HOMEOWNER REHABILITATION PRELIMINARY APPLICATION

Please print application, fill out and return to Public Facilities Board.

Or phone Samantha Berry @ 367-3973 for any questions.

Today's Date________________________________________________________________________

Application's Name________________________________________________________________________________________

Co-Applicant's Name_______________________________________________________________________________________

Social Security : Applicant ____________________________________Co-Applicant_______________________________

Applicants Age_____________________________________________Co-Applicant_______________________________

Race: ______________________(for statistical purposes only to ensure equal housing.)

Mailing Address_____________________________________________________________________________

City, State, Zip________________________________________________________________________________

Property Address:______________________________________________________________________________

City, State ,  Zip________________________________________________________________________________

Telephone Numbers:   Home: (870)________________________________________

                                        Work: (870)_________________________________________

Number of persons in household ______________Adults (18 or older)  _________________________Children (17 and under)

The household income for the next 12 months from all sources of all adults living in the household will be: 

_______________________________

I think we could afford to pay $______________________per/ month to repay a loan for home improvements.

How long have you owned the property? __________________________________________________

I currently :          

• __________Own my house free and clear

• __________am buying my house (I have a mortgage to pay off)

• __________Lease with option to buy.

• __________Other___________________________________________________________________

My residence is :

• __________ Single Family Home

• __________ Other________________________________________________________________

My Current housing related payments are:

• _____________________ Mortgage (monthly principal & interest)

• _____________________ Property taxes (annually)

• _____________________ Property Insurance ( annually)

• _____________________ Utilities- excluding telephone & cable( monthly)

My current mortgage balance is (approximately) $__________________________________

I/we certify that all statements on the pre-application are true and correct to the best of my/our knowledge.  I/We understant that any willful misstatement of material fact may be grounds for disqualification.

Applicant          _________________________________________       Date ____________________________

Co-Applicant:  __________________________________________     Date _________________________