County Owner Occupied Rehabilitation Program Preapplication

For a printable copy of the form, CLICK HERE

Initial Application

Are you a Veteran who served at least 90 active days during a time of War? *
Are you a single parent with minor children? *
Is your home a mobile/manufactured home? *
If yes, is it a single or double wide?
Do you have tenants in this property? *
Have you received State/Federal grant assistance before? *

Previous Work Completed

If any work has been done at this property in the past, please describe here:
Add Previous Work? *
Add More Work?

Housing Expenses

Do you have a Mortgage? *
Do you have home insurance? *
Are your property taxes current? *
Are you on a well/septic system? *
If no, is your water bill current

Household Income

List the names of all household members who are over 18, their source of income and monthly amount.
Do you have or have you received code violations? *
Are there health and safety hazards in your home? *
Are you without water, power, heat or basic kitchen and bathroom facilities? *

Please List Repairs Needed in this Property

Click the "X" button that appears within the signature field to clear your signature.