NORTH SUBURBAN CONSORTIUM

AFFORDABLE HOMEOWNERSHIP APPLICATION

80% Median Family Income for Households by Household Size
(effective March 30, 2016)

1 person $51,150
2 person $58,450
3 person $65,750
4 person $73,050

5 person $78,900
6 person $84,750
7 person $90,600
8 person $96,450

IV. Other Information

Are you a First Time Homebuyer? ___ Y ___ N

V. Supporting Documentation
In order to complete an income certification, submit the following income documentation with your application.
Please note, you can submit this application for review, but it will not be considered complete until all of the
necessary income documentation has been received.
3 most recent years Federal tax returns
3 most recent months bank statements for all bank accounts (checking & savings)
3 most recent months paystubs for all household members over 18 years of age
Documentation of "other" income sources (child support, social security, welfare, etc)
Signed Zero Income Affidavit for any households members over 18 years of age who have no income
Evidence of full time student status for any students over 18 years of age

The information on this form will be used to determine maximum income eligibility. I/we have provided
for each person(s) acceptable verification of current anticipated annual income.
Under penalties of perjury, I/we certify that the information presented in this application 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.
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Signature (Household Member)
(Date)

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Signature (Household Member)
(Date)

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Signature (Household Member)
(Date)

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Signature (Household Member)
(Date)

This form must be signed by ALL adult household members. Adult household members are those who
are 18 years or older
WARNING: Section 1001 of Title 18 of the United States Code makes it a criminal offense to make
willful false statements or misrepresentations to any Department or Agency of the United States.
Penalties of this Section include a $10,000 fine and/or five (5) years imprisonment.