I/we certify that all provided information is correct to the best of my knowledge and have received a copy of DHN's Privacy Policy. I/we authorize DHN Housing Network to verify all information contained in this online form.By typing my full name below, I hereby authorize DHN to release nonpublic personal information it obtains about me to any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices. I understand I will receive a copy of all information submitted at the email address I provided on Page 2, "Applicant E-mail Address".
Penalty For False or Fraudulent Statement
U.S.C. Title 18, Sec. 1001, provides: “Whosoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies or make any false, contain any false, fictitious or fraudulent statements or
representation, makes or uses any false writing response or document knowing the same to contain any false , fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both.” The undersigned certifies under penalty of law that all statements made in this intake/application form and supporting documents are true and accurate, correct and complete. If any of the information provided by the CLIENT(s) is untrue, inaccurate or incomplete, regardless of when this is discovered by the City, the City may, in its sole discretion, immediately terminate the CLIENT(s)’s participation in the Loan Program without liability.