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Home My WebLink About770428.tiff RESOLUTION RE: ACCEPTANCE OF APPLICATIONS FOR THE EVANSTON REHABILITATION PROJECT. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, a Weld County Department of Planning Services representative presented to the Board of County Commissioners , six potential applications of recipients of rehabilitation grants for the Evanston project, and WHEREAS , the list of applications is as follows, to-wit: App. Number Grant Number Amount EV-6-DN-08-3 #1 $4 , 878 EV-6-DN-08-3 #3 4 ,490 EV-6-DN-08-3 #4 5, 850 EV-6-DN-08-3 #5 7 , 500 EV-6-DN-08-3 #6 7 , 500 EV-6-DN-08-3 #7 7, 500 TOTAL $37, 718 WHEREAS, it was pointed out by the Planning representative that the total amount includes both the County grant and HUD loan, and WHEREAS, the Board of County Commissioners have agreed that the submitted applications are in order and recommends approval of the same. NOW, THEREFORE, BE IT RESOLVED by the Board of County Com- missioners of Weld County, Colorado, that the applications sub- mitted for approval concerning rehabilitation grants for the Evanston project, be, and hereby are, approved. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 9th day of November, A.D. , 1977. . N BOARD OF COUNTY COMMISSIONERS ATTEST: 1 ' i.:12, • (: • ^,:2- "Gn/ WE COUNT O O DO l ,/ Jy. Weld County Clerk and Recorder 4.--- 2_?, 1c__,- and -Clerk to the BolArYct. Deputy County\Clerk A OV AS TO FORM: ( — � County Attorney ip 770426 1 «'/` Date Presented: November 21, 1977 1111EMORginDurri !me To Board of County mmi /ss .[/ Date November 9, 1977 COLORADO From William Rodriguez '/ee"� subject: Final Review & Approval of Rehabilitation Grants for Evanston Project Clients Note : The enclosed applications were reviewed by the Board during a work session on Monday, October 7 , 1977. At that time , your preliminary approval was considered. Your final approval and signature is hereby requested for the following appli- cants. App. Number Grant Number Amount of Grant EV-6-DN-08-3 Grant #1 $4878 EV-6-DN-08-3 Grant #3 4490 EV-6-DN-08-3 Grant #4 5850 EV-6-DN-08-3 Grant #5 7500* EV-6-DN-08-3 Grant #6 7500* EV-6-DN-08-3 Grant #7 7500* *Includes County Grant and HUD Loan combined. u�,). T.-Fal 4 31 i`1 18 LOIAN & GRANT Hui)••62ni Form Approved (10 i0) c)MB No. 63—FtIl"(l r E. IDENTIFICATION T t� -7-7 �..., 1 DAYS OF WELD COUNTY I. APPLIi A 11l)N N11MHr.t BOARD OF COUNTY COMMISSIONERS i ! ! .EV 16 DN-71_1 Grant#7 3 1 APPLICATION FOR CBDG GRANT ,». oAY 3. NAME, ADDRESS, ANC) ZIP COUE OF PUBLIC POUT A. APPLICANT DATA Dept. of Planning Services I. NAME, ADDRESS, AND ZIP CODE OF APPLICANT(S1 A6E or Housing Division (Last name first) . APPLICANT P.O. Box 188 VALDEZ , ADRIAN AND PATSY (hem of household) Dacono, CO 80514 240 Dunmire Street P.O. Box # 404 F-7 -F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO Frederick, CO 80530 —_ APPLICANT'S DWELLING UNIT 2. TOTAL NUM- 3. APPLICANT (head of household) is: I. Mortgage payments (principal rind BER OF DEPEN- 5 + White (nonminority) inlerest only) $ NONEDENTS OF AP- b. Negro/Block PueANTtst i 2. Ground rent • LISTED ABOVE, [1C. American Indian N/A Dud. Spanish American - A es of r7 e. Oriental 3. Hazard irsuronce N/A g dependents: 11—15-17 `i—]I. Other minorities not included °hove 4. Real property taxes, special B. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT assessments $3. 32 5, Maintenance 3 . 00 Not Applicable (Social Security Income) 6. Heat and utilities $47. 38 C. TOTAL PRESENT MONTHLY INCOME OF APPLICANT(S) Auto 1. Other Ins .Liability 15 .00 1. Base pay: Husband $ $240 . 00 S.S. I . Wife 134. 80 S.S . I . 8. Total present monthly housing er• Other — 0 - pease (sum of Lines 1 through 7) b $68. 70 Total .All applicants $ $374. 80 G. CHARACTERISTICS OF PROPERTY 2. Other earnings — 0 — ` 1. As•is value(If application for Section 3. Net Income from property being f 312 loon is in process. show saute rehabilitated, if any — 0 - III as•i.s value; otherwise estimate 4. Social security, pensions, annuities See #1 as-ts value) $ 5. Other income — 0 — ears • 2. Age of structure 67 y 6. Total present monthly income (sum of Lines 1 through 5) s $374 . 80 3. Remaining economic life of structure D. ASSETS OF APPLICANT(S) after rehabilitation (If application 1. Total assets for Section 312 loan is in process. a. Cash on hand and in cosh accounts $ — 0 — show same number of years; other- ` raise estimate remaining economic b. Marketable securities and U.S. life) N/A years savings bonds — 0 — c. Equity in other reol estate, 4. Number of dwelling units (1) Motket value b • 1 O. Before rehabilitation 1 (2) Unpaid balance y (3) Egutty(Line c(1)mint. Line (.51)1 =._.9 - _ l d. AEI other assets (no riot include value of pro- b. After rehabilitation petty .shown in Item 11, or value of furniture, H. REHABILITATION COSTS clothing. automobiles or other personal pro- — T perry) y — 0 — 1. Amount of grant applied for s$7, 500 .00. e. Total assets (sum of Lines a, b. c(.3),. and d) — 0 — 2. if any, amount of Section 312 2. Unpaid bills for load, medical expenses, etc. loon applied for $11, 523 .00 (Do not include drtit.s on furniture, clothing, II UV,' 3. If any, funds from other mobiles, Of other personal property) _ t.ourCen — 0 — ._... ........ . — r_.—_.-- 4. Total rehabilitation costs. 3. Net assets r.r.,nr 1,. -.rims Lin.. 21 WUL (sum of Lints 1 through "1) $119, 023. 00 Previous editions ore obsolete �iii�-(Uver) HUD-6:e6 (10-70) I. CERTIFICATION BY APPLICANT(S) The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under the Community Development Act and is true and complete to the best of the Applicant's knowledgc sad belie!. The Applicant further certifies that he is the owner of the F:.,,.erty described in this application, and that the rehabili- tation grant proceeds will be used only for the work and materials necessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property .le,cribed in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or cannot be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, right, or claim. The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title VI of the Civil Rights Act of 1964 (78 Stat.252)- The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. Date Signature Date Signature Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION J. The undersigned has examined the application for a CDBG Grant described herein, including supporting data, and. finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld , of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, line 1. November 9, 1977 Date 5.rnature Chairman, Board of County Commissioners rtle I 254242-P HUD—Wash., D.C. L GPO 19]5.6]]:1]11915 Ifl Form Approved LOAN & GRANT HLI'I-6260 OMB No. 63—RI'';(1 '0. 101 E. IDENTIFICATION r I. Af'F'Llt A I IUN NIIMhrii 2. CATfs O>= WELD COUNTY I.I,I,,,vAL- BOARD OF COUNTY COMMISSIONERS ' EV__ 6-DN-8 ,Grant#6 , 3 1 A APPLICATION FOR CBDG GRANT YIr. NI,• o,,y 3. NAME, ADDRESS, ANI) ZIP CODE OF PUBLIC BOOS A. APPLICANT DATA �� Dept . of Planning Services I. NAME, ADDRESS, AND ZIP CODE OF APPLICANTCSI A;;F. OF Housing Division (Last name first) .APPLICANT P.O. Box 188 (held of Dacono, CO 80514 Vidal, Richard & Rose house'rildJ P.O. Box 6 - Frederick, CO fr AKA - 347 Dunmire Street 4Z F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO Evanston. CQ 80530 APPLICANT'S DWELLING UNIT 2. TOTAL NUM- 3. APPLICANT (head of household) 15: 1. Mortgage payments (principal rind .................wBER OF DEPEN- (-• interest only) $ — 0 — DENTS OF AP- 6 Li°• white(nnnminorityJ i PLICANTIS) Ob. Negro/Black 2. LISTED ABOVE: [ C. American Indian Ground rent • 0 - d. Spnish 5/13/17/19/20/47 � e. OrientalAmerican 3. Hazard Irsuroncr Ages of _ Q _ cri F. Other rnlnorities not included oheve dependents: — d. Real properly taxes, special 8. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT assessments $7. 86 Stanley Structures Co. 5. 5801 Pecos Street Maintenance Denver, CO 80221 6. Heat and utilities $70. 15 C. 'TOTAL PRESENT MONTHLY INCOME OF APPLICANT(S) 7. Other _ _ 1. Base pay: Husband S$1066 .00 - 0 ')life NONE 8. Total present monthly housing es• a NONE pense barn of Lives 1 through 7) •5 $78. 01 Other Total •All applicants $ $1066.00 G. CHARACTERISTICS OF PROPERTY 2. Other earnings Cp. Sharing Plan 5 , 33 1. As•is value Of application for Section 3. Net income from property being 312 loan is in process, show same rehabilitated, ii any 0 — as-is vat',e, otherwise estimate 4. Social security, pensions, annuities — 0 — as-is value) — 0 — S. Other income NONE 2. Age of structure 55 years 6. Total present monthly income (sum of Lines 1 through 51 $ $1071. 33 3. Remaining economic 11fe of structure D. ASSETS OF APPLICANTS) after rehabilitation(If application 1. Total assets for Section 312 loan is in process,a. Cash on hand and in cosh accounts $ $100 . 00 show same number of years; other- .r wise estimate remaining economic b. Marketable securities and U.S. life) 30 years savings bonds NONE • c. Equity in other real estate, 4, Number of dwelling units (1) Market value 5 (2) Unpaid balance a. Before rehabilitation —1.-.^ I r (3) Equity(Line r•(l) minus line �(2)) NONE _ 1 h. After rehabiIlotion _.--- d. All other assets (I(/),. MIL include polar of pro- perty shown In /rem Al. or r-slur of furniture, H. REHABILITATION COSTS 1 clothing, automobiles or other personal pro- -- I pertyl Credit Union Work 16 . 66 1• Amount of grant applied for 4 '.1 , 500 . 00 e. Total assets (.ram of Lines a. b, c(3), and dl $116 .66 2. If any, amount of Section 312 2. Unpaid bills for fooa, medical expense'.., etc. loon applied for 23, 891. 00 (Do ant include di'trtr on 1urnirurr, riot/wig, weir'- 3. If any, funds horn other mobiles, or other personal proprrtt) NQNE ;a"",-, — — 0 — 5 4. Total rehabilitation costs 3. Net assets O,inr• 1.. ..,inns Line 2) S116 _66 (sum of!.Ines i through I) $31, 391 .00, Previous editions ore obsolete (Over)1l HUD-62t. (10-70) I. CERTIFICATION BY APPLICANT(S) The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under thn Community Development Act end is true and complete to the best of the Applicant's knowledge a.-.d belief. The Applicant further certifies that he is the owner of the p..,.erty described in this application, and that the rehabili- tation grant proceeds will be used only for the work and materials necessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property dr+ctibtd in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or cannot be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, right, or claim. The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title VI of the Civil Rights Act of 1964 (78 Stat.252), The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. Date Signature Date Signature Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION J. The undersigned has examined the application for a CDBG Grant described herein, including supporting data, and finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld, of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, line 1. November 9, 19,77 -/ 7 -----e/ %17=777 Date Agnature airman, Board of County Commissioners Title 254242—P HUD—Wash., D.C. a GPO 1975-677.391.196 /8 ti • Form Approved LOAN & GRANT tttl,'i0?/oa OMIT Ni 63—RI i't.1 E. IDi:NTIFICAI iON _ _ t. AI'F'1_li A ION NUMIfrH - DATf-a OF WELD COUNTY „Iv^L BOARD OF COUNTY COMMISSIONERS i """'-T 1 APPLICATION FOR CBDG GRANT lEV ;6 DN-08IGrant#5a3 i L v ri. 51O why 3. NAME, ADDRESS, AND ZIP coot-: OF PUBLIC POW( A. APPLICANT DATA Dept. of •Planning Services I. NAME, ADDRESS, AND ZIP CODE OF APPLICANTIS) not OF Housing Division (Last name first) APPLICANT P.O. Box 188 f Moreno, Angela 1>vu=(head Dacono, CO 80514 P.O. Box 292 - Frederick, CO AKA - 530 Johnson - Evanston 1 F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO CO 80530 APPLICANT'S DWELLING UNIT 2. TOTAL NUM• 3. APPLICANT (head of household) is: 1. Mortgage payments(principal and $ — 0 — N' ..i.. .....BER OF DEPE 1 O. White(nonminority) interest only) DENTS OF AP.. PLICANTIS) rib. Negro/Block L 2. Ground rent LISTED ABOVE: []c. American Indian for trailer $135 . 00 1)(1 d. Sponi sh American • Ages of e. Oriental 3. Hazard insurance — — dependents: 71 (Self) Elf. Other minorities not included ohe,•e 0 4. Real property taxes, special B. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT assessments $2 .50 5. Maintenance - - Not Applicable (Retired) , 6. Heat and utilities $20 .00 C. TOTAL PRESENT MONTHLY INCOME OF APPLICANT(S) 7. Other - 0 - 1. Bose pay: Husband $ — 0 - , Wife $168. 40 S .S.I . 8. Total present monthly hnu;Inn er• $157 . 50 - 0 — pense (•on, of Lulrs I thrru,gh 7) $ Other e Total .All applicants $ $168. 40 G. CHARACTERISTICS OF PROPERTY 2. Other earnings OAA 9.00 1. As•is value (If application for Section 3. Net income from property being 3J2 loan is in process, show .came rehobilitoted, if any 0 — as•i.s value; otherwise estimate 4, Sociof security, pensions, annuities See #1 as-is value) $ — 0 5. Other income Royalties on well 15 .00 2. Age of structure 53 years 6. Total present monthly income (sum of Lines 1 through 51 $ 192 . 40 3. Remaining economic life of structure D. ASSETS OF APPLICANT(S) after rehabilitation Of application 1. Total assets for Section 312 loan is in process, o. Cash on hand and in cosh accounts $ $100 .00 show same number of years; other. wise estimate remaining economic b. Marketable securities and U.S. — 0 — life) 30 years savings bonds c. Equity in other real estate, 4. Number of dwelling units (I) Market value $(2) Unpaid balance _ a. Before rehabilitation 1 (3) Equity(Line e(1)minus Line c(2)) — 0 — 1 d. AlI other assets (1)o not include value of pro. b. After rehabilitation — — perry shown in /tem /11. or value of furniture. H. REHABILITATION COSTS clothing,automr+hilrs re other personal pro- — — perty) — 0 — 1. Amount of grant applied for $ $7, 500 .00 . e. Total assets (sum of Lines a, h, c(3), , and d) 0 . :_. 2. II any, amount of Section 312 2. Unpaid bills for food, medical expenses, etc. loon nppiied for $13, 558. 00 (Do not include deb(s on furniture. clnth+ug, aria+- 3. If any, funds from other mobiles, or other per u,na! proper()) — source; `� 4. Total rehabilitation costs 3. Net assets ((Line 1• ,ins, Line 21 $ of 81,0Q`40 _ . I,I,.; l.rnr.c l through rl 1$21, 058.00 Previous editions are obsolete (Or re-) HUD-OM, (10-70) I. CERTIFICATION BY APPLICANT(S) • The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under th° Community Development Act and is true and complete to the best of the Applicant's knowledgc sad belie!. The Applicant further certifies that he is the owner of the piuperty described in this application, and that the rehabili- tation grant proceeds will be used only for the work and materials necessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property .1,,cribtd in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or ca'not be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, tight, or claim. The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title VI of the Civil Rights Act of 1964 (78 Stat.252)- The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. Date Signature Date Signature Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION !. The undersigned has examined the application for a CDBG Grant described herein, including supporting data, and. finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld, of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, line 1. • • November 9, 1977 • Date Signature Chairman, Board of County Commissioners Title 254242—P HUD—wash., D.C. o GPO 1975-617.333-ree re HU:)-6260 - • Form Approved ii)• 20) OMB eJa. 63—R1134 _�.. E. IDENTIFICATION — ___ - _ _ I. AY•f'Lll A T ION NIIMHt',+ T DATTc OF WELD COUNTY A I' "'1 V,�,~. BOARD OF COUNTY COMMISSIONERS I 11 EV1 6-- DN-0p Grant#4` 3 _ ► �, • APPLICATION FOR CBDG GRANT . Mt,. pAV 3. NAME, ADDRESS, AND ZIP (-ODF OF PUBLIC. BODY A. APPLICANT DATA ---- Dept. of Planning Services 1. NAME, ADDRESS, AND ZIP CODE OF APPLICANT'S) AGE OF Housing Division (Last name first) .APPLICANT (hendof P.O. Box 188 Kerr, Perry E./Florence P. household} Dacono, CO 80514 P.O. Box 343 - Frederick, CO AKA - 131 Johnson St. 71 F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO Evanston, CO 80530 APPLICANT'S DWELLING UNIT 2. TOTAL NUM- 3. APPLICANT (head of household}IS: 1. Mortgage payments(principal and BER OF DEPEN- 2 ®a White(nonminority) interest only) S $67.00 DENTS OF AP- b, Negro/Block PLIGANTIS) [ 2. Ground rent LISTED ABOVE: Fie. American Indian N/A []d. Spanish American • �J e. 'Oriental 3. Hazard insurance Ages of 74 (wife) (•`11. Other minorities not included above I NONE dependents: • ► 4. Real properly taxes; special B. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT assessments $10.64 5. Mo,ntenance 3. 0 0 Not Applicable (Retired) 6. Heat and utilities 57 . 00 C. TOTAL PRESENT MONTHLY INCOME OF APPLICANT(S) 7, Other N/A �- 1. Base poy: Husband $ $284. 50 S .S. I . W,fe 116.90 S .S . I . 8. Total present monthly hnusin' ex• s$137 . 64. Other 90. 00 O.A.A. pl'nse (sum of Liner I through 7) Total -All applicants $ $491. 40 G. CHARACTERISTICS OF PROPERTY 2. Other earnings ___NYA 1. As-is value(lf application for Section 3. Net income from properly being 312 lone is in process, show .lame rehabilitated, if any N/A as-Is value; otherwise estimate 4. Social security, pensions, annuities See #1 as-is value) Is — 0 — S. Other income N/A 2. Age of structure 37 yecr'. 6. Total present monthly Income J (sum of Lines 1 through 5) 5 $491. 40 3. Remaining economic life of structure D. ASSETS OF APPLICANT(S) after rehobilitation(if application 1. Total assets — for Section 312 loan is in process. a. Cosh on hand ond'in cosh accounts S — 0 — show same number of years; other- wise estimate remaining economic b. Marketable securities and U.S. life) 30 savings bonds — 0 - c. Equity in other real estate, 4. Number of dwelling units 1 (1) Motkct value $ (2) Unpaid balance a. Before rehabilitation 1 (3) Equity(Line c(t)minus Line c(2)} — 0 — b. After rehobilitation 1 d. All other assets(DO not include value of pro- - perty shown in/tem Al, Cr value of furniture. H. REHABILITATION COSTS clothing,automobiles or other personal pro- r i perty) ._._- 0 - 1. Amount of grant applied for $ $5, 850 . 00 e.• Total assets(sum of Lines a,b.cf31.. and d) -- 0 — 2. If any, amount of Section 312 NONE 2. Unpaid bills For food,medicol expenses, etc. loon applied for (Do not include debts on furniture, clothing.mar,- 3. If any, funds from other mobiles, or other personal property} — 0 — sources NONE Total rehabilitation cast:. 3. Net assets (I,+II, l r• r.Iinus Line 2) $ Q — (sum of(.inns I through .1) s $5 , 850 . 00 , Previous editions ore obsolete (Oyer) MUD-626i. (10-70) I. CERTIFICATION BY APPLICANT(S) The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under the Community Development Act and is true and complete to the best of the Applicant's knowledge ai:d belief. The Applicant further certifies that he is the owner of the F::.,.erty described in this application, and that the rehabili- tation grant proceeds will be used only for the work•and matertalsnecessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property described in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or cannot be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, right, or claim. The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title vi of the Civil Rights Act of 1964 (78 Stat.252), The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. Date Signature Dale Signature Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than S10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION i. The undersigned has examined the application for a CDBG Grant described herein, including supporting data, and finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld, of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, line 1. November 9 , 1977 Date Signature Chairman, Board of County Commissioners --- Title - e A 254242—P MUD—Wash., U.C. u GPO 1975-677-333-196 18 A r Form Approved HUD-6760 �• OMB No. 63—RI I:I4 ;t0 70) v COUNTY r7� E. IDENTIFICATION__ __ - _ __ _ COUN lY I. A1.1•L1. Al IUN NIiMt ,i 2 DATA OF WELD Ar•, le,iVAL. BOARD OF COUNTY COMMISSIONERS I I ) REV [ 6- DN-08 Grant#31 3 I APPLICATION FOR CBDG GRANT .....—...L-__—....... v„"�o�y 3. NAME, ADDRESS. AND ZIP rODE OF PURLIC PODY A. APPLICANT DATA Dept. of Planning Services I. NAME. ADDRESS. AND ZIP CODE OF APPLICANTISI A„E CIF Housing Division (Last name first) APPLICANT P.O. Box 188 BRUSH, EDITH N. houseehold) Dacono, CO 80514 417 Johnson Street P.O. Box # 246 F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO Frederick, CO. 80530 I6 _1 APPLICANT'S DWELLING UNIT 2. TOTAL NUM- 3. APPLICANT (head of household) IS: 1. Mortgage payments(principal.and ER OF bEPEN- - White(nonminority) interest only D — 0 — D pc-Jo. DENTS OF A P- 1 r' o ) S --- PLICANT(SI — f]b. Negro/Black LISTED ABOVE: []c. American Indian 2. Ground rent — 0 - El d. Spanish American •Ages of L] e. 'Oriental -_3. Hazard insurance 0 g dependents; 23 E1 I. Other minorities not included above 4. B. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT Real property takes; special assessments $2. 92 Donald Nygren 5. Maintenance $3 .00 3154 So. County Rd. #11 Loveland, CO 6. Heat and utilities $50 . 75 • C. TOTAL PRESENT MONTHLY INCOME OF APPLICANTS) 7. Other _ 0 — 1. Base pay: Husband $ — 0 - _ Wile $300.00 S.S.I . 8. Total present monthly housing es• Other — 0 - pense (11.,14 II Lines 1 through 7) rl: $56 . 67 Total -All applicants S $300 .00 G. CHARACTERISTICS OF PROPERTY 2. Other earnings — 0 — 1. As-is value(If application for Section 3. Net income from property being 312 loan is in process, show same rehabilitated, if'any — 0 — ns-is valise; otherwise estimate 4. Social s.ecur,ty, pensions, annuities $124.00 es-is value) is — 0 — 5. Other income — 0 — 2. Age of structure 69 yr-(',s 6. Total present,monthly income (sum of Lines J through S) $424 . 00 3. Remaining economic life of structure D. ASSETS OF APPLICANTS) after rehobilitotion(If application 1. Total assets for Section 31.2 loan is in process, o. Cosh on hand and in cash accounts $ — 0 — show same number of years; other- wise estimate remaining economic b. Morketoble securities and U.S. savings bonds — 0 _ life) 30 yP�,s c. Equity en other real estate, 4. Number of dwelling units (1) Market value $ 89, 500_00 - (2) Unpaid balance — D- — a. Before rehabilitation i (3) Equity(Line c(11 minus line r(2)) $2, 500 .00 d. All other assets(h o not include value of pro. b. After rehobilitotion -- perry shown in Item Al, or value of furniture. N. REHABILITATION COSTS clothing,automobiles or other personal pro- — perry) — 0 — _ — 1. Amount of grant applied for $ $4 , 490 . 00 e. Total assets(sum of Lines ri. h, rill. and d) $2, 500 .00— 2. If any, amount of Section 312 2. Unpaid bills for food,medic-al.cepenses, etc. loon oppli•ed lot — 0 — (Do not include debts on furniturr, clot/inrp,, ann.- 3. II any, land•, from other mobiles, ..r other personal property) 0 _ sonny!: — 0 — — .__ 4. Total rehabilitation costs 3. Net osSets O.the 1. .nrnus Line 2l r1` enll.�0 (ssn4 of l.tncl I through 0 - 1 $4, 490 .00 . JV Previous editions ore Obsvlele fill e•rl HUD-6264 (10-70) CERTIFICATION BY APPLICANTS) The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under the Community Development Act and is true and complete to the best of the Applicant's knowledgc and belief. The Applicant further certifies that he is the owner of the p;ot.erty described in this application, and that the rehabili- tation grant proceeds will be used only for the work and materials necessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property do cribad in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or cannot be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, right, or claim. The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title VI of the Civil Rights Act of 1964 (78 Stat.252)- The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. Date Signature Date Signature Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION r. The undersigned has examined the application for a CDBG Grant described herein, including supporting data, and finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld, of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, line 1. _binvember 9, 1977 (E19 Date - Signature 'Chairman, Board of County Commissioners Tide j 254242—P HUD—Wash., D.C. tr GPO 1975-6773JYI96 18 ' • Form Approved Hu a-•a?M10;I-) 10) E. IDF:NTIFICATiON WELD 7 t. DATit OF 11 COUNTY I. Ar•I't.is A I It1N NniuNr,1 II AI•I'It. VAL• BOARD OF COUNTY COMMISSIONERS EV,6 __DN,-08 Grant#1 3 •..__ t APPLICATION FOR CBDG GRANT vet. PAY 3. NAME, ADDRESS, AND ZIP CODE OF PUOL-IC Pllcty A. APPLICANT DATA -_ ----- - Dept. of Planning Services I- NAME, ADDRESS, AND ZIP CODE OF APPLICANTISI A..L f)I- Housing Division (Last name first) A PPLICANT (heoxlof P.O. Box 188 RUIZ, TONY & RAMONA !sou. >r'ld; Dacono, CO 80514 445 Dunmire Street AKA P.O. Box 377 63 F. PRESENT MONTHLY HOUSING EXPENSE ALLOCABLE TO Frederick, CO $0530 APPLICANT'S DWELLING UNIT 2. TOTAL NUM- 3. APPLICANT (head of household) IS: I. Mortgage payments(principal and BER OF DEPEN- 2 n o' White (nonminorityJ interest only) $ — 0 — DENTS OF ANTIS) r-1 b. Negro/Block LLIC l J 2. Ground rent LISTED ABOVE: [ic. American Indian — 0 - Eld. Spanish American (_]e. Oriental 3. Hazard insurance 1 9 Ages of 66 (wife) i I. Other minonYies not included nhnve dependents! d. Real property foxes; special B. NAME, ADDRESS, AND ZIP CODE OF EMPLOYER OF EACH APPLICANT assessments $6 . 81 5. Maintenance $3 .00 Not Applicable (Retired) _� 6. Heat and 0tiltries $67 .75 - C. TOTAL PRESENT MONTHLY INCOME OF APPLICANT(S) 7. Other I. Base pay: Husband $ $3 25 . 70 S.S . I . Auto Insurance - $16 . 66 Wife 133 .70 S.S.I . 8. Total present monthly housing e.- $$103 . 22 Other -0- prrttie (•urri of Lniec ! through 7) Total - All applicants $ $459. 40 G. CHARACTERISTICS OF PROPERTY rt- 2. Other earnings pens iop 250 .00 , 1. As•is value(I(application for Section 3. Net income from property being .312 loan Ls in process. show some rehabilitated, it any — 0 — as•is value; otherwise estimate 4. Social security, pensions, annuities See #1 as-is value! $ — 0 5. Other income Retirement 45 . 42 2. Age of structure 55 years 6. Total present monthly'income (sum of Lines 1 through 5) $ $754 . 82 3. Remaining economic life of structure D. ASSETS OF APPLICANT(S) after rehabilitation(If application for Section 312 loan is in process. 1. Total assets a. Cash on hand and in cash accounts $ $900 .00 show same number of years; other- wise estimate remaining economic b. Morketable securities and U.S. • life) 30 years savings bonds — 0 - • c. Equity in other real estate, 4. Number of dwelling units (1) Market value $ a. Before rehabilitation 1 (2) Unpaid balance 6 (3) Equity(Line di)minus line c(2)) - 0 - — 1 -_ b. After rehabilitation d. All other assets (l)u not include value of prn- perry shown in /tem A1, or value of furniture. H. REHABILITATION COSTS clothing. automobiles or other personal pro- perty) _-_ --- 1. Amount of grant applied for s$4, 878 .00. e. Total assets (sum of lines n, h, c(3), and d) — 0 - 2. If any, amount of Section 312 — 0 - loan applied for 2. Unpaid bills for food, medical expenses, etc. ' (Do not include drhts on furniture. elnt)Ii'k. ,u,1•- 3. If any, funds from other — 0 — mobiles, ,it usher personal property) — 0 — ,:ourcc,, �— y $ d• Total rehabilitation costs 5$4, 878 . 00 3. Net onsets (Lane I. ••onus l.,inr• :) $900 .00 i'si,ni of Linea ! O:routh I) 7 Previous editions ore obsolete (Over) HUD-6266 (10-70) I. CERTIFICATION BY APPLICANT(S) The Applicant certifies that all information in this application, and all information furnished in support of this applica- tion, is given for the purpose of obtaining a grant under t he Community Development Act and is true and complete to the best of the Applicant's knowledge and beliet. The Applicant further certifies that he is the owner of the pa. .erty described in this application, and that the rehabili- tation grant proceeds will be used only for the work-and marorials necessary to meet the rehabilitation or code stand- ards, as applicable, which are prescribed for the property .;e- cribed in this application. If the Approving Officer de- termines that the rehabilitation grant proceeds will not or cannot be used for the purposes described herein, the Appli- cant agrees that the proceeds shall be returned forthwith, in full, Weld County and acknowledges that, with re- spect to such proceeds so returned, he shall have no further interest, right, or claim. • The Applicant covenants and agrees that he will comply with all requirements imposed by or pursuant to regulations of the Secretary of Housing and Urban Development effectuating Title VI of the Civil Rights Act of 1964 (78 Stat.252)- The Applicant agrees not to discriminate upon the basis of race, color, creed, or national origin in the sale, lease, rental, use, or occupancy of the real property rehabilitated with assistance of the grant. Weld County shall be deemed to be a beneficiary of these provisions both for and in its own right and also for the purpose of protecting the interests of the community and other parties, public or private, in whose favor or for whose benefit these provisions have been provided and shall have the right, in the event of any breach of these provisions, to maintain any actions or suits at law or in equity or any other proper proceedings to enforce the curing of such breach. Verification of any of the information contained in this application may be obtained from any source named herein. • Date Signature • Date S,twture _ Date Signature PENALTY FOR FALSE OR FRAUDULENT STATEMENT: U.S.C. Title 18, Sec. 1001, provides: "Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies . . .or makes any false, fictitious or fraudulent statements or representation, or makes or uses any false writing or docu- ment knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both." APPROVAL OF APPLICATION I. The undersigned has examined the application for a CDBG Grant described herein, including supporting data,. and finds that the application meets the requirements of the Weld County Board of County Commissioners for a CDBG Grant, and satisfies the rules and regulations issued by the County of Weld, of the Weld County Board of County Commissioners pertaining to the CDBG Grant program. Accordingly, the undersigned has approved the application for a grant in the amount in Block H, lined. November 9 , 1977/ Dare —�—t—�- 5tRna[urt Chairman, Board of County Commissioners ntle 254242-P HUD-Wash., D.C. d GPO 1915-b113a1196 /8 Hello