# **Application Kit**

**Loan Guarantee Assistance**

## **for Places of Worship and** 

**Other Nonprofit Institutions Damaged by Acts of Arson or Terrorism**

Sponsored by the

### **U.S. Department of Housing and Urban Development**

Office of Community Planning and Development

**Table of Contents**

###### 

####### **Part I**

Introductory Memorandum

Fact Sheet

### 

### **Part II - Submission Forms**

**A. [Nonprofit Institution, including Places of Worship
(\"Borrower\")]{.underline}**

\[Documents are to be submitted to Financial Institution\]

1\. Authorization t to Seek Loan Guarantee

> 2\. Eligibility Statement
>
> 3\. Certification of Eligible Activities
>
> 4\. Statement of Sources of Assistance
>
> 5\. Borrower Certification for Assisted Activities
>
> 6\. Certification of an Act of Arson - State or Local Official
>
> 7\. Information Regarding Incident
>
> 8\. Environment Thresholds
>
> 9\. Certification - Information on Damaged Property
>
> 10\. Features of Damaged Structure(s)
>
> 11\. General Guidelines - Financial Data - Loan Questionnaire
>
> 12\. Refinancing and Existing Loan

**B. [Financial Institution]{.underline}**

\[Documents to be submitted to HUD, along with underwriting analysis of
the Financial Institution\]

> 13 Financial Institution Submission Information and Documents
>
> 14\. Statement of Eligibility
>
> 15\. Application for Federal Assistance \[SF-424\]

**C. [Refinancing]{.underline}**

> 16\. Form - Refinancing an Existing Loan

#### **Part I**

To: Places of Worship, Other Nonprofit Organizations and Financial
Institutions

From: United.States. Department of Housing and Urban Development

Office of Community Planning and Development

Subject: Submission Information and Guidance for Loan Guarantee Pursuant
to Section 4 of the Church Arson Prevention Act of 1996

The U.S. Department of Housing and Urban Development (HUD) welcomes your
interest in the Loan Guarantee Recovery Fund. The enclosed materials and
information have been prepared to assist your organization in better
understanding the types of assistance available for affected
organization and to have in-depth information on this loan guarantee
program for rebuilding purposes.

**For Loan Guarantee Assistance.**

Rebuilding assistance from HUD may be obtained in the form of a
guaranteed loan. To inform you in more detail about this program, this
Application Kit includes a Table of Contents with a listing of
application forms in Part I this communication, as well as a Fact Sheet
and guidelines to the program regulations at 24 CFR 573. Part II
includes forms for submission of a guarantee application.

**Actions to be taken by Nonprofit Organization and State or Local
Government Official.**

Please note that this submission package includes forms to be completed
by the Place of Worship or other eligible nonprofit organization the
\"Nonprofit\" or \"Nonprofit Organization\") or by a State or local
government official. We note in particular the importance of two of
these forms, the Certification of an Act of Arson and the Features of
Damaged Structure(s). The first is to be signed by a State or local
official authorized to investigate possible acts of arson. The Features
of Damaged Structure(s) form is to provide to the Financial Institution
and HUD as much information as possible about the structure and property
that has been damaged or destroyed so that an estimate can be made of
what it would cost to rebuild, in your local market, the same or similar
structure and related property.

The eligible Nonprofit Organization is to complete the attached forms
1-13, as identified in the Table of Contacts, and to submit the
documents to the Financial Institution as part of its loan request. If
the loan requested is for a refinancing of an existing loan. the
Nonprofit should complete the form identified as number 15 in the Table
of Contents.

**Fact Sheet**

##### **Section 4 Loan Guarantee Recovery Fund** {#section-4-loan-guarantee-recovery-fund .unnumbered}

**United States Department of Housing and Urban Development**

**Office of Community Planning and Development**

The Loan Guarantee Recovery Fund is a program authorized under Section 4
of the Church Arson Prevention Act of 1996. Section 4 authorizes HUD to
guarantee loans made by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and
destruction to real and personal property caused by acts of arson or
terrorism. Regulations governing the Section 4 Loan Guarantee Recovery
Fund are found at 24 CFR part 573. \[See also the web site at
<http://www.hud.gov/offices/cpd/economicdevelopment/programs/section4/index.cfm>[.\]]{.underline}

An application for a loan guarantee is submitted to HUD by a qualified
Financial Institution on behalf of an eligible Borrower.

**\"Eligible Borrower\"** means an organization described in section
501(c)(3) of the Internal Rvenue Code of 1986, as amended, whose
property has been damaged or destroyed as a result of an act of arson or
terrorism and that incurs a debt obligation to a financial institution
for the purpose of carrying out activities eligible under 24 CFR 573.3.
Though the organization may not have sought or obtained a ruling from
the IRS under the section, its purpose must be consistent with that of
organizations described therein. \[See 24 CFR 573.2\]

**\"Financial Institution\"** means a lender, which may be a bank, trust
company, savings and loan association, credit union, mortgage company,
or other issuer regulated by the Federal Deposit Insurance Corporation,
the Office of Thrift Supervision, the Credit Union Administration, or
the U.S. Comptroller of the Currency. A Financial Institution may also
be a Pension Fund. \[See 24 CFR 573.2\]

###  {#section-2 .unnumbered}

**\"Eligible activities\"** \[See 24 CFR 573.3\] include the following
activities when certified in accordance with §573.6(e) that the activity
is necessary to address damage caused by an act or acts of arson or
terrorism as certified in accordance with §573.6(f):

\(a\) Acquisition of improved or unimproved real property in fee or
under long term lease.

\(b\) Acquisition and installation of personal property.

\(c\) Rehabilitation of real property owned, acquired, or leased by the
Borrower.

\(d\) Construction, reconstruction or replacement of real property
improvement.

> \(e\) Clearance, demolition, and removal, including movement of
> structures to other sites, of buildings, fixtures and improvements on
> real property.
>
> \(f\) Site preparation, including construction, reconstruction, or
> installation of site improvements, utilities, or facilities, which is
> related to the activities described in paragraph (a), (c), or (d)
> above.
>
> \(g\) Architectural, engineering and similar services necessary to
> develop plans in connection with activities financed under paragraph
> (a), (b), (c), or (d) above.
>
> \(h\) Acquisition, installation and restoration of security systems.
>
> \(i\) Loans for refinancing existing indebtedness secured by a
> property which has been or will be acquired, constructed,
> rehabilitated or reconstructed, if such financing is determined to be
> appropriate to achieve the objectives of the Act and this part.
>
> \(j\) Other necessary project costs such as insurance, bonding, legal
> fees, appraisals, surveys, relocation, and closing costs, which have
> been paid or incurred by the Borrower in connection with the
> completion of the above activities.

[**Replacement of Damaged Property** \[See 24 CFR
573.7(a)(4)\]]{.underline}

As provided in Section 24 CFR 573.7(a)(4) of the regulations governing
the use of the guaranteed loan funds, HUD may limit loan guarantees to
loans financing the replacement of damaged property with comparable new
property.

HUD considers the term "comparable new property" to mean a structure or
structure(s) with similar quantitative and qualitative features as the
damaged property. Generally, the comparable new property would be
approximately the same or similar in size, materials, and design as the
orginal structure

prior to the arson or terrorism incident. A comparable new property must
meet local building codes (as well as local or national historic
property standards, if applicable) and is handicapped accessible.

Where a need can be demonstrated for features not required by the local
building codes, such as fire retardent materials, security systems or
the like, HUD may allow up to an additional 20% of the replacement cost
of the comparable new property to be used to defray such additional
expenditures. HUD may finance the construction of a comparable new
property larger in square footage than the damaged property. However, a
new property may be permitted to be larger than 20% of the damaged
property on a case-by-case basis only where reasonable growth
assumptions can be supported.

Estimating the cost of a comparable new property requires as much
knowledge as possible about the damaged or destroyed property. That
knowledge may be gained from one or more of the following sources: (1)
original building plans of the property before the act of arson or
terrorism; (2) foundation layout, footprint, drawings or sketches,
surveys, and/or photos of the original structure's dimensions (total
square footage), exterior and interior materials, equipment and systems
(i.e. heat, air and plumbing) that were in place before the property was
damaged or destroyed.

**[Submission Requirements]{.underline}**

**Nonprofit Organization.**

A nonprofit organization, including a place of worship, applies to a
Financial Institution for a loan to to finance eligible activities. The
Financial Institution, in turn, applies to HUD for a guarantee of the
loan it will make to the nonprofit organization. The nonprofit\'s loan
application shall include the following information \[See also forms
1-14 identified in the Table of Contents\]:

-   a description of the assistance needed, including eligible
    activities

-   a statement of other funds available to finance the eligible
    activities;

-   a certification from the nonprofit organization that the activities
    to be assisted resulted from an act of arson or terrorism;

-   a certification by a Qualified Certification Official (QCO) that the
    damage or destruction to be remedied resulted from an act of arson
    or terrorism;

-   environmental documentation required under the regulations;

-   replacement information on the damage/destroyed structure;

-   construction/rebuilding plans for the new structure; and

-   other information required by the Financial Institution.

**Financial Institution**.

A Financial Institution shall sumbit its request for a loan guarantee to
HUD. The submission is to include:

-   the nonprofit's loan application;

-   a narrative of the Financial Institution's underwriting standards
    used in underwriting the nonprofit's loan request that includes an
    analysis of the nonprofit organization's ability to pay loan debt
    service and the value of the collateral assigned or pledged as
    security for the repayment of the loan. (In refinancing
    transactions, advise HUD of any premium or discount to be assessed);

-   the interest rate on the loan (which rate shall take into account
    the value of the HUD guarantee) plus any fees to be charged; and

-   the percentage of the loan for which a guarantee is requested.

### **Loan Term and Repayment Schedule.**

Loans may be guaranteed for up to 20 years with flexible repayment
terms.

**Underwriting Criteria.**

Nonprofits seeking a loan will note that a Financial Institutions may
use its usual underwriting standards which may include a review of:

-   financial statements for the past 3 to 5 years

-   the size of the congregation or membership for the past 3 to 5 years

-   monthly collections or revenues

-   real and personal property owned and pledged as collateral

-   a formal cost proposal for construction or rehabilitation of all
    damaged or destroyed real property

-   a formal cost proposal or use of loan other than for the
    construction or rehabilitation of all damaged or destroyed real
    property

-   property replacement information

-   a history of debt service performance or cash flow available from
    collections and other revenues to repay the loan

[Further Definitions \[See also 24 CFR 573.3\]]{.underline}

> **Arson** means a fire or explosion causing damage to (or destruction
> of) real or personal property that a Qualified Certification Official
> determines, or reasonably believes, to be deliberately set.
>
> **Terrorism** means an act of violence causing damage to (or
> destruction of) real or peronal property tht the Secretary or his
> designee, in consultation with the Federal Bureau of Investigation,
> determines to be, or reasonably believes to be, a terrorist act, as
> defined by applicable Federal law or guidelines.
>
> **Qualified Certification Official (QCO)** (1) For the purpose of
> certifying an act of arson. A State or local official authorized to
> investigate possible acts of arson. For the purposes of this
> definition, such an official is authorized to execute an Official
> Incident Report or its equivalent. The term "Qualified Certification
> Official" also includes HUD, which will consult with the Bureau of
> Alcohol, Tobacco, and Firearms of the Department of the Treasury in
> making its determintations. (2) For the purpose of certifying an act
> of terrorism. The Secretary or his designee, in consultation with the
> Federal Bureau of Investigation, shall determine whether an act of
> violence is a terrorist act or is reasonably believed to be a
> terrorist act.

**[Additional Information]{.underline}**

For more information contact the HUD Washington, D.C. office at
(202)708-2290. Information, including regulations for the Section 4
Guarantee Recovery Fund, is also available on the web site at

<http://www.hud.gov/offices/cpd/economicdevelopment/programs/section4/index.cfm>[.]{.underline}

#### 

#### 

#### 

#### 

#### 

#### 

#### 

#### 

#### **Part II**

**Authorization to Seek Loan Guarantee**

Certification Authorizing Person(s) to Seek Loan Guarantee Assistance
and to Execute Loan Documents under Section 4 of the Church Arson
Prevention Act of 1996

The governing body of \[name of Borrower\]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(the \"Borrower\") has duly adopted or passed as an official act a
resolution, motion or similar action authorizing the below identified
person(s) as the official representative(s) of the (church/nonprofit) to
submit to a financial institution for Section 4 Loan Guarantee
Assistance an application and amendments thereto and all understandings
and assurances contained therein, and directing and authorizing the
person(s) identified as the official representative(s) of the
(church/nonprofit) to act in connection with the application to provide
such additional information as may be required. Such person(s) is also
authorized by resolution to execute all documents necessary or desirable
to accomplish the transaction.

[Name of Authorized Person]{.underline} [Title]{.underline}

1\.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> [Certification Officials]{.underline}

Signature Signature

Name Name

Title Title

Date Date

**Eligibility Statement**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Eligibility Statement by Nonprofit Entity for Assistance under Section
4 of the Church Arson Prevention Act of 1996**

The Borrower, \[name of Borrower\]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
is an organization described in the following Section 501(c)(3) of the
Internal Revenue Code of 1986 as amended:

> \"Corporations, and any Community chest, fund, or foundation,
> organized and operated exclusively for religious, charitable,
> scientific, testing for public policy, literary, or educational
> purposes, or to foster national or international amateur sports
> competition (but only if no part of its activities involve the
> provision of athletic facilities or equipment) for the prevention of
> cruelty to children or animals, no part of the net earnings of which
> inures to the benefit of any private shareholder or individual, no
> substantial part of the activities of which is carrying on propaganda,
> or otherwise attempting to influence legislation (except as otherwise
> provided in subsection (h)), and which does not participate in, or
> intervene in (including the publishing or distributing of statements),
> any political campaign on behalf of (or in opposition to) any
> candidate for public office.\"

Signature Signature

Name Name

Title Title

Date Date

**Certification of Eligible Activities**

The governing body of \[name of Borrower\]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
hereby certifies that funds to be guaranteed by the U.S. Department of
Housing and Urban Development will be used to finance the following
eligible activities which are necessary to address damage or destruction
caused by an act or acts of arson or terrorism as certified under
appropriate provisions of the regulations governing the \"Loan Guarantee
Recovery Fund.\"

[Activity]{.underline} [Activity To Be Assisted]{.underline}

**Yes No**

\(a\) Acquisition of improved or unimproved real property in fee or
under

long ­term lease. \_\_\_ \_\_\_

\(b\) Acquisition and installation of personal property. \_\_\_ \_\_\_

\(c\) Rehabilitation of real property owned, acquired or leased by the
Borrower. \_\_\_ \_\_\_

\(d\) Construction, reconstruction or replacement of real property
improvement. \_\_\_ \_\_\_

\(e\) Clearance, demolition, and removal, including, movement of
structures to

other sites, of buildings, fixtures and improvements on real property.
\_\_\_ \_\_\_

\(f\) Site preparation, including construction, reconstruction, or
installation of site\
improvements, utilities, or facilities, which is related to the
activities pursu­ant\
to items (a), (c) or (d) above. \_\_\_ \_\_\_

\(g\) Architectural, engineering and similar services necessary to
develop plans in\
connection with activities financed under items (a), (b), (c) and (d)
above. \_\_\_ \_\_\_

\(h\) Acquisition, installation and restoration of security systems.
\_\_\_ \_\_\_

\(i\) Loans for refinancing existing indebtedness secured by a property
which has been\
or will be acquired constructed, rehabilitated or reconstructed. If\'
such financing is\
determined to be appropriate to achieve the objective of title
regulations and the statute. \_\_\_ \_\_\_

\(j\) Other necessary project costs such as insurance, bonding, legal
fees, apprais­als,\
surveys, relocation, closing costs, etc., paid or incurred by the
Borrower in connection\
with the completion of the above activities. \_\_\_ \_\_\_

Signature: Signature:

Name: Name:

Title: Title:

Date: Date:

**Statement of Sources of Assistance**

**Statement of Sources of Assistance**

  -------------------------------------- --------- -------- -------------------
  Sources of Funds                       **Yes**   **No**   **Estimated
                                                            Amount**

  Financial Institution (Loan guaranteed                    
  by HUD)                                                   

  Financial Institution (Loan not                           
  guaranteed by HUD)                                        

  National Council of Churches                              

  Congress of National Black Churches                       

  Borrower/ \[Nonprofit/Church\] Funds                      

  Private Donations                                         

  Insurance Funds                                           

  Other                                                     
  -------------------------------------- --------- -------- -------------------

**Borrower Certification for Assisted Activities**

Borrower Certification for Assisted Activities as a Result of a
Qualified Incident of Arson or Terrorism

Background

The Church Arson Prevention Act of 1996, Section 4, (P.L. 104‑155)
authorizes the U.S. Department of Housing and Urban Development (HUD) to
guarantee loans made by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and
destruction to real and personal property caused by acts of arson or
terrorism. Prior to HUD\'s provision of the loan guarantee, the Borrower
of funds from a financial institution seeking a Section 4 Guaranteed
Loan must certify that the activities to be assisted by the Guaranteed
Loan are the same activities that are certified to by a Qualified
Certification Official, pursuant to 24 CFR Part 573.6(f).

Summary of Incidence(s) of Arson or Terrorism

**The Secretary of HUD** or his designee, in consultation with the
Federal Bureau of Investigation, shall determine whether an act of
violence is a terrorist act or is reasonably believed to be a terrorist
act. The Borrower is requested to complete the following information to
assist in that certification.

1\. Description of Real or Personal Property:

2\. Address/Location of Real or Personal Property

> Street:
>
> City/Town: State: Zip Code:

3\. Date(s) of Incident(s) of Arson or Terrorism \[if exact date is
unknown, provide date of first report of

incident(s)\]:

4\. Brief description of damage to or destruction of the Real or
Personal Property described in 1. above and/or description of act(s) of
arson or terrorism:

The Borrower certifies that the activities for which funds are sought
are the same activities that are the subject of the certification
provided (or to be provided) by the Qualified Certification Official.

I am an authorized representative of the Borrower and I am authorized to
execute this Certification on behalf of the Borrower.

Signature of Borrower's Authorized Official:

Name:

Street Address:

City State Zip Code

**Definitions:**

**Borrower** means an organization described in section 501 (c) (3) of
the Internal Revenue Code of 1986, as amended, whose property has been
damaged or destroyed as a result of an act of arson or terrorism and
that incurs a debt obligation to a Financial Institution for the purpose
of carrying out activities eligible under 24 CFR 573 Loan guarantee
Recovery Fund.

> **Certification of an Act of Arson**

(To be completed by a State or Local Official as Qualified Certification
Official (QCO))

Background

The Church Arson Prevention Act of 1996, section 4, (P.L. 104-105)
authorizes the U.S. Department of Housing and Urban Development (HUD) to
guarantee loans mabe by financial institutions to certain nonprofit
organizations to finance activities designed to remedy the damage and
destruction to real and personal property caused by acts of arson or
terrorism. Prior to HUD's provision of the loan guarantee, a
certification must be provided by a Qualified Certification Official
(QCO) that the damage or destruction to be remedied by the use of the
Guaranteed Loan Funds resulted from an act or arson or terrorism.

Description of Incidence(s) of Arson

If the following information is contained in an official incident or
other equivalent report that has been completed, it may be attached in
lieu of completing this section. Otherwise, complete the description of
the property and related damage, as well as completing the Certification
of an Act of Arson below. Check if Incident Report is attached.

1.  Description of Real or Personal Property:

2.  Address/Location of Real or Personal Property

> Street:
>
> City/Town: State: Zip Code:

3.  Date(s) of Incident(s) of Arson (if exact date is unknown, provide
    date of first report of incident(s)):

4.  Brief description of damage to or destruction of the Real Personal
    Property described in item 1. above:

> **Certification of Qualified Certification Official**
>
> I, (enter name)
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
> have determined or reasonably believe that the damage or destruction
> to the real or personal property described on the front was
> deliberately set.
>
> I am a State or local official authorized to investigate possible acts
> of arson and am authorized to execute an Official Incident Report or
> its equivalent.
>
> Signature:
>
> Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Title:
>
> Agency/Office:
>
> Street:
>
> City:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> State: \_\_\_\_\_\_\_\_\_\_ Zip Code: \_\_\_\_\_\_\_\_\_\_\_
>
> Telephone:
>
> **Definitions:**

^    ^1. **[Arson]{.underline}** means a fire or explosion causing
damage to (or destruction of) real or personal property that a Qualified
Certification Official determines, or reasonably believes, to be
deliberately set.

^   ^

2\. **[Qualified Certification Official (QCO)]{.underline}**

(a) For the purpose of certifying an act of arson. A State or local
    official authorized to investigate possible acts of arson. For the
    purposes of this definition, such an official is authorized to
    execute an Official Incident Report or its equivalent and may be an
    official or employee of such agencies as the local fire department,
    the local police department, or the State Fire Marshall's Office or
    its equivalent. The term \"Qualified Certification Official\" also
    includes HUD, which will consult with the Bureau of Alcohol,
    Tobacco, and Firearms of the Department of the Treasury in making
    its determinations.

(b) For the purpose of certifying an act of terrorism. The Secretary or
    his designee, in consultation with the Federal Bureau of
    Investigation, shall determine whether an act of violence is a
    terrorist act or is reasonably believed to be a terrorist act.

3\. **[Terrorism]{.underline}** means an act of violence causing damage
to (or destruction of) real or personal property that the Secretary or
his designee, in consultation with the Federal Bureau of Investigation,
determines to be, or reasonably believes to be, a terrorist act, as
defined by applicable Federal law or guidelines.

**Information Regarding Incident**

To assist in determining or better understanding why your
organization\'s property was damaged or destroyed by fire, please
provide any information (copies of newspaper articles, police reports or
other accounts you or others may have) which might help to document the
motivation or likely reason ( i.e. religious hatred ) this incident took
place.

List of information attached:

**1.**

**2.**

**3.**

**4.**

**5.**

**6.**

**7.**

**8.**

**9.**

**10.**

Additional Comments:

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

Environmental Thresholds

HUD will need your assistance to determine whether an environmental
assessment is required in connection with your rebuilding initiative. In
providing this assistance, we encourage you to use the expertise of
architectural and engineering consultants who should answer the list of
questions on environmental factors. They may also provide information in
their plan narratives as to how their construction plans conform with
the environmental factors. Have these consultants assist you in
answering the questions below for submission with your application to
the Financial Institution.

In addition to assistance from an architect or engineer in answering the
questions below, you can use qualified data sources to obtain relevant
environmental information about the property you are rebuilding. A
qualified data source includes any Federal, State, or local agency with
expertise or experience in environmental protection (e.g., the local
community development agency; the local planning agency; the State
environmental protection agency, or the State Historic Preservation
Officer) or any other source qualified to provide reliable information
on the particular property.

**[Answer either Section A or Section B.]{.underline}**

A.  For rebuilding plans involving **[minor]{.underline}**
    rehabilitation of a building and acquisition of any property**,**
    please answer the following questions.

> Please answer the following questions: **Yes No**
>
> \(1\) Is the property to be assisted located within designated coastal
> barrier resources? \_\_\_ \_\_\_
>
> \(2\) Is the property contaminated by toxic chemicals or radioactive
> materials? \_\_\_ \_\_\_
>
> \(3\) Is the property located within a floodplain? \_\_\_ \_\_\_
>
> \(4\) Is a building involved for which flood insurance protection is
> required? \_\_\_ \_\_\_
>
> \(5\) Is the property located within a runway clear zone at a civil
> airport or within

a clear zone or accident potential zone at a military airfield? \_\_\_
\_\_\_

> \(6\) Is the property listed on, or eligible for listing on, the
> National Register of
>
> Historic Places; located within, or adjacent to, an historic district,
> or is a
>
> property whose area of potential effects includes a historic district
> or property? \_\_\_ \_\_\_

\[form continues on next page\]

B.  For rebuilding plans involving **[major]{.underline}**
    rehabilitation of a building or for new construction or rebuilding,
    an environmental assessment under NEPA is required.

> Please answer the following questions: **Yes No**
>
> \(1\) Does the property affect coastal zone management? \_\_\_ \_\_\_
>
> \(2\) Is the property located near hazardous industrial operations,
>
> handling fuels or chemicals of an explosive or flammable nature?
> \_\_\_ \_\_\_
>
> \(3\) Does the property affect a sole source aquifer? \_\_\_ \_\_\_
>
> \(4\) Does the property affect endangered species? \_\_\_ \_\_\_
>
> \(5\) Is it located within a designated wetland? \_\_\_ \_\_\_
>
> \(6\) Is it located in a high noise area? \_\_\_ \_\_\_

Signature:

Name:

Title:

Agency/Organization/Firm:

**Certification: Information on Damaged Property**

Name of Church/Nonprofit:

Date of Incident:

To help ensure the best estimation of the cost to replace the property
damaged or destroyed by arson, the following information is requested:

**Option I.** If available, please provide photos of the property prior
to and after the arson damage. Also provided the original building
plans, foundation layout, footprint, other drawings, sketches and/or
surveys of the original structure.

> Also, please check which of the following enhancement features will be
> part of your rebuilt structure:
>
> Fire Retardent Materials Handicap Accessibility Features
>
> Security Systems Energy Conservation Items
>
> Life and Safety Improvements
>
> **Option II.** If the items requested under Option I are not
> available, please answer the questions below and complete the chart to
> identify quantitative and qualitative features of the property prior
> to its damaged or destruction. You are welcome to add comments in
> narrative form to elaborate or explain any feature(s) of the property.
>
> What was the gross square feet of the original structure(s)?
>
> Was the damage limited to one structure or more? Please explain.
>
> Were additions made to the original structure? Yes\_\_\_\_ No\_\_\_\_
>
> Dates of those additions?
>
> What was the seating capacity of the former structure?
>
> Do you anticipate any unusual site improvements or landscaping at the
> site to prepare it for the new structure? Please explain.
>
> Will any special utilities (i.e.,water, sewer) be brought to the site
> for the new property? Please explain.
>
> Will you be assessed any special fees by the city/county as part of
> the cost of rebuilding? Please explain.

**Features of Arson-damaged Structure(s)**

**Exterior Wall:** Circle the primary type or combination:

Wood-Frame Solid Masonry Hollow Cinder Block Brick Veneer Stucco

Wood Siding Vinyl Siding Aluminum Siding Brick Other

**Roofing Material:** Circle the primary type or combination:

Asphalt Gravel Shingle Tile Other

**Interior Features:** Mark the interior features and provide
information requested:

Features Was part Was not part Square feet Other information

of original of original required

structure structure

\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--

  -----------------------------------------------------------------------
  Sanctuary Ceiling Height\*

  Choir Seating

  Pastor's Office

  Church Office Ceiling Height\*

  Choir Room

  Fellowship Hall

  Kitchen

  Dining Hall

  Rest Rooms

  Class Rooms

  Nursery

  A/C

  Heating

  Security System

  Stain Glass Windows

  Basement (Circle one) Partial Full None

  Floor Type?
  -----------------------------------------------------------------------

\* Height of ceilings impact cost, so please explain.

**General Guidelines - Financial Data**

The examples below are possible items of information the financial
institution may request from nonprofit organizations seeking a loan to
be guaranteed by HUD:

1\. Financial Statements for the last two years and year‑to‑date.

> a\. Income Statement showing income received and disbursed. (Weekly
> information may need to be summarized, or submit the organization\'s
> annual report).
>
> b\. Balance Sheet showing assets, liabilities, etc.

2.  A brief history of when the organization was founded; how it
    developed over the years and its incorporation status.

3.  Size: now and over the next 3 to 5 years.

4.  Projected revenues based on active membership and expected future
    active members.

5.  Basis for the amount of loan funds requested.

6.  Profile of the organizational structure.

7.  History of debt or recent debt account(s) paid and an authorization
    for the bank to obtain a copy of this information from a credit
    agency or have a credit agency send such information to the
    organizations which would in turn send the credit report to the
    bank. In lieu of this, the bank may accept credit applications on
    certain members.

8.  An environmental report on the building assessing termites,
    asbestos, and other possible contamination conditions.

9.  An appraisal of the property preferably by an MIA appraiser with
    local area experience.

**[Items to consider prior to seeking a loan from a bank.]{.underline}**

**General Information**

Name of organization:

Legal structure (Corporation, Partnership, Other):

Is the organization incorporated under the laws of State where located?
Yes \_\_\_ No \_\_\_

Address:

Telephone:

Name of Primary contact

Tax ID number

Inception date of organization

Length of time at current location

Number of worship services held per week

When are offerings collected

Seating capacity of current facility

Name of head clergyman

Length of time with organization

Full or part time

Age of head clergyman

Names of other staff clergyman

Member of denomination body, if any?

How is body structured?

Contributions to body annually, if any?

What committee is in charge of financial related affairs?

What committees are in charge of other decisions?

What is the length of service for persons involved in decision making
functions ?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Financial Information**

Copy of financial statement

Fiscal Year

Operating Budget

Actual Operating Income

Membership

Giving Units (family units or single, employed adults)

Average Worship Attendance

Average Sunday School Attendance

Breakdown of Current Membership:

Under 18

> 18-25
>
> 25-35
>
> 35-45
>
> 45-55
>
> 55-65
>
> 65 +

When was the membership list last purged

List the individual amount given by your top ten donors:

1 \$\_\_\_\_\_\_\_\_\_ 2 \$\_\_\_\_\_\_\_\_\_\_ 3 \$
\_\_\_\_\_\_\_\_\_\_ 4 \$ \_\_\_\_\_\_\_\_\_\_\_ 5 \$
\_\_\_\_\_\_\_\_\_\_\_\_\_

6 \$ \_\_\_\_\_\_\_\_\_ 7 \$\_\_\_\_\_\_\_\_\_\_ 8 \$
\_\_\_\_\_\_\_\_\_\_ 9 \$ \_\_\_\_\_\_\_\_\_\_\_ 10 \$
\_\_\_\_\_\_\_\_\_\_\_\_

Please provide a summary of any borrowings or capital additions
completed in the last ten years.

Property Information

How many acres do you currently own?

Square footage of current facility

Date facility acquired and cost \$

List a description, year completed, and cost of any improvements

How far to the nearest associated church?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Project Information** (Please attach all permanent budget, drawings,
etc. ) Please describe the current project (square footage, number of
buildings, etc.)

Who is the architect?

Who is the contractor?

What is the total cost of the project?

Construction

Soft cost

Furniture Fixtures

Contingency

Land

Interest during construction

What is the amount of the loan request?

What is the estimated length of construction?

Are you/will you be involved in a special fund

> raising campaign for the project? Yes \_\_\_ No \_\_\_

What is/was the start date?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

What is/was the length of the campaign?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

How much is pledged to date?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

How much has been collected to date?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please list any pledges over \$25,000?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Did you/will you use a professional fund raiser? Yes\_\_\_ No\_\_\_

If yes, which one?

Is the following insurance coverage in place?

Fire Yes \_\_\_ No \_\_\_ Extended Coverage Yes\_\_\_ No\_\_\_

Vandalism Yes \_\_\_ No \_\_\_ Malicious Mischief Yes\_\_\_ No\_\_\_

Will this coverage remain in force? Yes \_\_\_ No \_\_\_

Have all necessary local permits\
been received? Yes \_\_\_ No \_\_\_

Does the organization understand that in the mortgage there will be a
clause that, in the event the organization ceases to cooperate with the
local association in which the organization is located or affiliated, or
if the property should be sold, leased or otherwise disposed of, the
remaining indebtedness will become due and payable immediately? Yes
\_\_\_ No \_\_\_

Additional Information Requested:

1\. Resume from head clergyman

2\. Brief history of organization

3\. Last 5 years fiscal year end statements

4\. Current budget

5\. Operating projections for the next three years

**Refinancing an Existing Loan**

The Borrower shall provide to the lender, along with other required loan
application documents, a statement that the nonprofit is requesting a
refinancing of its guaranteed loan. The nonprofit should also document
that the funds from the original loan were used to carry out eligible
activities described in 24 CFR Part 573 of the HUD regulations \[See
also page 5 above for list of Eligible Activities\].

**Financial Institution - Information to HUD**

**Section 4 Loan Guarantee Recovery Fund**

The following information is to be submitted by the Financial
Institution from whom the nonprofit is seeking a loan to be guaranteed
by HUD.

1.  A statement that the organization is regulated by the FDIC, the
    Office of Thrift Supervision, Credit Union Administration or the
    U.S. Comptroller of the Currency.

2.  The Nonprofit/Church\'s application documents.

3.  A narrative of the underwriting standards used to review the
    Nonprofit\'s loan request that includes an analysis of the Nonprofit
    organization\'s ability to pay debt service and the value of the
    collateral assigned or pledged as security for the repayment of the
    loan. (In connection with a refinancing, advise HUD of any premium
    or discount that will be assessed in connection with the
    refinancing);

4.  The term of the loan (up to 20 years):
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

5.  The interest rate to be charged:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

6.  Any fees to be charged:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7.  The percent of the loan HUD is to guarantee:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[Statement of Eligibility of Financial Institution]{.underline}**

To be submitted by the Financial Institution

The
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
is a financial institution as defined by 24 CFR Section 573.2, which is
regulated by the FDIC, the Office of Thrift Supervision, Credit Union
Administration or

the U.S. Comptroller of the Currency.

Signature:

Name:

Title: Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

  ---------------- -------------- --- ------------- --- -------------- --- ---------------- --- ------- --- ---------- --------------- ----------------- ---------------- ------------------- ---
  **Application                                                                                                        U.S. Department                   OMB Approval                         
  for**                                                                                                                of Housing                        No.2501-0017                         

  **Federal                                                                                                            **and Urban                       (exp.                                
  Assistance**                                                                                                         Development**                     03/31/2005)                          

                                                                                                                                                                                              

                                                                                                                       2\. Date                          4\. HUD                              
                                                                                                                       Submitted                         Application                          
                                                                                                                                                         Number                               

  1\. Type of                                                                                                                                                                                  
  Submission                                                                                                                                                                                  

                                      Application                          Preapplication                              3\. Date and                      5\. Existing                          
                                                                                                                       Time Received                     Grant Number                         
                                                                                                                       by HUD                                                                 

                                                                                                                                                                                               

                                                                                                                                                         6\. Applicant                        
                                                                                                                                                         Identification                       
                                                                                                                                                         Number                               

                                                                                                                                                                                               

  7\. Applicant\'s                                                                                                                     8\.                                                     
  Legal Name                                                                                                                           Organizational                                         
                                                                                                                                       Unit                                                   

                                                                                                                                                                                               

  9\. Address                                                                                                                          10\. Name, title,                                      
  (give city,                                                                                                                          telephone number,                                      
  county, State,                                                                                                                       fax number, and                                        
  and zip code)                                                                                                                        e-mail of the                                          
                                                                                                                                       person to be                                           
                                                                                                                                       contacted on                                           
                                                                                                                                       matters involving                                      
                                                                                                                                       this application                                       

                   A. Address:                                                                                                         (including area                                        
                                                                                                                                       codes)                                                 

                   B. City:                                                                                                            A. Name:                                                

                   C. County:                                                                                                          B. Title:                                               

                   D. State:                                                                                                           C. Phone:                                               

                   E. Zip Code:                                                                                                        D. Fax:                                                 

                                                                                                                                       E. E-mail:                                              

  11\. Employer                                                                                                                        12\. Type of                                            
  Identification                                                                                                                       Applicant (enter                                       
  Number (EIN) or                                                                                                                      appropriate                                            
  SSN                                                                                                                                  letter in box)                                         

                                                                                                                                       A. State          I. University or                      
                                                                                                                                                         College                              

                                                                                                                                       B. County         J. Indian Tribe                       

  13\. Type of                                                                                                                         C. Municipal      K. Tribally                          
  Application                                                                                                                                            Designated                           
                                                                                                                                                         Housing Entity                       
                                                                                                                                                         (TDHE)                               

                   New                                  Continuation       Renewal                          Revision                   D. Township       L. Individual                         

                                                                                                                                       E. Interstate     M. Profit                             
                                                                                                                                                         Organization                         

  If Revision,                                                                                                                         F. Intermunicipal N. Non-profit                         
  enter                                                                                                                                                                                       
  appropriate                                                                                                                                                                                 
  letters in                                                                                                                                                                                  
  box(es)                                                                                                                                                                                     

  A. Increase                                                                                                                          G. Special        O. Public                            
  Amount B.                                                                                                                            District          Housing                              
  Decrease Amount                                                                                                                                        Authority                            
  C. Increase                                                                                                                                                                                 
  Duration                                                                                                                                                                                    

  D. Decrease                                                                                                                          H. Independent    P. Other                              
  Duration E.                                                                                                                          School District   (Specify)                            
  Other (Specify)                                                                                                                                                                             

                                                                                                                                       14\. Name of                                            
                                                                                                                                       Federal Agency                                         

                                                                                                                                       **U.S. Department                                      
                                                                                                                                       of Housing and                                         
                                                                                                                                       Urban                                                  
                                                                                                                                       Development**                                          

  15\. Catalog of                                                                                                                      16\. Descriptive                                        
  Federal Domestic                                                                                                                     Title of                                               
  Assistance                                                                                                                           Applicant\'s                                           
  (CFDA) Number                                                                                                                        Program                                                

                                                                                                **1 4**                                                                                        
                                                                                                \-\--                                                                                         

                   Title:                                                                                                                                                                      

                   Component                                                                                                                                                                   
                   Title:                                                                                                                                                                     

  17\. Areas                                                                                                                                                                                   
  affected by                                                                                                                                                                                 
  Program                                                                                                                                                                                     
  (boroughs,                                                                                                                                                                                  
  cities,                                                                                                                                                                                     
  counties,                                                                                                                                                                                   
  States,                                                                                                                                                                                     

                   Indian                                                                                                                                                                      
                   Reservation,                                                                                                                                                               
                   etc.)                                                                                                                                                                      

                                                                                                                                                                                               
  ---------------- -------------- --- ------------- --- -------------- --- ---------------- --- ------- --- ---------- --------------- ----------------- ---------------- ------------------- ---

<table>
<colgroup>
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 13%" />
<col style="width: 2%" />
<col style="width: 8%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 24%" />
<col style="width: 1%" />
<col style="width: 27%" />
<col style="width: 1%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="7">18a. Proposed Program start date</td>
<td colspan="6">18b. Proposed Program end date</td>
<td colspan="2">19a. Congressional Districts of Applicant</td>
<td colspan="2">19b. Congressional Districts of</td>
</tr>
<tr class="even">
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td>Program</td>
<td> </td>
</tr>
<tr class="odd">
<td colspan="14">20. Estimated Funding: <strong>Applicant must complete
the Funding Matrix on Page 2.</strong></td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td colspan="14">21. Is Application subject to review by State Executive
Order 12372 Process?</td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="odd">
<td></td>
<td>A.</td>
<td colspan="2">Yes</td>
<td> </td>
<td colspan="12">This preapplication/application was made available to
the State Executive Order 12372 Process for review on:
Date__________</td>
</tr>
<tr class="even">
<td> </td>
<td>B.</td>
<td colspan="2">No</td>
<td> </td>
<td colspan="7">Program is not covered by E.O. 12372</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td> </td>
</tr>
<tr class="odd">
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td colspan="9">Program has not been selected by State for review.</td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="even">
<td colspan="10">22. Is the Applicant delinquent on any Federal
debt?</td>
<td> </td>
<td> </td>
<td>No</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr class="odd">
<td> </td>
<td> </td>
<td colspan="11">Yes If "Yes," explain below or attach an
explanation.</td>
<td></td>
<td></td>
<td></td>
<td> </td>
</tr>
<tr class="even">
<td> </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td> </td>
</tr>
<tr class="odd">
<td> </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td> </td>
</tr>
<tr class="even">
<td> </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td> </td>
</tr>
<tr class="odd">
<td> </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><p>Form HUD-424 (01/2003)</p>
<p>Ref. OMB Circular A-102</p></td>
<td> </td>
</tr>
<tr class="even">
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
</tbody>
</table>