CHEROKEE NATION TRIBAL LOAN PROGRAM



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Citizen Potawatomi HITS Program Application

Citizen Potawatomi

Community Development Corporation

1545 Gordon Cooper Dr.

Shawnee, OK 74801

Phone: 405/878-4697 Fax: 405/878-4665

Qualifications:

Loan applicants must be at least 18, own their home, and live within the State of Oklahoma.

Eligible borrowers include the following:

1. Enrolled members of the Citizen Potawatomi Nation

2. Enrolled members of other federally recognized tribes, who live in Oklahoma

3. Full-time, active employees of Citizen Potawatomi Nation (CPN) for a minimum of 2 years

Applicants may have only one outstanding HITS loan at any given time.

Loan Amount:

The loan amount may not exceed $4,200 plus allowed fees and costs.

Terms:

1. Maximum repayment terms: 36 months.

2. Interest rate will be fixed at 6-9 points above prime.

3. A Processing fee of $75.00 plus 2% of base loan amount will be charged for all loans.

4. Loan recipients will receive an individualized budgeting and credit counseling sessions.

Application:

1. Loan applicant must complete ALL of the boxes on the enclosed application.

2. List all “liabilities”. This includes all types of payments made on a monthly basis.

3. Sign and date the application.

4. When applicable, provide copy of CDIB card.

5. Provide a copy of your driver’s license, pay stub and warranty deed with the application.

6. Submit the application to the Citizen Potawatomi Community Development Corporation (CPCDC) for processing.

Processing:

1. Return all information to the CPCDC.

2. All verifications will be made by the CPCDC staff.

3. Applicants will be notified once their application has completed the verification process and an appointment for closing the loan will be set.

Closing:

1. Closings will take place either at the CPCDC office or title company, at option of CPCDC

2. All loan disbursements will be made payable to Borrower AND vendor/installer

3. At its sole option, CPCDC may elect to file a real estate mortgage in addition to other liens

4. Costs or fees not approved in advance will be responsibility of Borrower

5. CPCDC may require Waiver of Notice of Entry form, at its option

|Citizen Potawatomi HITS Program Application |

|Section A: Primary Applicant Information |

|First Name |Middle Name |Last Name |Social Security Number |

|      |      |      |      |

|Ethnicity Caucasian Hispanic/Latino African American Asian/Other Pacific Islander |Email Address: |

|Native American If Native American what tribe?      ___________________ | |

|Birth Date |Telephone Number |Driver’s License |Social Security Number |Number of Dependants |Ages of Dependants |

|      |      |      |      |      |      |

|Current Street Address |City |State |Zip |County |

|      |      |      |      |      |

|Business Phone |Ext |Position or Title |Salary Per Month |

|      |      |      | |

| | | |Gross $ |Net $ |

| | | |      |      |

|Previous Employer |Address |City, State, Zip |Phone Number |From When? |To When? |

|      |      |      |      |      |      |

|Name and address of nearest friend or relative NOT LIVING WITH YOU |Relationship |Telephone Number (including area code) |

|      |      |      |

|Legal Description of Property where Storm Shelter will be located (located on your deed) |Is this legal description the| |

| |same as the address above? | |

| |

|Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. |

| |

|Alimony, child support, separate maintenance received under Court Order Written Agreement Oral Understanding |

|Other Employment Income (Employer Name, Address, Phone Number) |Income Per Month |

|      |      |

|Is any income listed in this Section likely to be reduced before the credit request is paid off? |Have you previously received credit from us? No Yes, If yes |

|Yes No, If yes, Please explain:       |When?       |

|Section B: Co-Applicant Information |

|First Name |Middle Name |Last Name |Social Security Number |

|      |      |      |      |

|Ethnicity Caucasian Hispanic/Latino African American Asian/Other Pacific Islander |

|Native American If Native American what tribe?       |

|Birth Date |Telephone Number |Driver’s License |Social Security Number |Number of Dependants |Ages of Dependants |

|      |      |      |      |      |      |

|Current Street Address |City |State |Zip |County |

|if same as Primary Applicant |      |      |      |      |

|      | | | | |

|Business Phone |Ext |Position or Title |Salary Per Month |

|      |      |      | |

| | | |Gross $ |Net $ |

| | | |      |      |

|Previous Employer |Address |City, State, Zip |Phone Number |From When? |To When? |

|      |      |      |      |      |      |

| |

|Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. |

| |

|Alimony, child support, separate maintenance received under Court Order Written Agreement Oral Understanding |

|Other Employment Income (Employer Name, Address, Phone Number) |Income Per Month |

|      |      |

|Is any income listed in this Section likely to be reduced before the credit request is paid off? |Have you previously received credit from us? No Yes, If yes |

|Yes No, If yes, Please explain:       |When?       |

|Section C: Assets |

|Description of Asset |Name In Which Account is Carried |Amount Owed |Value of Asset |

|Do you have a checking account? |      |      |      |

|Yes No | | | |

|Do you have a Savings account? |      |      |      |

|Yes No | | | |

|Do you have a 401K? |      |      |      |

|Yes No | | | |

|Do you have a Certificate of Deposit? |      |      |      |

|Yes No | | | |

|Do you own Real Estate? |      |      |      |

|Yes No | | | |

|Do you own more than the $25,000 in Life Insurance CPN |      |      |      |

|Provides? Yes No | | | |

|Do you own a vehicle? Yes No, if yes, please provide|      |      |      |

|Year, Make, & Model       | | | |

|Do you own any other assets? |      |      |      |

|Yes No | | | |

|Total Assets |      |      |      |

|Section C: Liabilities |

|Creditor |Name in Which |Original |Present |Monthly |

| |The Account is Carried |Amount |Balance |Payments |

|Landlord or Mortgage Holder |      |(Omit if Renting) |(Omit if Renting) |      |

|      | | | | |

| | |      |      | |

|Automobile (Year, make, Model) |      |      |      |      |

|      | | | | |

|Automobile (Year, make, Model) |      |      |      |      |

|      | | | | |

|Credit Card |      |      |      |      |

|      | | | | |

|Credit Card |      |      |      |      |

|      | | | | |

|Installment Loan |      |      |      |      |

|      | | | | |

|Installment Loan |      |      |      |      |

|      | | | | |

|Other liability |      |      |      |      |

|      | | | | |

| |      |      |      |      |

|Total Liabilities | | | | |

|Are you obligated to make any of the following Alimony Spousal Support Child Support Maintenance Payments, if yes to whom and the monthly amount?       |

|Are you a co-signor, endorser, or guarantor on any loan or contract? Yes No, if yes, to whom and the amount of the monthly payment?       |

Signatures: I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.

All parties understand and agree that the Citizen Potawatomi Nation Tribal Court has jurisdiction to resolve any dispute under the Citizen Potawatomi HITS Program of the Citizen Potawatomi Nation and the parties do herby submit to the personal jurisdiction of, and waive any objection to venue in, the Citizen Potawatomi Nation Tribal Court for the resolution of any dispute arising out of the employee loan program.

All costs, fees, and expenses of collection and/or litigation will be charged to the “Borrower”, added to the balance of the loan, and withheld from the “Borrower’s” final check.

_______________________________________________________ _______________________________________________________

Applicant’s Signature Date Co-Applicant’s Signature Date

EMPLOYMENT VERIFICATION

Request for Verification of Employment

Please Return To:

Citizen Potawatomi Community Development Corporation

1545 Gordon Cooper Dr.

Shawnee, OK 74801

I have applied for a loan through the Citizen Potawatomi HITS Program. My signature below authorizes verification and release of the information requested.

|Applicant Name: |      |Employee Number: |      |

|Address: |      |Social Security Number: |      |

|City, St, Zip: |      |Phone: |      |

|Applicant’s Signature: |      |

|Co-Applicant’s Signature | |

For Office Use Only:

Loan Amt: $     

|Breakdown of Loan Funds |

|Date |Purpose |Vendor |Amount |Completed |

|      |Tornado Shelter |      |      |      |

|      |UCCs |      |      |      |

|      |Lien Entry |      |      |      |

|      |Loan Fee(s) |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

Approved by:

Credit Committee:

_____________________________________________ ____________________

Credit Committee Approval Date

_____________________________________________ ____________________

Credit Committee Approval Date

Citizen Potawatomi Financial Wellness Checkup

Name:       Date:      

Complete the following: Mark A for Always, S for Sometimes and N for Never.

As a rule, do you:

A S N

1. Pay your rent/mortgage payment on time?

2. Pay your utilities payment on time?

3. Save 10 percent of your take home pay?

4. Try to keep three months of your net income in reserve for emergencies?

5. Plan ahead for large expenses such as buying a car and moving into an apartment?

6. Set goals and keep a budget for your net income?

7. Spend no more than 20 percent of your net income for credit payments,

excluding home mortgage?

8. Comparison shop for the purchase of most items?

9. Use credit only for expensive purchases or when you have the money in the bank

to cover the charge?

10. Balance your checkbook every month?

11. Keep yourself financially updated by reading personal

financial articles and magazines?

Please answer Yes or No Yes No

11. Do you have a checking account?

12. Do you have a savings account?

13. Do you follow a monthly budget?

14. Do you contribute to your 401K plan?

15. Do you borrow from payday/loan company lenders?

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