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<br />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 /> <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 /> I have not begun my home improvement project <br /> This home is my primary residence <br /> <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 the recorded 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 /> <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 /> <br />I hereby authorize Central Minnesota Housing Partnership staff to enter my home to identify <br />necessary rehabilitation work items, to take photographs and use photographs for program <br />marketing purposes. <br /> <br />Signature:______________________________________ Date:__________________________ <br />Application will be reviewed in the order they are received <br /> <br /> <br /> <br />2 <br /> <br />