Checklist - Philadelphia VIP



If you need more than one check cut, you must submit a separate form for each check request.

BASIC INFORMATION ON DISBURSEMENT REQUEST

Client’s name:

Amount of Disbursement Request:

Purpose of Disbursement Request:

Disbursement check should be made payable to:

Please attach documentation of the cost (including proof of payment, if seeking reimbursement). See the Disbursement Documentation Guidelines () for more information.

TITLE REPORT

If the client’s initial application was approved for payment of a title report, and client is now seeking additional disbursements, please complete the below:

____ The title report reveals no judgments and/or liens pertinent to the property.

____ The title report reveals minor judgments and/or liens* pertinent to the property. The client is aware of them and still wishes to obtain title.

____ The title report reveals major judgments and/or liens pertinent to the property, but there is an action plan in place and client still wishes to obtain title. Our action plan follows (Please attach a brief description of your action plan).

*Minor judgments and/or liens may include:

• Real estate tax liens, if client is currently in an Owner Occupied Payment Agreement

• Municipal liens, such as water and gas, if client is planning on entering a payment plan as soon as assuming title

• Other judgments and/or liens that do not amount to enough for a creditor to foreclose

UPDATED CASE DESCRIPTION AND ESTIMATED BUDGET

If the case description or estimated budget has significantly changed since it was last submitted, please attach an updated version.

HOUSEHOLD COMPOSITION AND INCOME

Have there been any changes in the applicant’s household composition or income since the applicant submitted his/her initial Tangled Title Fund Application or last disbursement request?

_______ No, there have been no changes in the applicant’s household composition or income. As a

result, we are not completing the Household Composition and Income section below.

Yes, there has been a change in the applicant’s household composition and/or income. As a

result, we have completed the Household Composition and Income section below:

Household Composition and Income for All Adults and Children Living in the Household, Including the Applicant:

|Name |Relationship to |Age |Income Source(s) |Gross Monthly Amount |

| |Applicant | | | |

| | | | |$ |

| | | | |$ |

| | | | |$ |

| | | | |$ |

| | | | |$ |

By signing below you are affirming that you are in contact with the applicant and that the disbursement check, if issued, will be cashed within 2 weeks of receipt. VIP will incur a significant financial penalty for all checks that need to be re-issued.

Attorney/Paralegal’s Signature: Date:

Please submit all disbursement requests and required documents by mail, fax or email to: Philadelphia VIP, Attn: Tangled Title Fund, 1500 Walnut Street, Suite 400, Philadelphia, PA, 19102, tangledtitlefund@, facsimile: (215) 564 - 0845. Submission by email is preferred. Please note that original versions are not needed.

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