Home Table of Contents

109.00.6 ATTACHMENT A. CRIMINAL BACKGROUND AND DISCLOSURE FORM - HOUSING

AR ADC 109.00.6 ATTACHMENT AArkansas Administrative Code

West's Arkansas Administrative Code
Title 109. Development Finance Authority
Division 00.
Rule 6. Criminal Background Check Policy
Ark. Admin. Code 109.00.6 ATTACHMENT A
109.00.6 ATTACHMENT A. CRIMINAL BACKGROUND AND DISCLOSURE FORM - HOUSING
Currentness
In connection with the 2006 Multi-Family Housing Application submitted to the Arkansas Development Finance Authority by __________(Name of Applicant) requesting a reservation of 2006 Low-Income Housing Tax Credits or 2006 Private Activity Volume Cap or HOME Investment Partnership Program (HOME) funds for the development of __________(Name of Develop/ment), I, __________(Name), on behalf of __________(Name of Development), being duly sworn , hereby certify that I or any principal [FN1] of __________(Name of Development Team Member):
1. Empty Checkbox​ have not been convicted by any state or federal jurisdiction of any felony.
or
Empty Checkbox​ have been convicted by a state or federal jurisdiction of a felony and the following details are provided:
Jurisdiction
Date
Offense
Punishment
Details
2. Empty Checkbox​ have not been fined, suspended, or debarred as a result of any financial, performance or housing activity by any state or federal agency.
or
Empty Checkbox​ have been fined, suspended, or debarred as a result of any financial, performance or housing activity by a state or federal agency and the following details are provided:
Agency
Date
Details
3. Empty Checkbox​ have not filed for bankruptcy or reorganization.
or
Empty Checkbox​ have filed for bankruptcy or reorganization and the following details are provided:
Jurisdiction
Date
Details
4. Empty Checkbox​ do not have any outstanding, uncorrected noncompliance issues with any state or federal housing program or agency.
or
Empty Checkbox​ do have outstanding, uncorrected noncompliance issues with a state or federal housing program or agency and the following details are provided:
Agency
Date
Details
5. Empty Checkbox​ do not have any existing contracts or indebtednesses with the Arkansas Development Finance Authority.
or
Empty Checkbox​ do have the following existing contracts or indebtednesses with the Arkansas Development Finance Authority:
Date
Borrower
Details
6. Empty Checkbox​ do not have any prior delinquent, defaulted or foreclosed upon contract, loan or indebtedness with the Arkansas Development Finance Authority:
or
Empty Checkbox​ do have the following existing contracts or indebtednesses with the Arkansas Development Finance Authority:
Date
Borrower
Details
I, __________(Name), in my capacity as __________(Title/Position with Development Team Member), further certify that I have the authority and knowledge to make the representations contained herein and agree to the terms of ADFA's Criminal Background Check Policy.
Date:
 
 
(Signature)
 
(Printed/Typed Name)
 
(Title/Position with Development Team Member)
STATE OF ______________________________
)
)
COUNTY OF ______________________________
)
Before me, __________, a Notary Public of the state and county stated above, personally appeared __________, with whom I have personal knowledge, and who, upon oath, acknowledged that__he executed the forgoing instrument for the purposes stated therein.
Witness my hand and seal this __________ day of __________, 20__________.
My Commission Expires:
 
 
Notary Public
[FN1]
If the development team member is a partnership, association, limited liability company, or corporation, “principal” shall include: it general partner(s), managing member(s), or any person who has at least a ten percent (10%) ownership interest in any ownership entity of such partnership, association, limited liability company or corporation.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 109.00.6 ATTACHMENT A, AR ADC 109.00.6 ATTACHMENT A
End of Document