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Program Certifications

(As used in this form, words imputing the singular number shall mean and include the plural number and vice versa, as the context may require.)


Authorization to Release Information

I have obtained a mortgage with the assistance of the North Carolina Housing Finance Agency's (NCHFA) FirstHome Mortgage or MCC program. As part of the mortgage process, NCHFA may verify information contained in my loan application and in other documents required in connection with the loan, due to investor requirements, or as part of its quality control program. I authorize you to provide to NCHFA any and all information and documentation that they request. Such information may include non-public personal information including, but not limited to employment history and income; bank, money market, and similar account balances; and copies of income tax returns for the three years prior to mortgage closing. NCHFA may address this authorization to any party named in the loan application. A copy of this authorization may be accepted as an original.


Compliance Certification for Non-Borrower Occupant

I agree to execute all documents required by the North Carolina Housing Finance Agency (NCHFA), and further understand and certify that my income will be included in calculations to determine eligibility for participation in the NCHFA FirstHome Mortgage Program or the NCHFA Mortgage Credit Certificate Program. I certify that I have not owned an interest in my principal residence for the last three (3) years and I will occupy the home to be purchased with NCHFA assistance as my principal residence within sixty (60) days of loan closing.

Signature of Non-Borrower/Occupant


Child Support Income Certification

I certify the following in regard to child support income for

Child(ren)'s Name(s)

______ I receive child support in the amount of $_______________ per __________________, and attach documentation to verify this amount (i.e. copy of recorded Separation Agreement, IF APPLICABLE, court order and, six months checks or bank statements, support unit records, etc). ______ I am owed child support in the amount of $______________ per __________________, but have no verification of receipt of this income because:

______ I attest that I do not receive child support. ______ I attest there is no Separation Agreement or Divorce Decree.

Down Payment Assistance (DAP) Disclosure and Certifications

I certify that I am applying for a below-market interest rate first mortgage and a down payment assistance second mortgage through the North Carolina Housing Finance Agency. The second mortgage has a 0% interest rate and requires no monthly payments. I understand the loan must be repaid when the house is sold, when the first mortgage is refinanced, when I no longer occupy the home or at the end of the 30 year term, whichever occurs first. In the event of a refinance, the second mortgage cannot be subordinated; it must be paid in full.

Loan Disclosure (required for all DAP Loans)

Pre-Purchase Educational Training Certification (required for all DAP Loans)

The borrower(s) are applying for a second mortgage loan through the North Carolina Housing Finance Agency. I (the lender) certify I have thoroughly reviewed an acceptable homeownership counseling guide with the borrower(s). A copy of an attendance certificate from a pre-purchase educational training seminar can be substituted for the lender's training. Date

Signature of Lender Representative

I certify that the following provisions have been made for my child(ren) during work hours (indicate name of provider and monthly or weekly cost):

Child Care Certification (required for all DAP Loans)


Cost: $




014 - FirstHome/MCC Rev. 2012

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Program Certifications



I acknowledge and understand that this affidavit is being made under penalties of perjury and will be relied on for purposes of determining my eligibility for a FirstHome Mortgage or MCC. Fraudulent Statements - Any fraudulent statement will result in (i) the revocation of my FirstHome Mortgage or MCC, and (ii) a $10,000 penalty under Section 6709 of the Internal Revenue Code. Material Misstatements due to Negligence - Any material misstatement due to negligence on my part will result in a monetary penalty under Section 6709(a) of the Internal Revenue Code. Other Remedies - In addition, any material misstatement due to negligence or misstatement due to fraud that is discovered before the issuance of a MCC or funding of a FirstHome Mortgage will result in denial of my application for a MCC or FirstHome Mortgage. If a MCC has been issued prior to the discovery of a fraudulent statement, then any MCC issued will automatically become null and void without any need for further action by NCHFA. If a FirstHome Mortgage has been funded prior to the discovery of a fraudulent statement, the fraudulent misstatement will constitute an event of default and will entitle the holder of the Mortgage to accelerate the Note and to institute foreclosure. Borrower Co-Borrower/Co-occupant Date Date

STATE OF COUNTY OF I certify that personally appeared before me this day, and acknowledged to me

that he or she signed the foregoing document for the purposes stated therein. Witness my hand and official stamp or seal, this the _______ day of _______________________, 20____.

(Apply Notary Seal) Signature of Notary Public My Commission expires

014 - FirstHome/MCC Rev. 2012

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