city of new haven

CITY OF NEW HAVEN

LIVABLE CITY INITIATIVE 165 Church Street, 3rd Floor

New Haven, CT 06510 Phone: (203) 946-7090 Fax: (203) 946-4899

Justin Elicker

Mayor Arlevia T. Samuel Acting Executive Director

RE: CASTLE PROGRAM We are sorry to hear that you are experiencing an income disruption due to Covid-19 and are having housing insecurity. Attached please find an information/ application packet regarding the Castle Program. To expedite our response and process, we ask that you review the information thoroughly. The Complete Application package includes forms that you are required to complete, as well as your landlord. The forms are labeled at top for your convenience as to whom needs to sign. Please note that in the “Complete Package” is a document named Program Understanding that needs to be filled out by you and the landlord or property owner. If you have ANY QUESTIONS about anything in the information packet or about the program, please contact your program liaison Marta Arroyo-Quirama at [email protected] or by phone at (203) 946-5363. To expedite your questions, please send to [email protected]. Thank You.

City of New Haven Coronavirus Assistance and Security Tenant Landlord Emergency Program (CASTLE) El Programa de emergencia para inquilinos y propietarios de seguridad y asistencia para el coronavirus de la ciudad de New Haven ("CASTLE") ayudará a los inquilinos y propietarios de New Haven que han experimentado una pérdida de ingresos debido al Covid-19 y están experimentando inseguridad en la vivienda. CASTLE puede ayudar como un programa independiente o en conjunto con cualquiera de los programas de asistencia de vivienda del estado de Connecticut, lo que permite a los inquilinos y propietarios maximizar su asistencia. El programa ayudará a mitigar el riesgo de desalojo y / o ejecución hipotecaria y creará estabilidad en la vivienda. Requisitos de Eligibilidad Para Inquilinos/ Duenos: Para Propretarios:

• Residente de New Haven. • Ingreso no supere el 80% del ingreso medio del

area Income (AMI). • Verificada Interrupcion de ingreso debido a Covid-

19. • Propiedad es la residencia primaria del inquilino. • La propiedad es ocupada por el dueno y es su

residencia primaria. • Inquilino no esta bajo una orden de eviccion antes

de Marzo 11, 2020

• La propiedad no está atrasada en impuestos o

está en un plan de pago y es parte del programa de licencias de alquiler residencial si es necesario para inscribirse

• No esta recibiendo alguna otra ayuda estatal o federal para asistencia hipotecaria.

Terminos de Asistencia Alquiler/Hipoteca atrasado Pre-COVID: Los pagos de alquiler/ hipoteca adeudados antes de Marzo 2020 se consideran alquiler/ hipoteca atrasados antes del COVID.

• Alquiler atrasado Pre-COVID debe ser completamente canselada por el propetario y no puede ser cobrada ni puede ser causa para una eviccion.

• Alquiler atrasado COVID: Alquiler atrasado despues de Marzo 2020.

CASTLE finaciara hasta $3,000 de alquiler atrasado de Covid. Propietario cancelara el balance de cualquier renta atrasada causada por Covid despues del

Pago de Castle. Propetario anulara todos los cargos y pago de intereses. Propetario considerara el inquilino corriente en su renta y los registros mostraran zerobalance en

toda la deuda Pre-Covid y renta atrasada relacionada con Covid Propetario acordara a NO comenzar procedimientos de eviccion por renta atrasada antes de

Covid o renta atrasada por el Covid.

• Pagos de hipoteca Pre-COVID/COVID Propietario debe estar trabajando con su banco y un consejero certificado de HUD

Hipoteca COVID para propietarios con pagos de hipoteca atrasados despues de Marzo 2020 Se require un consejero de Vivienda certificado de HUD para ayudar con la mitigacion con el

banco. CASTLE financiara hasta $4,000 de hipoteca COVID para asistir con la modificacion de hipoteca.

City of New Haven Coronavirus Assistance and Security Tenant Landlord Emergency Program (CASTLE) The City of New Haven Coronavirus Assistance and Security Tenant Landlord Emergency Program (“CASTLE”), will assist tenants and homeowners in New Haven who have experienced income loss due to Covid-19 and are experiencing housing insecurity. CASTLE can assist as a standalone program or in conjunction with any of the State of Connecticut’s housing assistance programs, enabling tenant’s and homeowners to maximize their assistance. The program will assist in mitigating the risk of eviction and/or foreclosure and create housing stability.

Eligibility Requirements For Tenants/Homeowners: For Landlords:

• A resident of New Haven. • Income does not exceed 80% of Area

Median Income (AMI). • Verified income disruption due to Covid-19. • Property is primary residence of tenant. • Property is Homeowner occupied and

primary residence • Tenant not under court ordered eviction

prior to March 11, 2020

• Property is not delinquent on taxes or is on

a payment plan and is part of the residential rental licensing program if required to enroll.

• Not receiving any other State or Federal subsidy towards mortgage assistance.

Assistance Terms Pre-COVID Back Rent/Mortgage: Rent/Mortgage payments owed before March 2020 is considered Pre-COVID back rent/mortgage.

• Pre-COVID Back Rent must be completely written off by the landlord and cannot be collected or used as a cause for eviction.

• COVID Back Rent: Rent owed after March 2020.

CASTLE will fund up to $3,000 of Covid Back Rent Landlord will write off the balance of any Covid Back Rent after Castle payment Landlords will waive all late fees and interest payments. Landlords will deem tenant current in rent, and the rent records will show a zero balance

on all Pre-Covid Back Rent and Covid Back Rent. Landlord will agree NOT to commence eviction proceeding for Pre-COVID/COVID rent.

• Pre-COVID/COVID Mortgage Payments homeowner must be working with Lender and HUD Certified

Counselor COVID Mortgage for homeowner with mortgage payments owed after March 2020 HUD Certified Housing Counselor required to assist with mitigation with lender CASTLE will fund up to $4,000 of COVID Mortgage to assist with mortgage modification

or forbearance

CITY OF NEW HAVEN



ALL DOCUMENTATION MUST BE INCLUDED IN YOUR APPLICATION TO BE ACCEPTED FOR PROCESSING; IN THE EVENT DOCUMENTS ARE MISSING, YOUR APPLICATION WILL BE RETURNED FOR COMPLETION. PLEASE CALL TO SCHEDULE AN APPOINTMENT TO RETURN APPLICATION FOR PRELIMINARY REVIEW FOR COMPLETENESS:

MARTA QUIRAMA CITY OF NEW HAVEN

LIVABLE CITY INITIATIVE 165 CHURCH STREET, 3RD FLOOR

NEW HAVEN, CT 06510 203-946-5363

[email protected]

CITY OF NEW HAVEN



CHECKLIST REQUIRED APPLICATION DOCUMENTS

CASTLE PROGRAM

______ LCI APPLICATION – COMPLETELY FILLED OUT AND SIGNED

______ INCOME VERIFICATION o 2019 TAX RETURNS W/ W-2

______ PROOF OF COVID-19 INCOME DISRUPTION o COPY 4 PAYSTUBS OR UNEMPLOYMENTo COPY OF LAST PAYCHECK FROM EMPLOYERo COP OF UNEMPLOYMENT VERIFICATION/STATEMENTo COPY OF UNEMPLOYMENT DENIAL

______ COPY OF WRITTEN LEASE

______ COPY OF UI BILL

______ RENT STATEMENT FROM LANDLORD/MORTGAGE STATEMENT

______ COPY OF DRIVER’S LICENSE

______ PROGRAM UNDERSTANDING (FORM ENCLOSED)

______ LEGAL DISCLOSURE (FORM ENCLOSED)

______ NON-COLLUSION AFFIDAVIT (FORM ENCLOSED)

______ AFFIDAVIT OF ELIGIBILITY (FORM ENCLOSED)

______ CHILD UNDER SIX AFFIDAVIT (FORM ENCLOSED)

______ DEMOGRAPHIC FORM (FORM ENCLOSED)

Tenant and Landlord

Tenant and Landlord

Tenant and Landlord

LEGAL REPRESENTATION NOTICE AND DISCLOSURE

Coronavirus Assistance and Security Tenant Landlord Emergency Program (CASTLE)

DATE: ______________________________________________________

APPLICANT(S): ______________________________________________________

PROPERTY ADDRESS: ______________________________________________________

MAILING ADDRESS (if different from above): _____________________________________

CHECK ONE: LANDLORD_____ TENANT_____ PROPERTY OWNER _______

The Applicant has legal interests that differ from that of the City of New Haven (the “City”), the tenant(s), the landlord and/or the property owner.

Should the Applicant be approved for and agree to the terms and conditions of the CASTLE Program, the Applicant hereby acknowledges that he/she/it may be waiving certain legal rights the Applicant may otherwise have the right to pursue.

The Applicant may, at its sole cost and expense, engage an attorney for personal representation in connection with this transaction. Should the Applicant engage an attorney for personal representation in connection with this transaction, the Applicant hereby acknowledges that such representation is a matter between the Applicant and the attorney, and the City of New Haven makes no representations as to the nature or quality of legal services to be performed by any attorney whom the Applicant may select.

The City, including its agents and representatives, cannot provide any legal advice to the Applicant with respect to the CASTLE Program and no statements or representations made by the City to the Applicant shall be relied upon or construed as legal advice.

It is not required as part of the CASTLE Program that the Applicant be represented by an attorney. However, should the Applicant have any questions or concerns regarding Applicant’s legal rights and/or obligations under the CASTLE Program, it is strongly recommended the Applicant seek independent counsel.

Should Applicant decline to obtain independent legal counsel, it is hereby acknowledged by the Applicant that the Office of Corporation Counsel represents the City of New Haven and Applicant will be acting on his/her/its own behalf in said transaction.

By signing below, the Applicant hereby acknowledges receiving a copy of this Legal Representation Notice and Disclosure.

______________________________ Applicant Name Each Applicant to complete individual form

X

TENANT

AVISO Y DIVULGACION DE REPRESENTACION LEGAL (LEGAL REPRESENTATION NOTICE AND DISCLOSURE)


FECHA: ______________________________________________________

SOLICITANTE(S): ______________________________________________________

DIRECCION DE PROPIEDAD: _______________________________________________

DIRECCION POSTAL (si es diferente a la anterior): ________________________________

MARQUE UNO: LANDLORD_____ INQUILINO_____ DUENO _______

El Solicitante tiene intereses legales que difieren de los de la Ciudad de New Haven (la “Cuidad”), el inquilino (s), el propietario y/o el dueno de la propiedad.

En caso de que el Solicitante sea aprobado y este de acuerdo con los terminos y condiciones del Programa CASTLE, por la presente, el Solicitante reconoce que puede estar renunciando a ciertos derechos legales que el Aplicante podria tener el derecho de ejercer.

El Solicitante puede, a su propio costo, contratar un abogado para que lo represente personalmente en relacion con esta transaccion. Si el Solicitante contrata a un abogado para que lo represente personalmente en relacion con esta transaccion, el Solicitante reconoce por la presente que dicha representacion es un asunto entre el Solicitante y el abogado, y la Cuidad de New Haven no hace declaraciones sobre la naturaleza o calidad de los servicios legales realizados por cualquier abogado que el Solicitante pueda seleccionar.

La Cuidad, incluyendo sus agentes y representantes, no puede proveer ningun consejo legal al Solicitante con respecto al Programa CASTLE y ninguna declaracion o representacion hecha por la Cuidad al Solicitante se basara en o interpretara como asesoramiento legal.

No se require como parte del Progama CASTLE que el Solicitante sea representado por un abogado. Sin embargo, si el solicitante tiene alguna pregunta o inquietud con respecto a los derechos legales y/o obligaciones bajo el Programa CASTLE, se recomienda encarecidamente que el Solicitante busque un abogado independiente.

Si el Solicitante se niega a obtener asesoria legal independientemente, el Solicitante reconoce por la presente que la oficina de Corporation Counsel que representa a la Cuidad de New Haven y que el Solicitante actuara en su propio nombre en dicha transaccion.

Al firmar a continuacion, el Solicitante reconoce haber recibido una copia de este Aviso y Divulgacion de Representacion Legal.

______________________________ Nombre del Solicitante Cada Solicitante debe completar una forma individual

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TENANT

City of New Haven Coronavirus Assistance and Security Tenant Landlord Emergency Program (CASTLE)

PROGRAM UNDERSTANDING

The City of New Haven Coronavirus Assistance and Security Tenant Landlord Emergency Program (“CASTLE”), will assist tenants and homeowners in New Haven who have experienced income loss due to Covid-19 and are experiencing housing insecurity.

CASTLE can assist as a standalone program or in conjunction with any of the State of Connecticut’s housing assistance programs, enabling tenant’s and homeowners to maximize their assistance. The program will assist in mitigating the risk of eviction and/or foreclosure and create housing stability .

Eligibility Requirements For Tenants/Homeowners: For Landlords:

• A resident of New Haven.• Income does not exceed 80% of Area

Median Income (AMI).• Verified income disruption due to Covid-19.• Property is primary residence of tenant.• Property is Homeowner occupied and

primary residence• Tenant not under court ordered eviction

prior to March 11, 2020

• Property is not delinquent on taxes or is ona payment plan and is part of the residentialrental licensing program if required to enroll.

• Not receiving any other State or Federalsubsidy towards mortgage assistance.

Assistance Terms

Pre-COVID Back Rent/Mortgage: Rent/Mortgage payments owed before March 2020 is considered Pre-COVID back rent/mortgage.

• Pre-COVID Back Rent must be completely written off by the landlord and cannot be collected orused as a cause for eviction.

• COVID Back Rent: Rent owed after March 2020. CASTLE will fund up to $3,000 of Covid Back Rent Landlord will write off the balance of any Covid Back Rent after Castle payment Landlords will waive all late fees and interest payments. Landlords will deem tenant current in rent, and the rent records will show a zero balance

on all Pre-Covid Back Rent and Covid Back Rent. Landlord will agree NOT to commence eviction proceeding for Pre-COVID/COVID rent.


• Pre-COVID/COVID Mortgage Payments homeowner must be working with Lender and HUD CertifiedCounselor

COVID Mortgage for homeowner with mortgage payments owed after March 2020 HUD Certified Housing Counselor required to assist with mitigation with lender CASTLE will fund up to $4,000 of COVID Mortgage to assist with mortgage modification

or forbearance

Tenan/Homeowner: Date:

Program Consent and Acceptance Form

I, ______________________________________ have reviewed the above summary, and the City of New Haven has explained the process and requirements in full for the program I have applied for funding under. I further understand my obligations under this funding and my responsibility to the contractor.

Applicant Applicant

___________________________ _________________________

Landlord: Date:

Program Consent and Acceptance Form

I, ______________________________________ have reviewed the above summary, and the City of New Haven has explained the process and requirements in full for the program I am fully aware and agree to the Assistance Terms as a Landlord. I further understand my obligations under this funding and my responsibility.

LANDLORD

___________________________ _________________________


ENTENDIMIENTO DEL PROGRAMA

El Programa de emergencia para inquilinos y propietarios de seguridad y asistencia para el coronavirus de la ciudad de New Haven ("CASTLE") ayudará a los inquilinos y propietarios de New Haven que han experimentado una pérdida de ingresos debido al Covid-19 y están experimentando inseguridad en la vivienda.

CASTLE puede ayudar como un programa independiente o en conjunto con cualquiera de los programas de asistencia de vivienda del estado de Connecticut, lo que permite a los inquilinos y propietarios maximizar su asistencia. El programa ayudará a mitigar el riesgo de desalojo y / o ejecución hipotecaria y creará estabilidad en la vivienda.

Requisitos de Eligibilidad Para Inquilinos/ Duenos: Para Propretarios:

• Residente de New Haven.• Ingreso no supere el 80% del ingreso medio

del area Income (AMI).• Verificada Interrupcion de ingreso debido a

Covid-19.• Propiedad es la residencia primaria del

inquilino.• La propiedad es ocupada por el dueno y es

su residencia primaria.• Inquilino no esta bajo una orden de

eviccion antes de Marzo 11, 2020

• La propiedad no está atrasada enimpuestos o está en un plan de pago y esparte del programa de licencias dealquiler residencial si es necesario parainscribirse

• No esta recibiendo alguna otra ayudaestatal o federal para asistenciahipotecaria.

Terminos de Asistencia

Alquiler/Hipoteca atrasado Pre-COVID: Los pagos de alquiler/ hipoteca adeudados antes de Marzo 2020 se consideran alquiler/ hipoteca atrasados antes del COVID.

• Alquiler atrasado Pre-COVID debe ser completamente canselada por el propetario y no puede sercobrada ni puede ser causa para una eviccion.

• Alquiler atrasado COVID: Alquiler atrasado despues de Marzo 2020. CASTLE finaciara hasta $3,000 de alquiler atrasado de Covid. Propietario cancelara el balance de cualquier renta atrasada causada por Covid

despues del Pago de Castle. Propetario anulara todos los cargos y pago de intereses. Propetario considerara el inquilino corriente en su renta y los registros mostraran

zerobalance en toda la deuda Pre-Covid y renta atrasada relacionada con Covid Propetario acordara a NO comenzar procedimientos de eviccion por renta atrasada

antes de Covid o renta atrasada por el Covid.


• Pagos de hipoteca Pre-COVID/COVID Propietario debe estar trabajando con su banco y un consejerocertificado de HUD

Hipoteca COVID para propietarios con pagos de hipoteca atrasados despues de Marzo2020

Se require un consejero de Vivienda certificado de HUD para ayudar con la mitigacioncon el banco.

CASTLE financiara hasta $4,000 de hipoteca COVID para asistir con la modificacion dehipoteca.

Inquilino/Dueno: Fecha:

Forma de Consentimiento y Aceptacion del Programa

Yo, ______________________________________ he revisado el resumen anterior y la Ciudad de New Haven ha explicado el proceso y los requisites en su totalidad para el programa bajo el cual he solicitado fondos. Entiendo ademas mis obligaciones bajo esta financiacion y mi responsabilidad al contratista.

Aplicante Aplicante

_____________________________ ____________________________

Propietario: Fecha:

Forma de Consentimiento y Aceptacion del Programa

Yo, ______________________________________ he revisado el resumen anterior y la Ciudad de New Haven ha explicado el proceso y los requisitos en su totalidad para el programa. Estoy plenamente consciente y acepto los Terminos de asistencia come arrendador. Ademas entiendo mis olbigaciones bajo esta financiacion y mi responsabilidad.

Aplicante Aplicante

_______________________________ _____________________________

TENANT

CITY OF NEW HAVEN BUREAU OF PURCHASES

Justin Elicker Mayor

NON-COLLUSION AFFIDAVIT (INCLUDING DISCLOSURE OF OBLIGATIONS TO/INTEREST IN BUSINESS WITH THE CITY OF NEW HAVEN)

1. Personally appeared __________________________________________ who being duly sworn, deposesand says that:

1. I am/We are over the age of eighteen and I understand the obligation of an oath.2. I am/We are the ______________________ of _______________________________ that

submitted an application, bid, proposal, request to the City of New Haven for a contract, agreement, grant, loan and am acting in my individual capacity or, if an entity, on behalf of said entity, as the case may be.

3. I am/We are fully apprised of the contents of said application/bid/proposal/request and allpertinent facts and circumstances relative to the same.

4. Such application, bid, proposal, request is genuine and is not collusive or a sham.5. Neither said individual (including any of his/her immediate family as defined in Section 12-5/8 of

the local ordinance)/entity nor any of his/her/its officers, partners, owners, agents, representatives, employees, affiliates or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other individual/entity to submit a collusive or sham application/bid/proposal/request in connection with the contract/agreement/grant/loan for which the application/bid/proposal/request has been submitted or to refrain from applying/bidding/proposing/requesting in connection with such contract/agreement/grant/loan, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other individual/entity to fix the prices/quotes/estimates/costs/overhead/figures/profits/amount of the application/bid/proposal/request or of any other individual/entity, or to fix the same of the application/bid/proposal/request or prices/quotes/estimates/costs/overhead/figures/profits/amount of any other individual/entity, or to secure through any collusion, conspiracy/connivance or unlawful agreement any advantage against the City of New Haven or any individual/entity interested in the proposed application/bid/proposal/request.

6. The prices/quotes/estimates/costs/overhead/figures/profits/amount in thecontract/agreement/grant/loan are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the individual/entity or any of its officers, partners, owners, agents, representatives, employees, affiliates or parties in interest, including this affiant; and

7. No alderman or other elected/appointed or city/state/federal employee or person/entity whosesalary/compensation is payable in whole or in part from city, state or federal funds is directly or indirectly interested in/will benefit financially by/has any is in a position to participate in a decision making process or gain inside information about the application/bid/proposal/request or in the supplies, materials, equipment, work or labor to which it relates, or in any of the profits thereof (This paragraph is hereinafter referred to as “conflict of interest.”).

8. The individual/entity referred to in paragraph 2 above has no outstanding financial or otherobligations to the City of New Haven or to any state or federal government that funds the individual’s/entity’s

LANDLORD

activity, nor is it a party to a lawsuit that may affect the use of any funds that will be derived from the contract/agreement/grant/loan. 9. The individual/entity has filed a list of taxable personal/real property with the City of New Haven and is not delinquent in the same. 10. The attached Schedule A, which is incorporated herein as though set forth, contains a list of the names, home/business addresses, telephone numbers and titles of the individual/entity’s officers, partners, owners, agents, representatives, employees, affiliates or parties in interest including this affiant as well as any conflict-of-interest as described herein in paragraph numbered 7 above, and any applicable local, state or federal law, involving the same. 11. The attached Schedule A further contains a list of any members of my immediate family who are either employed by the City of New Haven or who are members of city boards, commissions, agencies or task forces. 12. Except as disclosed in the attached Schedule A, the affiant is not and no member of his/her immediate family is not a city employee or, having been a city employee in the past 12 months, seeking employment with any individual/entity engaged in business with the City of New Haven. 13. Except as disclosed in the attached Schedule A, the affiant has not and no member of his/her immediate family has applied for within the last twelve month for any city/state/federal program or benefit over which he/she has had control, influence or discretionary authority. 14. Except as disclosed in the attached Schedule A, the individual/organization has no intention of transacting business with any related and/or affiliated individuals/organizations. ________________________________________________ Affiant Name(s) STATE OF CONNECTICUT ) ) ss: New Haven , 20________ COUNTY OF NEW HAVEN ) Personally appeared ____________________ of ______________________________ who identified himself/herself as such and who subscribed and swore to the truth of the foregoing before me this _______ day of __________, 20________. ___________________________________ Commissioner of the Superior Court Notary Public My commission expires on: Page 2 of 3

SCHEDULE “A” Please list your responses to Items 10-14 below. If your response is none, please print or type “N/A”. Applicant signature(s) must appear on this schedule. 10. 11. 12. 13. 14. ______________________________________________ Affiant Signature(s) Page 3 of 3 (Non-Collusion Affidavit)

CITY OF NEW HAVEN



AFFIDAVIT OF ELIGIBILITY FOR LCI LOAN PROGRAM (No Delinquent Obligations Owed to the City of New Haven)

State of Connecticut ) ) SS.

County of New Haven )

_______________________________________________, being first duly sworn, deposes and says that: (Name of Property Owner or Property Owner’s Agent)

RE: Application Repair Program for property situated in the City of New Haven at:

(Property Address)

Property Rehabilitation Exterior House Painting EERAP Down Payment/ Closing Costs Lead-Based Paint Abatement Elderly & Disabled

1. He/She is the owner of the Property identified above and resides at the above address., -OR-

He/She currently resides at_______________________________________________________ and intends to purchase and reside at the address first indicated above .

2. This statement is provided as a condition of qualification for LCI Loan Program indicated above.Check ONE:

3. That neither this applicant, nor any member of his/her immediate family as defined in Section 12-5/8 of the New Haven Code of Ordinances, has any outstanding delinquent financial or other obligations owing to the City of New Haven, nor do they have a financial interest in any entity which has any such obligations.

There are outstanding financial or other obligations owed to the City of New Haven by this applicant, or members of his/her immediate family as defined in Section 12-5/8 of the New Haven Code of Ordinances.. (List all obligations on a separate sheet and indicate the nature of the obligation, including any payment agreement entered into with the Tax Collector concerning delinquent taxes, and the parties involved.)

4. That neither the applicant, nor any member, of his/her immediate family as defined in Section 12-5/8of the New Haven Code of Ordinances, has failed to file a list of taxable personal property with the Cityof New Haven as required by state law.5. That neither this applicant, nor any member of his/her immediate family as defined in Section 12-5/8of the New Haven Code of Ordinances, is an owner, partner or officer of any business entity. ( If anysuch party is an owner, partner of any business entity, list their names and requested informationbelow. Additional information may be required.)

Page 1 of 1 1421 Affidavit

LANDLORD

of 3 1421 Affidavit THIS FORM MUST BE NOTARIZED

_____________________________________ __________________________ Primary Applicant (Print Name) Date _____________________________________ Primary Applicant Signature _____________________________________ _____________________________ Secondary Applicant (Print Name) Date _____________________________________ Secondary Applicant Signature (Title) _____________________________________________________________________ Subscribed and sworn to before me this day of , 20____ Notary: My Commission Expires_________________, ___________.

Name Position Held Name of Business % Interest Owned

Relationship to Applicant

of 3 1421 Affidavit

Tax Collector and Assessor to Certify above information on page 1 and 2 of this form.)

TAX COLLECTOR CERTIFICATION AS TO THE APPLICANT:

ASSESSOR CERTIFICATION AS TO THE APPLICANT:

____ NO BACK TAXES OWED CURRENT LIST OF TAXABLE PROPERTY ____ FILED

____ BACK TAXES W/CURRENT AGREEMENT CURRENT LIST OF TAXABLE PROPERTY ____ NOT REQUIRED

____ BACK TAXES W/DEFAULT AGREEMENT

AS TO ALL BUSINESS ENTITES: AS TO ALL BUSINESS ENTITIES:

____ NO BUSINESS ENTITIES LISTED ____ NO BUSINESS ENTITIES LISTED

____ NO BACK TAXES OWED CURRENT LIST OF TAXABLE PROPERTY ____ FILED

____ BACK TAXES W/ PAYMENT AGREEMENT AGREEMENT ___CURRENT // ___ IN DEFAULT

CURRENT LIST OF TAXABLE PROPERTY ____ NOT REQUIRED

____ OK TO PROCESS AGREEMENT ____ OK TO PROCESS AGREEMENT

BY:__________________________ TAX COLLECTOR

BY:____________________________ ASSESSOR

LEGAL REPRESENTATION NOTICE AND DISCLOSURE


DATE: ______________________________________________________

APPLICANT(S): ______________________________________________________

PROPERTY ADDRESS: ______________________________________________________

MAILING ADDRESS (if different from above): _____________________________________

CHECK ONE: LANDLORD_____ TENANT_____ PROPERTY OWNER _______

The Applicant has legal interests that differ from that of the City of New Haven (the “City”), the tenant(s), the landlord and/or the property owner.

Should the Applicant be approved for and agree to the terms and conditions of the CASTLE Program, the Applicant hereby acknowledges that he/she/it may be waiving certain legal rights the Applicant may otherwise have the right to pursue.

The Applicant may, at its sole cost and expense, engage an attorney for personal representation in connection with this transaction. Should the Applicant engage an attorney for personal representation in connection with this transaction, the Applicant hereby acknowledges that such representation is a matter between the Applicant and the attorney, and the City of New Haven makes no representations as to the nature or quality of legal services to be performed by any attorney whom the Applicant may select.

The City, including its agents and representatives, cannot provide any legal advice to the Applicant with respect to the CASTLE Program and no statements or representations made by the City to the Applicant shall be relied upon or construed as legal advice.

It is not required as part of the CASTLE Program that the Applicant be represented by an attorney. However, should the Applicant have any questions or concerns regarding Applicant’s legal rights and/or obligations under the CASTLE Program, it is strongly recommended the Applicant seek independent counsel.

Should Applicant decline to obtain independent legal counsel, it is hereby acknowledged by the Applicant that the Office of Corporation Counsel represents the City of New Haven and Applicant will be acting on his/her/its own behalf in said transaction.

By signing below, the Applicant hereby acknowledges receiving a copy of this Legal Representation Notice and Disclosure.

______________________________ Applicant Name Each Applicant to complete individual form

LANDLORD

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