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TEST TEST Housing Pre-Application Owner-Occupied Health & Safety Rehabilitation Program

Please correct the field(s) marked in red below:

1
Please provide the following information:
 *
Please provide the following information:
2
1. List all household members. Start with yourself.
 *
1. List all household members. Start with yourself.
3
Do you anticipate any changes in your household composition within the next 12 months?
 *
Do you anticipate any changes in your household composition within the next 12 months?
4
If yes,
5
2. What type of home do you own?
 *
2. What type of home do you own?
6

 Year built

 *
7
3. How long have you owned AND lived in this home as your principal residence?
 *
8
4. Do you own the real property on which your home is located?
 *
4. Do you own the real property on which your home is located?
9
5. Do you have homeowners insurance?
 *
5. Do you have homeowners insurance?
10
6. Do you own or have interest in any other home or other real estate?
 *
6. Do you own or have interest in any other home or other real estate?
11
If yes,