Document Checklist

Please review the following to ensure you successfully submit a complete application.

The items below are required for all adult household members aged 18 and over.

A. Proof of Identity

CA Driver's License/CA Identification Card/Municipal ID

B. Documentation of Income

Employment information, including paystubs for the past two (2) months
If self-employed, YTD Profit & Loss Statement
Gross annual income for each additional income source such as SSI, Pension/Annuity
Gift Income , child/spousal support etc. for the past two (2) months
If a household member is NOT earning income, please include a Zero-Income Affidavit (If needed, please request from StarHarborBMR@gmail.com OR call/text 707-653-6559)

C. Tax Documents

Most recent tax year Federal 1040 Tax Return
4506-t Verification of Non-Filing Form
Most recent tax year W-2s/1099s

D. Financial Accounts

The most recent two (2) consecutive statements for all financial accounts including bank, retirement, stocks/mutual funds, CDs etc.
Documentation for any unlabeled deposits on your bank account for over $500

Household Economic Profile

Please provide accurate information on all household members, aged 18 and over.

Income eligibility will be determined based on the gross combined household income

and will be verified based on the supporting documentation submitted with this

certification.

Social Security, SSDI, Pension, or Paystubs

Social Security Annual Statement, Paystubs, or Transcripts (Reminder to upload two of the most recent paystubs if this is your form of income)

Household Member Name

Annual Award Amount

Household Financial Account Information & Statements

The information you provide on this page helps determine your eligibility for the

financial requirements of the City of Alameda BMR Program.

Please upload statements for all open accounts for all household members aged 18 and

over, even if they contain a $0 balance. Assets will be verified based on the supporting

documentation submitted with this application, so please be sure to provide

accurate information.

**Please note if you do not have any bank accounts; you will need to type in N/A and explain why the household member has no account.

Bank & Financial Accounts

Please upload the last two (2) consecutive FULL statements from this account

Account Owner Name

Bank or Financial Institution Name

Current Account Balance

Explanation for no account:

Deposit Explanation

Please provide a written explanation for any unlabeled deposits over $500 in the box

below.

Backup documentation such as cancelled check, paystub, etc.

Tax Documents

Most Recent Tax Year Federal 1040 Tax Return - Must be included for all income earning household members

Most Recent Tax Year W-2s/1099s - Must be included for all income earning household members

If you were not required by law to file Federal Income Tax returns, please provide an explanation below why you did not file taxes. Please include what years you have not filed.

Certification of Information

By checking this box, and writing my name in the space below, I certify that the

foregoing certification accurately reflects all income received from all sources for all

members of the household.

I certify under penalty of perjury under the laws of the United States of America that

the foregoing is true and correct to the best of my knowledge. I further understand

that providing false representations herein constitutes an act of fraud and that false,

misleading, or incomplete information may result in the termination of real estate

purchase documents related to this application (28 U.S. Code 1746).

First Name

Last Name

Today's Date

Ready to Submit?

All required fields must be filled in before you can submit your paperwork.
Any required fields left blank will be highlighted in red when you attempt to submit your certification/recertification.
Once your certification/recertification is submitted, you will receive a confirmation email.

First Name	Last Name
Email	Phone
Current Address	City
State	Zip/Postal Code
Birth Date	Please Enter Address You Are Applying To

Full-Time/Part-Time	Pension	Self-Employment	Social Security/SSDI
Child Support	Spouse Support	Gift Income	Other

First Name	Last Name
Birth Date Phone	Email Is the person applying the age of 18 or over? YesNo

Document Checklist

Household Information

Household Economic Profile

Household Financial Account Information & Statements

Tax Documents

Certification of Information