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HOMEOWNER CONSENT <br /> Does the homeowner give consent for their personal information, including information on this form and in any <br /> attachments,to be shared with the Orange County Department of Housing and Community Development <br /> (OCHCD),the Orange County Tax Department,the Orange County Finance Department and with other parties,as <br /> needed in order for OCHCD to provide assistance to the homeowner? <br /> ❑ Yes ❑ No <br /> HOMEOWNER CERTIFICATION <br /> Does the homeowner certify that all information included in this application and any attachments is correct and <br /> complete? <br /> ❑ Yes ❑ No <br /> REQUIRED ATTACHMENTS: <br /> ❑ Documentation verifying gross income for all household members over age 18 <br /> ❑ Income certification form(see next page for form) <br /> AND,IF POSSIBLE,ONE OR MORE OF THE FOLLOWING: <br /> ❑ Copy of last two(2)bi-weekly or four(4)weekly paycheck stubs OR <br /> ❑ W-2 or other wage statement OR <br /> ❑ Current benefit award letters or other documents that includes name and amount of the benefit OR <br /> ❑ Tax form 1040 from latest tax year OR <br /> ❑ Bank statements showing income OR <br /> ❑ Employer letter attesting to income <br /> ❑ Copy of property tax bill <br /> NOTES: <br /> Revised 917121 <br /> 2 <br />