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Home Improvement Program (HIP) Application

BID #: N/A

DUE: TBD

VALUE: $22,000

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Executive Summary

The Township of Belleville Home Improvement Program (HIP), administered by CME Associates, aims to bring housing up to code by providing financing for necessary repairs or replacements of major systems, such as roofs, plumbing, heating, electrical, and structural components. Eligible homeowners can receive a forgivable loan ranging from $10,000 to $22,000 for qualifying rehabilitation work. The loan is forgivable after 10 years if the homeowner meets the terms of the loan agreement and HIP requirements. If the property is sold or title/occupancy changes within the first 10 years, the loan must be repaid, subject to certain exceptions.

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--- Document: Home Improvement Program (HIP) Application Document ---
Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 1 of 10 
 
 
 
 
Township of Belleville 
Home Improvement Program Application 
 
 
ABOUT THE PROGRAM: 
 
The purpose of the program is to bring housing up to code. In order to qualify for the program, repair 
or replacement of at least one major system must be necessary. A major system can be one of the 
following:  roof, plumbing (including wells), heating, electrical, sanitary plumbing (including septic 
systems), load bearing structural systems or weatherization (building insulation for attic, exterior 
walls and crawl space, siding to improve energy efficiency, replacement storm windows and storm 
doors and replacement windows and doors).  Financing in the form of a forgivable loan for 
rehabilitation costs in an amount of at least $10,000 and up to $22,000 shall be made available for 
eligible rehabilitation work on residential units owned by eligible households. 
 
Property owners may be eligible for an interest free loan which will be forgiven after 10 years and 
be considered a grant only if the unit and occupant have satisfied all of the terms of the loan 
agreement and all applicable requirements of the HIP Program.  If the property is sold and/or 
title/occupancy changes between years 1 through 10, except for allowable conditions under loan 
repayment terms, the loan must be repaid. Upon the completion of year 10 of the loan, the loan 
shall be forgiven  
 
If the owner decides to sell the property, transfer title, or if the owner should die before the terms of 
the lien expire, the owner, heirs, executors or legal representatives must repay the loan according 
to the schedule above upon a title change. If the transfer of title occurs before the ten year period, 
100% of the original loan will be due. Rental of house is allowable under certain conditions subject 
to approval by the Administrative Agent. 
 
Exceptions to Loan Repayment Terms above during the lien period: 
 
1. 
If the loan transfers due to inheritance of very low-, low- or moderate-income family member 
beneficiary who will take occupancy upon death of program mortgagee and assume the balance of 
the lien, or 
 
2. 
If the house is sold at an affordable price pursuant to N.J.A.C. 5:97-9.3 to someone who can 
be qualified as income eligible, takes occupancy and agrees to assume the program lien for the 
remaining duration of the lien period, or 
 
3. 
If the house is sold at an affordable price pursuant to N.J.A.C. 5:97-9.3 to an investor who 
assumes the lien and also signs a deed restriction for the remaining duration of the lien period to 
rent the dwelling at the affordability controls restricted rental rate and according to the affirmative 
marketing requirements for re-rentals. When this occurs, the Township’s Administrative Agent will 
be responsible for monitoring compliance over that unit. 
 
 
I have read the above and agree to the terms noted above   
Please Initial ________ 


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 2 of 10 
 
 
 
INCOME/ASSET QUALIFICATIONS  
 
# of Household 
Members 
One (1)  
household 
member 
Two (2) 
household 
members 
Three(3))  
household 
members 
Four (4)  
household 
members 
Five (5)  
household 
members 
Maximum Income 
$75,840 
$86,640 
$97,440 
$108,240 
$116,960 
 
If household income exceeds the maximum allowable income for the household size as listed above, please do 
not continue  with this application. 
 
Total allowable assets in Region 2 (Essex, Morris, Union and Warren Counties) is $300,000.00.  This 
amount includes real estate.  If the primary residence, has no mortgage or debt and is valued at or above the 
regional asset limit, the household will be determined ineligible for the HIP Program. 
 
HOUSEHOLD INFORMATION 
 
APPLICANT: 
  
EMAIL ADDRESS:  
PHONE:   
DATE OF BIRTH:   
SS #: 
ADDRESS: 
  
CITY: 
STATE:   
ZIP: 
MARITAL STATUS: MARRIED:____ SINGLE:____ DIVORCED____ SEPARATED_____  
APPLICANT: 
  
EMAIL ADDRESS:  
PHONE:   
DATE OF BIRTH:   
SS #: 
ADDRESS: 
  
CITY: 
STATE:   
ZIP: 
MARITAL STATUS: MARRIED:____ SINGLE:____ DIVORCED____ SEPARATED_____  
 
HOUSEHOLD MEMBERS (Anyone Living In the Home) 
 
NAME 
RELATIONSHIP 
TO APPLICANT 
GENDER 
DATE OF 
BIRTH 
FULL TIME 
STUDENT  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PROPERTY INFORMATION 
 
 
WHAT YEAR WAS YOUR HOME BUILT? ___________ 
WHAT REPAIRS DO YOU WANT MADE TO YOUR HOME THROUGH THE HIP PROGRAM?   
 
 
 
 


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 3 of 10 
 
 
 
EMPLOYMENT INFORMATION 
 
Please provide information for ALL household members who receive income from present employment 
and is 18 years of age or older (also include any part-time employment).  Use additional pages if more 
than three household members have employment income. 
 
Household Member Name: 
Employer Name: 
Employer Address 
County: 
                                                    How Long at Current Job 
Immediate Supervisor                                           Phone Number 
Job Title 
Household Member Name: 
Employer Name: 
Employer Address 
County: 
                                                    How Long at Current Job 
Immediate Supervisor                                           Phone Number 
Job Title 
 
INCOME SOURCES 
 
Do you or your co-applicant receive alimony and/or child support? 
Yes 
No 
                                               Alimony $ 
  
 
Child Support 
                                How long will this support continue? 
 
Do you or your co-applicant pay alimony and/or child support? 
Yes 
No 
                                               Alimony $ 
  
 
Child Support 
 
                                How long will this support continue? 
  
 
Do any of your children or other family members receive SSI? 
Yes 
No 
SSI amount 
                                          How long will these payments continue? 
Do you receive disability income, is it for a permanent disability? 
Yes 
No 
        Disability amount 
                                         How long will these payments continue? 
Do you obtain income from directly held assets, such as real estate or 
other businesses? 
Yes 
No 
Do you maintain any trust accounts, stocks and bonds (in brokerage 
accounts) and IRAs? 
Yes 
No 
Do you have any interest in a corporation or partnership? 
Yes 
No 
 


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 4 of 10 
 
 
 
Please state the amount of your current annual projected gross income from each applicable source.  
Use additional pages if more than two adults have income: 
 
Source of Income 
Adult #1 
Adult #2 
Other Household 
Member 
Gross Salary/Wages 
 
 
 
Pension(s) 
 
 
 
Social Security 
 
 
 
Unemployment Compensation 
 
 
 
Child Support Received  
(added to income) 
 
 
 
Child Support Paid  
(deducted to income) 
 
 
 
Disability Payment 
 
 
 
Welfare 
 
 
 
Tips/Commissions 
 
 
 
Alimony 
 
 
 
Other 
 
 
 
Sub-Totals 
 
 
 
 
TOTAL OF ALL ADULT INCOMES:  $____________________ 
 
OTHER INCOME/ASSET INFORMATION 
 
Please list all checking and savings accounts, CDs, Money Market Funds, Mutual Funds and any other 
assets held by financial institutions below, whether or not you gain any interest from them, for all 
household members.   
 
Name & Address of 
Financial Institution 
Account Number 
Current 
Balance/Value 
Projected Annual 
Interest Income  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TOTAL PROJECTED INTEREST INCOME FROM THIS SECTION:  _________________ 
 
OUTSTANDING DEBTS 
 
    MORTGAGE INFORMATION: 
    Lender:____________________________________________________________________ 
    Address:____________________________________  Phone Number:__________________ 
    Principal Balance:_____________________________  Monthly Payment Amount:_________ 
 
 


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 5 of 10 
 
 
OTHER DEBTS: (Include Car Payments, Credit Cards etc.) 
Name & Address of Financial 
Institution 
Account Number 
Current 
Balance 
Monthly 
Payment  
 
 
 
 
 
 
 
 
 
 
Have you filed for bankruptcy in the last 7 years?  Yes______  No_____ 
 
If yes, indicate the current status.  If the matter has been resolved, attached a copy of the final ruling or 
discharge. 
 
 
 
Please make sure to include all the documentation requested on the required document list 
attached. 
 
I hereby certify that to the best of my knowledge and belief, the above information 
is true and correct and that I am an owner-occupant of the property for which 
rehabilitation is proposed. 
 
Warning: §1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful 
false statements or misrepresentations to any Department or Agency of the United States 
as to any matter within its jurisdiction. 
 
  
 
Applicant’s Signature________________________________________ 
Date_______________ 
 
Co-Applicant’s Signature_____________________________________ 
Date_______________ 
 
 
 
 
 
 
SIGN
SIGN


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 6 of 10 
 
 
Required document list 
 
Please submit all the following documents along with your application: 
 
1. Copy of the deed to the property 
2. Proof that the property taxes, water, and sewer bills are current 
3. Proof of property insurance, including liability, fire and flood insurance where 
necessary 
4. Mortgage Documentation 
a. Include a Bank/Mortgage Company Statement indicating Current Mortgage 
Balance, any lien, mortgage or other security interest on your home. 
5. Proof of income for all members of the household who are 18 years of age or older 
a. Four current consecutive pay stubs [including both the check and the stub], 
including bonuses, overtime or tips, or a letter from the employer stating the 
present annual income figure or if self-employed, a current Certified Profit 
& Loss Statement and Balance Sheet. 
b. Copies of Federal and State income tax returns for each of the preceding 
three tax years - A Form 1040 Tax Summary for the past three tax years 
can be requested from the local Internal Revenue Service Center or by 
calling 1-800-829-1040. 
c. A letter or appropriate reporting form verifying monthly benefits such as: 
• Social Security or SSI – Current award letter or computer print-out letter 
• Unemployment – verification of Unemployment Benefits 
• Welfare - current award letter 
• Disability - Worker’s compensation letter or 
• Pension income (monthly or annually) – a pension letter 
d. A letter or appropriate reporting form verifying any other sources of 
income claimed by the applicant, such as alimony or child support – 
copy of court order or recent original letters from the court or education 
scholarship/stipends – current award letter. 
e. Current reports of savings and checking accounts (bank statements and 
passbooks) and income reports from banks or other financial institutions 
holding or managing trust funds, money market accounts, certificates of 
deposit, stocks or bonds (In brokerage accounts – most recent 
statements and/or in certificate form – photocopy of certificates). 
f. 
Evidence or reports of income from directly held assets, such as real 
estate or businesses. 
g. For rental property attach copies of all leases. 
h. Interest in a corporation or partnership – Federal tax returns for 
each of the preceding three tax years. 
i. 
Copies of Divorce Decree or status of divorce (if applicable); 
alimony and child support court documents and custody verification, 
if applicable, is required. 


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 7 of 10 
 
 
 
 
Inspection Acknowledgement 
 
I understand and agree to the following inspection guidelines and requirements: 
1. If my application for assistance from the Township of Belleville Home 
Improvement Program (HIP) is approved. A complete inspection as well as 
a Lead Based Paint Risk Assessment will be performed by the Township of 
Belleville’s Home Improvement Program. 
 
2. All deficiencies existing at my premises will be identified at the time of the 
inspections. 
 
3. I understand that any HIP assistance that may be received shall be used in 
a way that prioritizes the correction of the most serious deficiencies existing 
at my home before any less serious deficiencies may be considered. Priority 
consideration will be given to those items which are a hazard to the health, 
safety and welfare of the household. 
 
 
 
Applicant’s Signature________________________________________ 
Date_______________ 
 
Co-Applicant’s Signature_____________________________________ 
Date_______________ 
 
 
 
 
 
 
SIGN
SIGN


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 8 of 10 
 
 
 
Financial Privacy Act 
Notice 
Acknowledgement 
 
Notice 
 
This notice is provided to you pursuant to the requirements of the Right to Privacy Act of 
1978. As a result of your request for and/or receipt of financial assistance under the 
Township of Belleville Home Improvement Program (HIP), the Township of Belleville and 
CME Associates as the Township’s authorized representative will have a right of access 
to financial records held by the Township in connection with the consideration and/or 
administration of assistance to you. 
 
Pursuant to these rights of access, financial records involving your transaction will be 
available to these authorized officials without further notice or authorization from you. 
However, your financial records and information contained therein will not be disclosed or 
released to any other persons, government agency or department without your prior written 
consent, except as may be permitted and/or required by law. 
 
ACKNOWLEDGEMENT 
 
I have read the Right to Financial Privacy Act Notice presented above, and by my 
signature below, acknowledge and accept the terms and conditions set forth therein. 
 
 
 
Applicant’s Signature________________________________________ 
Date_______________ 
 
Co-Applicant’s Signature_____________________________________ 
Date_______________ 
 
SIGN
SIGN


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 9 of 10 
 
 
Notice of Right of Rescission 
Applicants Name: 
Date of Agreement: 
 
Address: 
 
Notice to Customer Required by Federal Law: 
 
 
You have entered into a transaction on  
, 20 which will result in a lien, mortgage or 
other security interest on your home. You have a legal right under federal law to cancel this 
transaction, if you desire to do so, without any penalty or obligation within three business days 
from the above date or any later date on which all material disclosures required under the Truth 
in Lending Act have been given to you. If you so cancel the transaction, any lien, mortgage or 
other security interest on your home arising from this transaction is automatically void. You are 
also entitled to receive a refund of any down payment or other consideration if you cancel. If you 
decide to cancel this transaction, you may do so by notifying: 
CME Associates 
Office of the Administrative Agent 
Attn: Patty Gallagher 
1460 Route 9 South 
Howell, NJ 07731 
Or via email at pgallagher@cmeusa1.com 
This form must be sent no later than 3 days after the signing. 
You may also use any other form of written notice identifying the transaction if it is delivered to 
the above address not later than that time. This notice may be used for that purpose by dating 
and signing below. 
I hereby cancel this transaction. 
Homeowner signature:   
 
 
Date:   
 
The undersigned acknowledge receipt of two completed copies of this notice on this  
day of 
  
, 20 . 
CME Representative:   
 
 
Date:   
 
Effect of Rescission. When an owner exercises his right to rescind under paragraph (a) of this 
section, he is not liable for any finance or other charge and any security interest becomes void 
upon such a rescission. Within 10 days after receipt of a notice of rescission, the creditor shall 
return to the owner any money or property given as earnest money, down payment, or 
otherwise, and shall take any action necessary or appropriate to reflect the termination of any 
security interest created under the transaction. If the creditor has delivered any property to the 
owner, the owner may retain possession of it. Upon the performance of the creditor’s 
obligations under this section, the owner shall tender the property to the creditor, except that if 
SIGN


Township of Belleville Home Improvement Program 
Administered By CME Associates 
 
Page 10 of 10 
 
 
return of the property in kind would be impractical or inequitable, the owner shall tender its 
reasonable value. Tender shall be made at the location of the property or at the residence of 
the owner, at the option of the owner. If the creditor does not take possession of the property 
within 10 days after tender by the owner, ownership of the property vests in the owner without 
obligation on his part to pay for it.