIONS APPLY TO ALL BORROWERS:

A) Is the head of household applicant on the mortgage and title of property?

 Yes

 No

B) Does the applicant(s) have any outstanding judgements?

 Yes

 No

C) Has the applicant(s) declared bankruptcy in the past ten (10) years?

 Chapter 13 Discharge Date: _______________

 Chapter 7 Discharge Date: _______________

 Yes

 No

D) Are there any delinquent tax liens or other liens against the property?

 Yes

 No

E) Are the applicant(s) currently living in the property?

 Yes

 No

F) Are the HOA monthly assessment delinquent?

Number of months behind: ______ Total past due amount: _____________

HOA Name: _________________________ Phone #: __________________

 Yes

 No

G) Are any mortgages delinquent?

Number of months behind _____ Total past due amount: _________

 Yes

 No

H) Have you received a Notice of Default?

Name of Entity filing NOD: ______________________ NOD Date: ____________

 Yes

 No

I) Have you obtained a mortgage modification?

If yes, please provide date modification was granted: __________________

 Yes

 No

J) Is property listed for sale? If yes, please provide the following information:

Date of listing: ___________ Realtor Name:________________ Realtor Phone No.____________

 Yes

 No

K) Do you own other properties? If yes, please list addresses below:

 Yes

 No

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 5 of 14

HOUSEHOLD EMPLOYMENT AND INCOME

You must complete this form as a part of your application.

See application instructions for more information and examples.

**PLEASE PROVIDE A TWO YEAR WORK HISTORY**

“HH#” = Household Member Number

EMPLOYMENT: 2 YEAR WORK HISTORY IS REQUIRED

(Please write “unemployed” under “Name of Employer” for unemployed household members)

HH#

Employer Name

Employer Address

Day of Employment

(mm/dd/yyyy)

Self-Employed?

(Yes/No)

Gross Annual

Income

“HH#” = Household Member Number

GROSS ANNUAL INCOME for each household member

HH#

Wages

Social Security/Pensions

Received Annually

Public Assistance

Received Annually

Other Income Received

Annually (i.e. Income from

Retirement - if drawing funds;

Income from Investments; Child

Support; Alimony; etc.)

TOTALS

$ (a)

$ (b)

$ (c)

$ (d)

TOTAL GROSS ANNUAL INCOME Add (a) through (d):

$ (e)

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 6 of 14

HOUSEHOLD ASSETS – NON RETIREMENT

HOUSEHOLD MONTHLY

EXPENSES

You must complete this form as a part of your application.

See application instructions for more information and examples.

INCOME FROM ASSETS

Important: You must list every cash account that shows the household member as an account holder.

Asset accounts can include, but are not limited to, checking accounts, savings accounts, Certificates of

Deposit, Mutual Funds, stocks, bonds, trust funds, limited liability investments, gifts for down payment or

other costs, retirement accounts, monthly income from retirement and any other account in which money

is saved. If money is not saved in an institution (e.g. it is saved at home), applicants must list this amount,

as well. Do not include material assets such as cars, boats, etc. -- only cash assets.

You must also list all joint accounts, custodial accounts for minors, and other accounts on which the

household member’s name appears. Failure to list all accounts will disqualify your household from

applying for a Homeowner Emergency Loan. Retirement money will not be counted toward the asset test

and should not be listed below.

“HH #” = Household Member Number

HH #

Name of Institution

(bank name, etc.)

Type of Asset

(e.g: bank account, savings account, CD,

mutual fund, trust fund, gift, etc.)

Current Cash

Value of Asset

Total Household Liquid Assets (do not include retirement):

YOU MUST ATTACH THE 2 MOST RECENT AND CONSECUTIVE STATEMENTS FOR EACH ASSET LISTED ABOVE.

Monthly Housing Expenses:

Expense Type

Description/Name/Loan #

Current

Balance

Monthly

Payment

Mortgage

Mortgage/HELOC

Homeowner’s

Insurance

Property Taxes

Homeowners

Association (HOA)

Tenant Information:

Name

Unit #

Rent Amount

Phone #

Is Rent Delinquent?

 Yes  No

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 7 of 14

BORROWER CERTIFICATION AND SIGNATURES

The Mayor’s Office of Housing and Community Development (MOHCD) must obtain any documents needed to

verify the information provided. You must understand the requirements and the provisions of the loan agreement

prior to closing the loan. If you have any questions, please make sure you understand the program requirements

before loan closing. The information on this application will be used to determine loan eligibility. I/we have listed

all persons in my/our household. I/we have provided for each person(s) set forth in this application acceptable

verification of current annual income. I have also disclosed ALL assets held by each person listed in this

application, and have provided documentation thereof.

Under penalties of perjury, I/we certify that the information presented in this Certification is true and accurate to

the best of my/our knowledge and belief. The undersigned further understands that providing false

representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the

termination of the Homeowner Emergency Loan Program (HELP).

Borrower’s Signature

Borrower’s Printed Name

Date

Co-Borrower’s Signature

Co-Borrower’s Printed Name

Date

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 8 of 14

HOUSEHOLD CERTIFICATION AND SIGNATURES

The undersigned specifically acknowledge (s) and agree (s) that: 1) the loan requested by this application

would be secured by a junior deed of trust on the property described herein, 2) the property will be used

solely as the principal residence of the undersigned, 3) all statements made in this application are true and

made for the purpose of obtaining a Homeowner Emergency Loan Program (HELP) loan from the City and

County of San Francisco. Verification may be obtained from any source named in this application. I/we fully

understand that to make any false statements, whether negligent or intentional, concerning this application

will result in the City’s denial of a Homeowner Emergency Loan Program (HELP) loan or will be a default

under the Homeowner Emergency Loan Program (HELP) loan, as applicable.

The information on this form will be used to determine income eligibility. I/we have listed all persons in

my/our household. I/we have provided each household member’s acceptable verification of current annual

income. I/we have also disclosed all assets held by each person listed on the application, and have provided

documentation thereof. Under penalties of perjury, I/we certify that the information presented in this

certification is true and accurate to the best of my/our knowledge and belief. The undersigned further

understands that providing false representations herein constitutes an act of fraud.

Public records act: the City and County of San Francisco is subject to the requirements of the California public

records act, government code section 6250, et seq. the public records act provides that virtually all

documents held or used by the city in the course of conducting the public’s business are public records which

the city, subject to certain limited exemptions, must make available for inspection and copying by the public.

Applications for loans or grants from the city are public records as are the completed loan and grant

documents. Under section 67.24(e) of San Francisco administrative code, applications for financing and all

other records of communication between the City and the borrower must be open to public inspection

immediately after a contract has been awarded. All information provided by the borrower which is covered

by that ordinance (as it may be amended) will be made available to the public upon appropriate request.

MOHCD will not disclose personal sensitive information including dates of birth, social security numbers and

bank account numbers.

Must be signed by all applicants 18 years or older.

Applicant’s Signature

Applicant’s Printed Name

Date

Applicant’s Signature

Applicant’s Printed Name

Date

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 9 of 14

REQUIRED DOCUMENTS CHECKLIST

You must include copies of the following documents for each household member 18 years old or older. If any form is

missing, your application may be disqualified. Please check each box upon completion.

Item

Description (check at least one box per item)

Photo ID

☐ Copy of photo identification for all title holders.

Application

☐ Completed, signed and dated HELP Application (this form) (one for the entire

household).

Hardship Letter

☐ Signed and date hardship letter (include copy of any applicable supporting document

or form)

☐ OR – If you’re experiencing financial hardship due to COVID-19, submit a signed

and dated “Affidavit of Financial Hardship due to COVID-19” form (include copy

of any applicable supporting document or form)

Mortgage Statements

☐ Copy of most recent mortgage statements for all existing mortgages.

HOA Statements

☐ Copy of most recent homeowner’s association statement if applicable.

Homeowner’s

Insurance

☐ Copy of current homeowner’s insurance declaration.

Tax Information

☐ Signed and dated copies of last 2 years of Federal Income Tax Returns (IRS Form

1040 or 1040EZ or 1040A form ONLY).

Include all SCHEDULES and/or attachments required by the IRS

Include all W-2 and/or 1099 form(s).

☐ OR – If applicable, complete attached Income Tax Declaration form, and submit

with supporting documents as specified in the form.

Proof of Income

☐ Copies of 2 most recent and most consecutive paystubs and/or income statements.

☐ OR – If applicable, complete the attached Unemployed Declaration form. (Form

is not necessary if receiving any form of income that should be noted in the

application, such as unemployment income or government assistance)

☐ OR – If applicable, complete the attached Self-employed Declaration form.

Must be submitted with most recent and current Profit and Loss statement.

☐ OR – Benefits award letter.

☐ OR – Employment offer letter if less than 3 weeks from date of hire.

Bank Statements

☐ Copies of 2 most recent and most consecutive bank or asset statements from all

bank or other liquid asset accounts (listed on page 5 of 9 of this application). Must be

official statements. All pages must be included.

Year 1

Year 2

Paystub 2

Statement 1

Statement 2

Paystub 1

*If unemployed, include plans to support your ongoing housing expenses

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 10 of 14

CONSUMER FINANCIAL AND CREDIT REPORT RELEASE FORM

MAYOR’S OFFICE OF HOUSING AND COMMUNITY DEVELOPMENT

HOMEOWNER EMERGENCY LOAN PROGRAM (HELP)

By my signature below I authorize the Mayor’s Office of Housing and Community

Development to verify my bank accounts, employment, outstanding debts,

including any present or previous mortgages, to order a consumer credit report,

and to make any other inquiries pertaining to my qualification for a loan secured

by my property. You may make copies of this letter for distribution to any party

with which I have a financial relationship or credit relationship and that party may

treat such copy as an original.

Privacy Act Notice: This information is to be used by the agency collecting it or its

assignees in determining whether you qualify as a prospective mortgager under its

program. It will not be disclosed outside the agency except as required and

permitted by law. You do not have to provide this information, but if you do not,

your application for approval as a prospective mortgagor or borrower may be

delayed or rejected.

Applicant’s Name

Date of Birth

Social Security Number

Current Street Address

Signature

Date

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 11 of 14

THE HOUSING FINANCIAL DISCRIMINATION ACT OF 1977

FAIR LENDING NOTICE

It is illegal to discriminate in the provision of or in the availability of financial assistance because of the

consideration of:

1. Trends, characteristics or conditions in the neighborhood or geographic area surrounding a housing

accommodation, unless the financial institution can demonstrate in the particular case that such

consideration is required to avoid an unsafe and unsound business practice; or

2. Race, color, religion, sex, marital status, domestic partnership, national origin or ancestry.

It is illegal to consider the racial, ethnic, religious or national origin composition of a neighborhood or

geographic area surrounding a housing accommodation or whether or not such composition is undergoing

change, or is expected to undergo change, in appraising a housing accommodation or in determining whether

or not, or under what terms and conditions, to provide financial assistance.

These provisions govern financial assistance for the purpose of the purchase, construction, rehabilitation or

refinancing of one- to four-unit family residences occupied by the owner and for the purpose of the home

improvement of any one- to four-unit family residence.

If you have any questions about your rights, or if you wish to file a complaint, contact the management of this

financial institution or the Department of Real Estate at one of the following locations:

2550 Mariposa Mall, Suite 3070

Fresno, CA 93721-2273

320 W. 4th Street, Suite 350

Los Angeles, CA 90013-1105

1515 Clay Street, Suite 702

Oakland, CA 94612-1462

1651 Exposition Boulevard

Sacramento, CA 95815

P.O. Box 137000 (mailing address)

Sacramento, CA 95813-7000

1350 Front Street, Suite 1063

San Diego, CA 92101-3608

ACKNOWLEDGMENT OF RECEIPT

I (we) received a copy of this notice.

_____________________________________________ ___________________

Signature of Applicant Date

_____________________________________________ ___________________

Signature of Applicant Date

DEPARTMENT OF REAL ESTATE — Mortgage Lending Unit RE 867 (Rev. 7/18)

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 12 of 14

INCOME TAX DECLARATION

Complete this form only if you do not have copies of Federal Income Tax Returns for any year during the

preceding three years. Please complete the option(s) below that apply.

I (We) the undersigned, hereby declare the following:

 I (We) (name here) ___________________________________ hereby declare that I (we) was (were)

not required by law to file a Federal Income Tax Return for the following year(s) ______________________

for the reason(s) below (attach documentation to support reason):

_______________________________________________________________________________________

Please provide applicable documentation supporting the above explanation such as income earning did not

meet requirement for tax filing, proof of date of entry to US, school transcripts or diploma, etc. for that

period of time.

 I (We) hereby declare that I (we) was (were) not required hereby certify that the application in

connection with which I (we) am (are) applying for the San Francisco Homeowner Emergency Loan Program

(HELP) is occurring between January 1 and April 15, and that I (we) have not yet filed our Federal Income Tax

Return for the prior tax year. The income I (we) have for 20 is $

and does not exceed the income limits for the San Francisco Homeowner Emergency Loan Program (HELP).

By signing below, I (we) certify, under penalty of perjury, that the information presented in this Declaration

is true and accurate to the best of my (our) knowledge and belief. I (We) further understand that this

Declaration will be relied upon for purposes of determining my (our) household’s eligibility for the San

Francisco Homeowner Emergency Loan Program (HELP). I (We) acknowledge that a material misstatement

fraudulently or negligently made in this declaration or in any other statement made by me (us) in

connection with an application may constitute a federal violation punishable by a fine and/or denial of my

(our) application.

Dated: ____________________________ __________________________________

Signature of Applicant

Dated: ____________________________ __________________________________

Signature of Applicant

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 13 of 14

SELF-EMPLOYED DECLARATION

I (name here) _____________________________hereby declare the following:

I hereby attach copies of my federal tax returns (both individual returns and business returns if applicable)

for the immediate preceding three calendar years for which self-employment tax returns could have been

filed (or, if not filed, were not required to be filed) and certify that the information shown in such income tax

returns is true and complete to the best of my knowledge. Business income counted towards income

eligibility for the San Francisco Homeowner Emergency Loan Program (HELP) is net income from the operation

of a business or profession, including cash withdrawals from the business.

I have been self-employed from the following month and year forward: __________/___________

Number of Self-Employment Federal Tax Returns filed in the last three years: ____________

_______tax return income: $_________

(Year of)

_______tax return income: $_________

(Year of)

_______tax return income: $_________

(Year of)

By signing below, I certify, under penalty of perjury, that the information presented in this Declaration is true

and accurate to the best of my knowledge and belief. I further understand that providing false representation

herein constitutes an act of fraud, and results in the denial of my application.

Dated: ____________________________ __________________________________

Signature of Applicant

Attach a) copies of Federal Income Tax Returns (both individual returns and business returns if

applicable) for preceding three calendar years; and b) signed and dated Profit/Loss Statement to date

from last tax filing.

If this is a new business, or if you do not file income taxes, you will need to provide a) a signed and dated

Profit/Loss Statement; and b) copies of all invoices and payments made to the borrower as a part of self-

employment in the current calendar year.

Mayor’s Office of Housing and Community Development

City and County of San Francisco

SAN FRANCISCO HOMEOWNER EMERGENCY LOAN PROGRAM

(HELP) APPLICATION

January 2021 San Francisco HELP Application Page 14 of 14

UNEMPLOYED DECLARATION

This Declaration is to be signed by each household member 18 years of age and older when no employment

income for them is indicated on the San Francisco Homeowner Emergency Loan Program (HELP)

Application.

I (name here) ___________________________am not presently employed, not currently receiving any

income and will not file for unemployment benefits in 20 ____ (current calendar year). I am NOT eligible

to apply for or have exhausted my unemployment benefits and/or any other type of compensation based

on employment history.

Please read carefully and complete all statements that apply:

 I am not presently employed and do not anticipate becoming employed within the next twelve (12)

months.

 I am not presently employed, but anticipate becoming employed within the next twelve (12) months.

Based on my past work experience, skills, and income history, I expect to earn $____________ /year

when I become employed.

 I am not presently employed, but am aware of an employment start date of _______________ at

$________________ per ________________ (If amount is hourly, please provide number of hours

per week, ________). Please attach supporting documents, such as borrower’s offer or contract for

future employment and anticipated income if available.

By signing below, I certify, under penalty of perjury, that the information presented in this Declaration is

true and accurate to the best of my knowledge and belief. I further understand that this Declaration will be

relied upon for purposes of determining my eligibility for the San Francisco Homeowner Emergency Loan

Program (HELP). I acknowledge that a material misstatement fraudulently or negligently made in this

declaration or in any other statement made by me in connection with a loan application may constitute a

federal violation punishable by a fine and/or denial of my application.

Dated: ____________________________ __________________________________

Signature of Applicant

Mayor’s Office of Housing and Community Development

City and County of San Francisco

San Francisco Below Market Rate (BMR) Homeownership Program

Help us ensure we are meeting our goal to serve all people

How did you hear about this listing?  Newspaper  MOHCD Website  Developer Website  Flyer  Friend

 Email Alert  Housing Counselor  Radio Ad  Bus or Billboard Ad  Other

These OPTIONAL questions will not affect your eligibility for housing in any way.

Your individual answers are kept completely confidential and used only for statistical purposes.

What best describes your race and ethnicity? (select all that apply)

Asian

 Chinese

 Filipino

 Japanese

 Korean

 Mongolian

 Central Asian

 South Asian

 Southeast Asian

 Other Asian _____________________________________

Black

 African

 African American

 Caribbean, Central American, South American or Mexican

 Other Black ______________________________________

Indigenous

 American Indian/Native American

(Specific Group: _____________________________________)

 Indigenous from Mexico, the Caribbean, Central America or

South America (Specific Group: _________________________)

 Other Indigenous __________________________________

Latino

 Caribbean

 Central American

 Mexican

 South American

 Other Latino _________________________________

Middle Eastern/West Asian or North African

 North African

 West Asian

 Other Middle Eastern or North African ____________

Pacific Islander

 Chamorro

 Native Hawaiian

 Samoan

 Other Pacific Islander __________________________

White

 European

 Other White _________________________________

What is your gender? (Check one that best describes your current

gender identity)

 Female  Male

 Genderqueer/Gender Non-binary

 Trans Female  Trans Male

 Not listed – please specify: ___________________________

How do you describe your sexual orientation or sexual identity?

(Check one)

 Bisexual

 Gay/ Lesbian/Same-Gender Loving

 Questioning/Unsure

 Straight/ Heterosexual

 Not listed - please specify: ____________________________

Which primary language is spoken at home? (select one)

 Chinese – Cantonese

 Chinese – Mandarin

 English

 Filipino

 Russian

 Spanish

 Vietnamese

 Other Language Spoken at Home

For Service Rending: Pronouns and Chosen Name

 She/Her/Hers

 He/Him/His

 They/Them/Theirs

 Not listed. Please specify: _______________________

By what name do you wish to be called?

_______________________________________________