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Property Owners Name: <br /> Property Owners Address: <br /> Address to be improved: <br /> City: State: Zip: Phone: Date: <br /> Short Project Description: <br /> Number of people in Household: Estimated Yearly Gross Household Income: $ <br /> Eligibility Requirements: <br /> Ll I own and live in the house to be remodeled <br /> IJ My home receives homestead credit on my Sherburne county taxes <br /> Ll My home is at least 20 years old and was build in (year built) <br /> o If home is older than 1978 lead assessment required <br /> IJ I have not begun my home improvement project <br /> IJ This home is my primary residence <br /> Your application is not complete if you do not include: <br /> 1. Application <br /> 2. Work requested checklist <br /> 3. Most recent Federal tax return <br /> 4. Proof of ownership copy of deed <br /> 5. Homeowners insurance binder(must show current dates of coverage) <br /> 6. Property tax statement(most recent) <br /> 7. Conflict of interest form (signed by all owners) <br /> I agree with and understand the following: <br /> I have read and am within the guidelines for the Housing Rehabilitation Loan Program. I <br /> understand that if any information is incorrect or incomplete,my chances of receiving funding <br /> will be delayed and/or hindered. I understand I cannot begin work before approval of my <br /> application. <br /> Signature: Date: <br /> Application will be reviewed in the order they are received <br />