09-C Homebuyer Assistance Grant App

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~ P~0F~ i ~ w ~ x UNIFORM HOUSING PROGRAMS APPLICATION FOR SINGLE FAMILY ACTIVITIES Texas Department of Housing and Community Affairs (TDHCA) Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941 Physical Address: 221 E. 11th Street, Austin, TX 78701 Special Notation Symbols Used in the Application: ~ Attachment may be required. X Section does not apply to all Applicants ~ Significant Issue The undersigned hereby makes application to TDHCA for financial assistance, has read and understands the application instructions, and certifies that all information herein is true and correct to the best of their knowledge and belief. 1 Submitted Application must have the original signature from a representative with authority to execute documents on the ApplicanYs behalf. Kevin Carruth ApplicanYs Aufhorized Representative's Signature Representative's Printed Name, Title Date 1. APP0CAWit~F0W►i0N Provide the contact data for the Applicant's staff person who is responsible for application and contract administration. This contact will not be the consultanf or the end service provider. A. APPLICANT CONTACT INFORMATION Applicant Legal Name: City of Paris Phone: (903) 784-9202 Applicant Contact Name: Kevin Carruth Fax: (903) 785-8519 Applicant Mailing Address: P. 0. Box 9037 City, State, ZIP: Paris, Texas 75461-9037 Email: kcarruth@paristexas.gov IfApplicanYs "Physical Address" is different from the `Mailing Address," provide the physical address below: Applicant Physical Address: 1351St Street S.E. City, State, ZIP: Paris, Texas 75460 B. APPLICANT LEGAL DESCRIPTION Applicant is legally formed? ❑ No Z Yes If yes, the Federal Taxpayer ldentification #(TIN) is: 75-6000635 Legal Form of Applicant (check only one): ❑ For-profit Corporation ❑ Non-profit Corporation ❑ General Partnership ❑ Limited Partnership ❑ Limited Liability Company Z Unit of Local Government ❑ Individual/D.B.A. ❑ Housin Authority Other Designations (Mark all that apply.): 0 Historically Underutilized Business ❑ CHDO ❑ COG Z Federal Tax Exemption Applicant is in good standing with the Secretary of State? ❑ No Z Yes The State Filing # is: ApplicanYs Fiscal Year Ends: Month Seqtember Day: 30 C. APPLICANT DISCLOSURES ~ If "Yes" is answered for any of items "1" through "5" below, please provide a thorough explanation of the circumstances and copies of correspondence regarding the status of ruling from the authority that made the determination, and place behind Tab 1. Has the Applicant: 1) been delinquent on filing of any federal or state tax returns? Z No ❑ Yes 2) received federal or state findings? Z No ❑ Yes 3) been delinquent on federal or state debt? Z No ❑ Yes 4) been debarred from HUD' or other federal programs? Z No ❑ Yes 5) filed bankruptcy in the last 10 years? Z No ❑ Yes I It is the responsibility of the Applicant fo contact HUD to ensure they have not been disbarred, as HUD does not always notify persons that they have been disbarred. Attachment 1, Page 3 of 15 _ _ . , .