Pre-Purchase Counseling Intake Form

Thank you for your interest in Housing counseling. Please know the City of South Bend is a U.S. Department of Housing and Urban Development (HUD) authorized housing counseling agency and there is no charge for our Counseling services.  With the completed application you will need to provide copies of the following documents:

• Proof of income
  • If you have wages, please provide current, consecutive paystubs for the last 30 days
  • If you are paid biweekly, please provide three (3) current paystubs
  • If you are paid weekly, please provide five (5) current paystubs
  • If you receive child support, please provide a copy of the court order and six months of payment history
  • If you receive Social Security. disability. unemployment, a pension. food stamps, or any other type of income, please provide a copy of the award letter
  • If you are self-employed, please provide a typed year-to-date Profit and Loss Statement along with the corresponding bank statements and two (2) years of federal income tax returns, signed and dated on page 2, with all W-2(s), 1099(s), forms and schedules.
    
    
• Bank Statements for the most recent 2 months
  • Bank statements must show the following: your name & address, your bank's name, your full account number, and the period of time covered. Please include all numbered pages, even if blank.
    
    
• Photocopy of your driver's license or state-issued picture identification card

 

Please know your application is considered incomplete until we receive all the above items. After we have received your completed application and all requested documents, we will contact you to schedule an appointment.

If you have any special needs or require special accommodation, please contact our office in advance. If you have questions, feel free to call us at (574) 235-5848 or email jdavis@southbendin.gov.

Definitions

Monthly Gross Income: Income before tax

Monthly Net Income: Income after tax.

 

Click into the input table below to fill it out. 

The applicant(s) certifies that all information given in this application and all information furnished in support of this application is given for the purpose of obtaining housing counseling through the City of South Bend. Furthermore, all of the information is true and complete to the best of the applicant’s(s’) knowledge.

Penalty for false or fraudulent statement
U.S.C. Title 18, Section 1001 provides:

“Whoever, in any matter within jurisdiction of any department or agency of the United States, knowingly and willfully falsifies or makes any false, fictitious, or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined no more than $10,000, or imprisoned not more than five (5) years, or both.”

I {name} and {spousesName} authorize and instruct the City of South Bend to obtain information concerning our: 

For purposes of determining my/our mortage readiness.

The City of South Bend through its Department of Community Investment (the "City") provides a number of counseling programs for first-time homebuyers, including Pre-Purchase, Mortgage Default, Credit Counseling and Homebuyer Education. The City has been authorized to offer remote counseling services, provided that the potential homebuyer executes this Informed Consent for Video Counseling. Please read and complete the document. If you have any questions related to video counseling, please notify Janella Davis at jdavis@southbendin.gov.

The undersigned hereby requests counseling as set forth above. In requesting remote counseling and signing this document, I confirm that I have read and understand the following:

1. Technical Requirements. I hereby confirm that I have a computer or smartphone with sufficient operating functionality and an internet connection with the capability to run an audio and video program that will allow me to participate in real time one on one counseling with a representative from the City. I also confirm that I have an e-mail address at which I am able to receive a secure invitation to a video conference.
   
   
2. Privacy Requirements. I understand that the video counseling session is a replacement for the in-person counseling session that I would normally be required to attend. As such, I understand that the City will perform such remote counseling services from a private and secure location, and I agree that it is my responsibility to locate a private and secure location from which to accept such counseling. In the event that I am uncomfortable with any aspect of the video counseling session, I understand that I may end it at any time; however, I will be required to continue such counseling in-person, when such services are offered. The video conference will not be recorded.
   
   
3. Confidentiality. I understand and agree that the same duty of confidentiality that applies during an in-person counseling session shall apply to the City during a video counseling session; however, I understand that while the City will endeavor to provide a password protected video conferencing environment and secure method in which to deliver my financial and other information in order to limit the potential for unauthorized access to it, there is a chance that technology may be interrupted, accessed without authorization, or otherwise fail. I understand and agree that if at any time I am concerned for the security of my information, I may terminate the video counseling session at any time or request to provide my data by an alternate method; however, I may be required to reschedule the video counseling session or continue the counseling session in-person, when such services are offered.
   
   
4. Other. In signing this Informed Consent for Video Counseling, I acknowledge and represent that:
   
   
   1. I have read the foregoing document, understand it and sign it voluntarily as my own free act and deed;
   2. No oral representation, statement or inducement, apart from the foregoing written document has been made;
   3. I am at least ( 18) years of age and fully competent; and
   4. I expressly agree that this Informed Consent for Video Counseling in intended to be as broad and inclusive as permitted by the laws of the State of lndiana and that it shall be governed by and interpreted in accordance with the laws of the State of Indiana.
      
      

IN WITNESS WHEREOF, I have hereunto set my hand today, {todaysDate}

I/We, {name}, {spousesName} understand that I/We have the right to choose my/our house, lender, mortgage product, and real estate professional.

However, I/We understand that the Housing Counseling Agency, the City of South Bend, Indiana, may provide information on specific mortgage products, and housing Professionals for informational purposes to help me/us make a more informed home purchase decision. I/We understand that there is no obligation to use the programs or firms listed or provided.

I/We have read and understand the above Housing Counseling Disclosure.

I/We, {name}, {spousesName} understand that the City of South Bend's Housing Counseling Agency provides the following housing counseling services, of which I/We am/are participating in the services that we will check below:

 

In the course of providing the above noted services, the Housing Counseling Agency may provide information on a variety of topics to include but not be limited to: specific mortgage products, lenders and financial institutions; housing, insurance, tax and real estate professionals, and more. I/We understand that this is for informational purposes to help me/us make a more informed decision.

I/We understand that I/We am/are not obligated to receive, purchase or utilize any other services offered by the City of South Bend or any of its partners in order to receive housing counseling services.

I/We have read and understand this Housing Counseling Disclosure, and it will be included in my/our counseling file.

I/We, {name}, {spousesName} understand that the housing counselor has pulled my/our credit report from only one reporting bureau: (Transunion). I/We may request my/our credit reports from all three reporting credit bureaus. They are: Equifax, Experian, and Transunion. I/We may do so by going to the following website: www.annualcreditreport.com, or I/we may contact them at (877) 322-8228 to order my/our reports over the phone.

Because the City of South Bend's housing counseling agency can only pull one credit report, I/we acknowledge the housing counselor cannot completely assess my/our potential for mortgage readiness.

I/we understand that after I/we have received all three (3) credit reports, I/we may schedule another meeting with the housing counselor, so she can review all of my/our credit reports.

I/We have read and understand the above Housing Counseling Disclosure.