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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 />______________________________________________________________________________ <br />______________________________________________________________________________ <br />Number of people in Household:___Estimated Yearly Gross Household Income: $_________ <br />Eligibility Requirements: <br />I own and live in the house to be remodeled <br />My home receives homestead credit on my Sherburne county taxes <br />My home is at least 20 years old and was build in _______(year built) <br />If home is older than 1978 lead assessment required <br />o <br />I have not begun my home improvement project <br />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 />2 <br /> <br /> <br />