Homeowner’s Self-Certification Statement

Name

This field is for validation purposes and should be left unchanged.

I/We attest that my/our deed-restricted affordable home located at

Address(Required)

Street Address Address Line 2 City State ZIP Code

in Falmouth, Massachusetts is owner-occupied 12 months of the year by me/us. I/We have not refinanced my/our mortgage, nor have I/we further encumbered the property with un-authorized loans or liens, home-equity lines, or other mortgages or notes payable against the property. I/we understand that in order to refinance the property I/we must obtain written approval from the monitoring agent (Falmouth Housing Trust) in an effort to avoid the risk of future foreclosure. I/We also understand that major capital improvements to the property should be pre-approved by Falmouth Housing Trust prior to beginning improvements as they will affect the resale price of my home.

Owner's Name(Required)

First Last

Date(Required)

Owner's Signature(Required)

Type in your name; this represents your digital signature.

First Last

Is there a co-owner of the property?(Required)

Yes

No

Co-owner

Co-owner's Name(Required)

(If applicable)

First Last

Date(Required)

Co-owner's Signature(Required)

Type in your name; this represents your digital signature.

First Last

Required Documents

For you to meet these requirements, please send copies of ONLY two (2) of the following documents:

Copy of driver's license, passport, or other state issued photo identification

Upload a copy of your driver’s license, passport, or other state issued photo identification showing the property address as your residence.