Housing Group City of Campbell
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Submission Received

Thank you for completing the Annual Monitoring Certification. We have received your documents and will review them shortly.

City of Campbell

Annual Monitoring Certification Form

When you purchased a home and/or received a loan through the City of Campbell BMR Program, you agreed to reside in the property as your principal residence for the term of your agreement.

Please complete the following form and upload the required documentation in order to complete the annual occupancy verification. Please contact campbell@housing-group.org should you have any questions.

1 Contact Information

First name is required
Last name is required
Valid email is required
Phone number is required
Mailing address is required
City is required
Required
Zip is required

2 Property Information

Property address is required
Please select an option
Required (max 5)

3 Household Members

At least one household member is required

4 Required Documentation

Click or drag to upload
PDF, JPG, or PNG
Insurance evidence is required
Click or drag to upload
PDF, JPG, or PNG
Utility bill is required
Click or drag to upload
PDF, JPG, or PNG
Mortgage statement is required
Click or drag to upload
PDF, JPG, or PNG
ID is required

5 Declarations & Certifications

The undersigned declares and certifies the following information under penalty of perjury under the laws of the State of California:

  1. Ownership: The owner information listed above accurately reflects the information on title to the Property. Owner has not transferred or encumbered title without providing notice to the City of Campbell as required under the Agreement.
  2. The Property is being used as a Primary Residence for the homeowner.
  3. Owner is in compliance with all other terms and conditions of the restriction agreement.
Is the above referenced property being occupied as your principal residence?
Required
Is the above referenced property currently in good repair?
Required
Has the above referenced property been sold, transferred or conveyed to any person or entity since you originally purchased your home? (Including refinancing/HELOCs)
Required
Have you added or subtracted a co-owner, put the home into a trust or changed the manner in which title is held since you originally purchased?
Required

6 Acknowledgment & Signature

I Acknowledge the information provided is true and accurate as of the date of submittal. Furthermore, I understand that any misrepresentation of the information provided herein, either intentional or negligent, can constitute non-compliance with the terms of the agreement with The City of Campbell and could result in default of the agreement. Also, I understand that all the documentation provided is being used to determine compliance with the City of Campbell agreement and non-compliance may result in a default of those terms.
Signature is required
Date is required