Owner Occupied Housing Rehabilitation Application

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

1
Please provide the following information:
 *
Please provide the following information:
2
Please Check All Boxes That Apply
Please Check All Boxes That Apply
3
LIST ALL HOUSEHOLD MEMBERS INCLUDING YOURSELF AND ALL GROSS MONTHLY INCOME:
 *
LIST ALL HOUSEHOLD MEMBERS INCLUDING YOURSELF AND ALL GROSS MONTHLY INCOME:
THE FOLLOWING INFORMATION IS BEING REQUESTED TO COMPLY WITH EQUAL OPPORTUNITY REQUIREMENTS AND TO ASSURE THAT NO DISCRIMINATION OCCURS. YOUR ANSWER WILL NOT AFFECT YOUR SELECTION FOR THE PROGRAM.
4
The Head of Household:
 *
The Head of Household:
5
The Head of Household:
 *
The Head of Household:
6
The Head of Household:
 *
The Head of Household:
7
List all assets of all household members (checking/savings/CD/IRA/stocks/bonds/life insurance, etc.)
 *
List all assets of all household members (checking/savings/CD/IRA/stocks/bonds/life insurance, etc.)
8
Does anyone outside of your household pay for any of your bills or give you money?
 *
Does anyone outside of your household pay for any of your bills or give you money?
9
If yes,
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PROPERTY INFORMATION
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What type of home do you own?
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What type of home do you own?
12

 Year built

 *
13
How long have you owned AND lived in this home as your primary residence?
 *
14
Do you own the real property on which your home is located?
 *
Do you own the real property on which your home is located?
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Do you have homeowners insurance?
 *
Do you have homeowners insurance?
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Do you own or have interest in any other home or other real estate?
 *
Do you own or have interest in any other home or other real estate?
17
If yes,