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Homeowner COVID-19 Hardship Declaration
Steve King
2021-03-14T23:36:39+00:00
Homeowner COVID-19 Hardship Declaration & Affidavit
Please fill out this form if you are a current OakCLT homeowner and are seeking financial support as a result of a COVID-19 related hardship.
First Name
Last Name
Phone
Email
Home Address Line 1
Home Address Line 2
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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Nevada
New Hampshire
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Postal Code
Names of all other household members
First Name
Last Name
I declare, under penalties of perjury, as follows:
1. I pay a mortgage to:
2. I am current on my mortgage payments.
Yes
No
3. I am current on all my property tax payments.
Yes
No
4. My household has lost significant income due to COVID-19 and is now unable to pay mortgage, property taxes, ground lease fees, home insurance, or other financial obligations under our mortgage and ground lease with OakCLT because of one or more of the following reasons.
Loss of income caused by the COVID-19 pandemic.
Increased out-of-pocket expenses directly related to performing essential work during the COVID-19 pandemic.
Increased expenses directly related to health impacts of the COVID-19 pandemic.
Childcare responsibilities or responsibilities to care for an elderly, disabled, or sick family member directly related to the COVID-19 pandemic that limit my ability to earn income.
Increased costs for childcare or attending to an elderly, disabled, or sick family member directly related to the COVID-19 pandemic.
Other circumstances related to the COVID-19 pandemic that have reduced my income or increased my expenses. Any public assistance, including unemployment insurance, pandemic unemployment assistance, state disability insurance (SDI), or paid family leave, that I have received since the start of the COVID-19 pandemic does not fully make up for my loss of income and/or increased expenses.
5. My household’s estimated gross income for the current month is:
6. My household’s monthly payment (principal, interest, taxes, insurance, etc.) to the mortgage company is:
7. My household
does not
have sufficient savings or liquid assets to make this monthly payment.
8. Please check any of the boxes below that apply to your situation:
I applied for
and received
a mortgage forbearance from the mortgage company.
I applied for, but
did not
receive
a mortgage forbearance from the mortgage company.
I would like more information on how to possibly apply for a forbearance.
I am not currently interested in a mortgage forbearance or other adjustment to the terms of my mortgage.
NOTE: a forbearance is a temporary postponement of required payments.
I hereby swear and affirm under penalty of perjury that the above information is true and correct to the best of my knowledge and belief.
I am signing this Declaration and Affidavit by electronically entering my name below .
Date
First Name
Last Name
OakCLT Contact
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