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'E_0F <br />x <br /> <br />UNIFORM HOUSING PROGRAMS APPLICATION <br />FOR SINGLE FAMILY ACTIVITIES <br />Texas Department of Housing and Community Affairs (TDHCA) <br />Mailing Address: P.O. Box 13941, Austin, Texas 78711-3941 <br />Physical Address: 221 E. 11"h Street, Austin, TX 78701 <br />Special Notation Symbols Used in the Application: <br />~ Attachment may be required. X Section does not apply to all Applicants ~ Significant Issue <br />The undersigned hereby makes application to TDHCA for financial assistance, has read and understands the application instructions, <br />and certifies that all information herein is true and correct to the best of their knowledge and belief. <br />! Submitted Application must have the original signature from a representative with authority to execute documents on the <br />ApplicanYs behalf. <br />Kevin Carruth <br />ApplicanYs Authorized Representative's Signature Representative's Printed Name, Tifle Date <br />1: APPU+CAN't tNMOMAMPI <br />Provide the contact data for the ApplicanYs staff person who is responsible for application and contract administration. This contact will <br />not be the consultant or the end seivice provider. <br />A. APPLICANT CONTACT INFORMATION <br />Applicant Legal Name: City of Paris Phone: (903) 784-9202 <br />Applicant Contact Name: Kevin Carruth Fax: (903) 785-8519 <br />Applicant Mailing Address: P. 0. Box 9037 <br />City, State, ZIP: Paris, Texas 75461-9037 Email: kcarruth@paristexas.gov <br />If Applicant's "Physical Address" is different from the "Mailing Address," provide the physical address below., <br />Applicant Physical Address: 13515t Street S.E. <br />City, State, ZIP: Paris, Texas 75460 <br />B. APPLICANT LEGAL DESCRIPTION <br />Applicant is legally formed? ❑ No 0 Yes If yes the Federal Taxpayer ldentification #(TIN) is: 75-6000635 <br />Legal Form of Applicant (check only one): <br />❑ For-profit Corporation ❑ Non-profit Corporation ❑ General Partnership ❑ Limited Partnership <br />❑ Limited Liability Company 0 Unit of Local Government ❑ Individual/D.B.A. ❑ Housing Authority <br />Other Designations (Mark all that apply.): ❑ Historically Underutilized Business ❑ CHDO ❑ COG M Federal Tax Exemption <br />Applicant is in good standing with the Secretary of State? ❑ No M Yes The State Filing # is: <br />ApplicanYs Fiscal Year Ends: Month September Day: 30 <br />C. APPLICANT DISCLOSURES <br />It If "Yes" is answered for any of items 1 " through "5" below, please provide a thorough explanation of the circumstances and <br />copies of correspondence regarding the status of ruling from the authority that made the determination, and place behind Tab 1. <br />Has the Applicant: <br />1) been delinquent on filing of any federal or state tax returns? Z No ❑ Yes <br />2) received federal or state findings? Z No R Yes <br />3) been delinquent on federal or state debt? Z No ❑ Yes <br />4) been debarred from HUD' or other federal programs? Z No El Yes <br />5) filed bankruptcy in the last 10 years? Z No ❑ Yes <br />I It is the responsibility of the Applicant to contact HUD to ensure they have not been disbarred, as HUD does not always notify <br />persons that they have been disbarred. <br />Attachment 1, Page 3 of 15 <br />