CAR DONATION REQUEST. Please KEEP THIS PAGE for your records. CAR DONATION GUIDELINES:
|
|
- Marian Shepherd
- 6 years ago
- Views:
Transcription
1 CAR DONATION GUIDELINES: CAR DONATION REQUEST Please KEEP THIS PAGE for your records. MUST BE A CONTINUOUS RESIDENT OF ANOKA COUNTY MN FOR AT LEAST THE PAST SIX MONTHS Age 21 or older Must be employed Must have income in the very low to moderate income range listed on the application Must demonstrate a minimum of $ monthly disposable income Must have a valid driver s license that shows current address Must be able to get car insurance and provide proof prior to receiving car No previous assistance from Cars for Neighbors or Free to Be, Inc. No other working vehicles in applicant s household Be able to pay a $100 pay-it-forward fee * * If you qualify for car donation a pay-it-forward fee of $100 will be due prior to receiving a vehicle. The proceeds are used to get a car prepared for the next vehicle recipient. CAR DONATION VERIFICATION CHECKLIST: Please submit the following documents to the 2nd floor reception desk at the Blaine Human Services Center, via fax, , or mail (see fax/address at bottom of the page). Fill out and sign ALL pages of application Provide documentation of all income * Provide copy of rental agreement or lease * Provide monthly childcare expense documentation * Copy of driver s license for EVERY REGISTERED DRIVER in your household (showing current address or the yellow DMV receipt). If drivers license was issued within the past six months please provide proof of continuous residency in Anoka County as well (lease, utility bill, etc.) Take Dollars into $ense Class. The class is an hour and a half long and is offered once a month at the Blaine Human Services Center. Call to register for the next class. OR, you can take the TCF Financial Fitness Program online at you will be required to provide a printed copy of the certificate of completion. * This will be used to establish monthly disposable income Once you submit your application, you will have 30 DAYS to supply all required documents. If after 30 days, you have not supplied the required documents your request for service will be denied based on insufficient information. PLEASE NOTE: After all the information is received, verified, and accepted you will be put on our waiting list. Once a car is available you will be notified. If you have been on the waiting list more than 30 days we will complete a followup verification of your information. Cars for Neighbors th Ave NE, Suite 230 Blaine, MN Phone: Fax: info@carsforneighbors.org
2 CONTACT INFORMATION: Name (print): Maxis Case: Address: City, ST, Zip: Home Phone: Cell Phone: Work Phone: Other contact info: HOUSEHOLD INFORMATION: List all of the people who live at your residence below. NAME DATE OF BIRTH RELATIONSHIP SSN DRIVERS LICENSE# SELF Type of housing: OWN RENT SHELTER HOMELESS OTHER How long have you lived in Anoka County? DEMOGRAPHICS: Marital status: SINGLE MARRIED WIDOWED DIVORCED SEPARATED Are you a U.S. citizen? YES NO If no, Alien#: Date card expires: 1 st Language: 2 nd Language: Health Insurance: PRIVATE MEDICAL ASSISTANCE Are you working? YES NO If yes, please provide the following information: NAME OF EMPLOYER HOURS PER WEEK HOURLY WAGE START DATE Is your spouse/significant other working? YES NO If yes, please provide the following information: NAME OF EMPLOYER HOURS PER WEEK HOURLY WAGE START DATE Page 1 of 4 Effective 1/1/2017
3 Are you looking for work? YES NO Is your spouse/significant other looking for work? YES NO List other sources of income for entire household including any financial assistance below. NAME SOURCE OF INCOME AMOUNT RECEIVED HOW OFTEN ASSISTANCE REQUESTED: CAR REPAIR CAR DONATION Is the car driveable? YES NO Are you able to drive a stick shift? YES NO For car repair, describe vehicle problem: Vehicle needing service: YEAR MAKE MODEL MILEAGE AMOUNT OWED HOW WILL THIS SERVICE HELP YOU? (OPTIONAL) Please explain how our Transportation Assistance Program can help you in your current situation. This is so we have a better understanding of your needs and how the program can better your life. Your statement WILL NOT be used for qualification. We may contact you at a future date to follow up on this statement. SIGNATURE: Applicant signature: My signature acknowledges that the information provided is correct, true and complete. Page 2 of 4 Effective 1/1/2017
4 Participation Survey- Effective 3/28/2016 Applicant signature: Page 3 of 4 Effective 1/1/2017
5 Cars for Neighbors th Ave NE, Suite 230 Blaine, MN Phone: Fax: PERMISSION TO VERIFY APPLICATION AND AUTHORIZATION FOR RELEASE AND EXCHANGE OF INFORMATION I, permit Cars for Neighbors to share and verify the information provided to determine benefits I may be eligible for. The following agencies may receive and exchange information to qualify me for the Transportation Assistance Program: Anoka County Community Action Program (ACCAP) Anoka County Community & Governmental Relations Department Anoka County Income Maintenance Department Anoka County Job Training Center Community Emergency Assistance Programs (CEAP) My Employer Car insurance company Car repair shop Auto dealer BridgeLink Other This data is private. Cars for Neighbors can only give this information if they have my permission in writing. They may give data without my permission if otherwise provided by state or federal law. I understand that I have the right to refuse release of this data. If I refuse, Cars for Neighbors may be unable to assist me. Cars for Neighbors verifies that the information provided on the application is correct, true and complete with information through exchange of information with Anoka County agencies. Cars for Neighbors is not responsible for disclosure of the information or resulting damages in the event of a cyber-attack or data security breach. For car donation assistance, Cars for Neighbors will verify that there are no working vehicles in the household; verification will be done using DMV vehicle ownership information. I hereby authorize Cars for Neighbors to release and exchange information pertaining to my application and eligibility for programs/services they administer for the purpose of evaluating my need for assistance. I authorize release and exchange of the information requested for car repair or car donation. This permission is good for one year from the date I sign it. Applicant signature authorizing release: Warning: Section 1001 of Title 18 of US. Code makes it a criminal offense to make false statements or misrepresentations to any Department or Agency of the U.S. as to matters within its jurisdiction. Page 4 of 4 Effective 1/1/2017
Our Mission. Promoting Independence by Providing Car Care
Please Submit the Following: Our Mission Check List Douglas County Residents Only Promoting Independence by Providing Car Care FOR ALL APPLICANTS Fill out application completely and sign Sign the attached
More informationWe Do Business in Accordance to the Federal Fair Housing Law
PLEASE COMPLETE IN FULL Housing Authority of the City of Fort Myers Affordable Housing - HORIZONS APARTMENTS 5360 Summerlin Road, Fort Myers, FL 33919 Telephone (239) 936-6760 Fax (239) 936-6761 TDD (239)
More informationEXCEPTIONS TO THE ABOVE CRITERIA MAY BE MADE AT THE SOLE DISCRETION OF SOTO Property Management. ADDITIONAL SECURITY DEPOSIT MAY BE REQUIRED.
SOTO Property Solutions screens all prospective tenants. The screenings consist of rental history, employment verification, criminal background check, and credit check. Applicants must meet the following
More informationSUPPLEMENTAL INFORMATION. Spouse Information Form
SUPPLEMENTAL INFORMATION Spouse Information Form NJ FamilyCare Aged, Blind, Disabled Programs SECTION 1 Applicant 2 (Spouse) STATE of NEW JERSEY Department of Human Services Division of Medical Assistance
More informationEMERGENCY SHELTER GRANT APPLICATION (Please be advised; this is a once in a life-time grant)
EMERGENCY SHELTER GRANT APPLICATION (Please be advised; this is a once in a life-time grant) Application Date: The Emergency Shelter Grant is a ONCE IN A LIFETIME assistance program. These monies may be
More informationNebraska Ryan White Program
For office use only: Date Received: MR#: Nebraska Ryan White Program Application Information Date: Check all the programs applying for: Part B Part C Part D ADAP ADAP co-payment assistance Wait list If
More informationExterior Accessibility Grant Program
City of Davenport Community Planning and Economic Development Exterior Accessibility Grant Program This application is for use in determining eligibility for the City of Davenport s Exterior Accessibility
More informationPURCHASE ASSISTANCE PROGRAM COMMUNITY DEVELOPMENT DEPARTMENT
PURCHASE ASSISTANCE PROGRAM COMMUNITY DEVELOPMENT DEPARTMENT CITY OF NORTH LAUDERDALE 701 SW 71 AVENUE NORTH LAUDERDALE, FLORIDA 33068 If you have not owned a home in the past three years and are interested
More informationOwner Occupied Housing Rehab Loan Program
City of Davenport Community Planning and Economic Development Owner Occupied Housing Rehab Loan Program This application is for use in determining eligibility for the City of Davenport s Owner Occupied
More informationOcala Housing Authority Application for Continuing Eligibility PUBLIC HOUSING Annual Income Adjustment Transfer
Ocala Housing Authority Application for Continuing Eligibility PUBLIC HOUSING Annual Income Adjustment Transfer Head of Household (H of H) of Birth Social Security Number Marital Status Married Married
More informationHousing Choice Voucher Program (Section 8) Change Form
QC Date: LHA Official Proceed to Process by Case Worker Lakeland Housing Authority 430 Hartsell Ave No Action Lakeland FL 33815 Required Tel: 863-687-2911 Housing Choice Voucher Program (Section 8) Change
More informationFINANCIAL ASSISTANCE PROGRAM
Financial Assistance Application FINANCIAL ASSISTANCE PROGRAM As part of our mission, Benefis Health System (including Benefis Hospitals in Great Falls and Benefis Teton Medical Center in Choteau) is committed
More informationWe Do Business in Accordance to the Federal Fair Housing Law
PLEASE COMPLETE IN FULL SW Florida Affordable Choice Foundation, Inc. Application for Covington Meadows Covington Meadows Circle, Lehigh Acres, FL 33936 Telephone (239) 344-3220 Fax (239) 344-3273 TDD
More informationEmergency Home Repair (EHR) Information & Application
Emergency Home Repair (EHR) Information & Application Objective: Clearfield City has established the Emergency Home Repair (EHR) Program to provide lower income homeowners up to $3,000 in grant money to
More informationRENTAL APPLICATION. PLEASE PRINT Bedroom Size: Application Date: Time: A.M. / P.M.
RENTAL APPLICATION If there are not enough extremely Iow-income families on the waiting list, we will conduct outreach on a non-discriminatory basis to attract extremely Iow-income families to reach the
More informationSENIOR HOME REPAIR GRANT (SHRG) Application Package
SENIOR HOME REPAIR GRANT (SHRG) Application Package 5555 Arlington Ave. Riverside, CA 92504 951-343-5469 Updated 10/22/12 Application Submission Checklist APPLICATION PACKAGE SUBMISSION CHECKLIST Participation
More informationPlease check the type of assistance you are requesting: Rent Deposit Utility Medication Food Bus Passes ID Dental Medical COBRA Other
Last Name IC New Case # For office use only Application for County Assistance Primary language Do you need an Interpreter? Y N Please check the type of assistance you are requesting: Rent Deposit Utility
More informationAPPLICATION AGREEMENT
APPLICATION AGREEMENT APPLICATION FEE IS NON-REFUNDABLE PLEASE FILL OUT THIS FORM COMPLETELY. APPLICATION FEE = $65.00 PER ADULT ($120.00 Joint). Application Fee is to be in the form of a Money Order REQUIRED
More informationBRUCE TOWNSHIP MACOMB COUNTY POVERTY EXEMPTION APPLICATION TAX YEAR 2018
B.O.R. Mar Jul Dec Letter / Appt Parcel No. Name: Date: Time: Petition #: A. DEADLINE BRUCE TOWNSHIP MACOMB COUNTY POVERTY EXEMPTION APPLICATION TAX YEAR 2018 YOU MUST COMPLETE THIS APPLICATION IN FULL
More informationSENTRY PROPERTY MANAGEMENT, INC North Broad Street Colmar, PA PHONE: 215/ or 717/ FAX: 215/
SENTRY PROPERTY MANAGEMENT, INC. 2312 North Broad Street Colmar, PA 18915 PHONE: 215/822-9729 or 717/391-7739 FAX: 215/822-0502 DATE: APPLICANT S NAME(S): PROPERTY: Park Manor Apartments APARTMENT NUMBER:
More informationNapa Valley Community Disaster Relief Fund application for Wildfire Recovery Assistance for Homeowners and Renters
Napa Valley Community Disaster Relief Fund application for Wildfire Recovery Assistance for Homeowners and Renters Napa Valley Community Disaster Relief Fund is now accepting applications from Napa County
More informationCONSUMER LOAN APPLICATION
CONSUMER LOAN APPLICATION Bring In: Pay stubs from the last 30 days Fill Out & Sign: Application Covered Borrower Identification Statement Borrower Email Address: CONSUMER CREDIT APPLICATION IMPORTANT
More informationThe Housing Authority of the City Of New Albany 300 Erni Avenue New Albany IN 47150
The Housing Authority of the City Of New Albany 300 Erni Avenue New Albany IN 47150 Public Housing: GENERAL INFORMATION We do not have emergency housing. Emergency housing is available only through a shelter.
More informationAirport Drayage NE 112 th Ave Portland, OR 97220
Airport Drayage 6331 NE 112 th Ave Portland, OR 97220 APPLICATION FOR CUSTOMER SERVICE/OPERATIONS POSITIONS (Answer all questions Please Print Incomplete applications will not be considered) In compliance
More informationHough Heritage. Application Instructions. 2. Use only black or blue ink. Colored inks, markers or pencil are not permitted.
Hough Heritage Application Instructions 1. Please print all answers. 2. Use only black or blue ink. Colored inks, markers or pencil are not permitted. 3. If a question does not apply, please write N/A
More informationAPPLICATION FOR STERN CENTER/CONGREGATE TRUMBULL HOUSING AUTHORITY 210 Hedgehog Circle Daisy Torres
CONGREGATE LIVING Updated August 15, 2017 About the Congregate: THE CONGREGATE IS A SMOKE-FREE BUILDING By definition, the Congregate is a non-institutional, independent group living environment that integrates
More informationHousing Stabilization Program Policy
Housing Stabilization Program Policy Effective Date: November 7, 2016 Revised: April 11, 2018 Program Overview The Housing Stabilization Program is designed to provide a one- time financial assistance
More informationHome Purchase Assistance Program Application
Thank you for your interest in the City of West Palm Beach s Home Purchase Assistance Program. The Home Purchase Assistance Program is administered by the Department of Housing and Community Development
More informationFAMILY NEEDS ASSESSMENT (FY 14-15)
APPLICANT INFORMATION PLEASE LIST ALL HOUSEHOLD MEMBERS: (Please print all information in black or blue pen only) RELATION NAME SSN DOB SEX ETHNI CITY RACE Health Ins. Veteran Please answer Y or N Disabled
More informationHousing Stabilization Program Policy
3677 Central Ave # F, Fort Myers FL 33901 239-275-5105 Housing Stabilization Program Policy Effective Date: February 6, 2017 Program Overview The Housing Stabilization Program is designed to provide financial
More informationCommunity Planning and Economic Development Homebuyer Down Payment Grant Program
Community Planning and Economic Development Homebuyer Down Payment Grant Program This application is for use in determining eligibility for Down Payment Assistance Program. You must have been pre-approved
More informationTo become an Amador Rides Volunteer Driver, you must provide:
Become an Volunteer Driver! Amador Rides is a collaborative effort from several organizations who want to make sure that Amador County residents can get to their medical, dental, and mental health appointments.
More informationRENTAL HOUSING APPLICATION
SAMPLE RH-3 RENTAL HOUSING APPLICATION This is a preliminary application for apartment at. It holds no lease or rent obligations. All information will be verified by the management prior to an applicant
More informationLoan Application Checklist
If you have questions or need assistance completing the application, please contact the Community Economic Development Department at 260-423-3546 ext. 563 Loan Application Checklist For All Loans Signed
More information** TEAR OFF THIS TOP SHEET AND RETAIN FOR YOUR INFORMATION**
** TEAR OFF THIS TOP SHEET AND RETAIN FOR YOUR INFORMATION** An application for the Public Housing Program is attached. NO EMERGENCY HOUSING is available. We must serve all applicants in order by placement
More informationCRISIS ASSISTANCE. Follow the checklist below to ensure your application is complete.
ANOKA COUNTY COMMUNITY ACTION PROGRAM, INC. 1201 89 th Avenue NE Suite 345 Blaine, MN 55434 Phone 763-783-4747 FAX 763-783-4700 Website: www.accap.org CRISIS ASSISTANCE Anoka County Community Action Program,
More informationLONG-TERM RENTAL APPLICATION
p LONG-TERM RENTAL APPLICATION For approval on APCHA-managed units, W2 s, 1099 s and/or Employment History Report from the Social Security Office may be required. THE FOLLOWING MUST BE SUBMITTED FOR ANYONE
More informationCHILD CARE FINANCIAL ASSISTANCE Day Care Program - Application for IMPORTANT PLEASE READ
Checklist IMPORTANT PLEASE READ To qualify for Child Care Financial Assistance you must answer to the following questions: Are you and your child a resident of New Trier Township? Is this program state
More informationRENTAL APPLICATION AGREEMENT
RENTAL APPLICATION AGREEMENT Envision Property Management Services LLC understands that moving to a new home can be both exciting and stressful. Our mission is to make this process as smooth and stress
More informationInformation about Application Process for Moorhead Public Housing
Information about Application Process for Moorhead Public Housing After filling out an application with all the information needed, including copies of original Social Security card for ALL household members
More informationBURLEIGH COUNTY GENERAL ASSISTANCE APPLICATION. You may return your completed, signed application by:
BURLEIGH COUNTY GENERAL ASSISTANCE APPLICATION A signed application for General Assistance must be completed and returned to Burleigh County. The application should be completed by a household member who
More informationThank you for your interest in becoming a Habitat for Humanity partner/homeowner. I have enclosed some forms you need to complete and return to me.
Thank you for your interest in becoming a Habitat for Humanity partner/homeowner. I have enclosed some forms you need to complete and return to me. Included are the following forms: Application for Partnership
More informationCITY OF FRASER BOARD OF REVIEW 2018 POVERTY EXEMPTION POLICY & GUIDELINES
CITY OF FRASER BOARD OF REVIEW 2018 POVERTY EXEMPTION POLICY & GUIDELINES The attached guidelines and application are to be used for 2018 only Section 211.7u(1) of the Michigan General Property Tax Act
More informationSAMPLE HOMEBUYER APPLICATION
SAMPLE HB-3 HOMEBUYER APPLICATION This is a preliminary application for a unit at. It holds no purchase obligations. All information will be verified by the management prior to an applicant being placed
More informationHOMEOWNERSHIP APPLICATION (Rev. 3/16/17) = Submit a copy of each requested item to the application
PART 1: Applicant(s) Information HOMEOWNERSHIP APPLICATION (Rev. 3/16/17) = Submit a copy of each requested item to the application Application deadline: no exceptions APPLICANT (Head of Household owner
More informationHOUSING CHOICE VOUCHER (SECTION 8) INCOME ADJUSTMENT
HOUSING CHOICE VOUCHER (SECTION 8) INCOME ADJUSTMENT INSTRUCTON FOR INCOME ADJUSTMENT: Complete attached Income Adjustment Packet & Release of Information form. Attach verification of ALL household income
More informationphone fax
480-898-0228 phone 480-898-9007 fax www.affordablerental.org Save the Family's Transitional Program was designed to promote self-sufficiency and stabilize family lifestyles with the community through intensive
More informationClient Contract. Client Full Name: Social Security Number: POA/Guardian Name: Phone: Address:
Client Contract Client Full DOB: Social Security Number: POA/Guardian Phone: _ I, or my advocate, have discussed my needs with my POA/Guardian. I agree to have Thrive serve has my representative payee
More informationAll prospective tenants 18 years of age and older MUST complete an application.
It is our policy not to discriminate on the basis of race, ancestry, handicap, children, religion, national origin, sex, or marital status. In determining the suitability of a prospective resident the
More informationEAST GEORGIA REGIONAL MEDICAL CENTER STATESBORO, GEORGIA APPLICATION FOR VOLUNTEER SERVICES
EAST GEORGIA REGIONAL MEDICAL CENTER STATESBORO, GEORGIA 30458 APPLICATION FOR VOLUNTEER SERVICES DATE Names: Last First Middle Initial Address: P.O. Box or Route Street City State Zip Code Telephone Number:
More informationCAREGIVER APPLICATION FOR EMPLOYMENT Continued
Visiting Angels is an equal opportunity employer, dedicated to a policy of non-discrimination on any basis including race, color, age, sex, religion, disability, national origin or marital status. Date:
More informationThe following criteria must be met to be eligible for financial assistance from Champlain Valley Physicians Hospital:
Champlain Valley Physicians Hospital 75 Beekman St., PO Box 2868 Plattsburgh, New York 12901 518-562-7074, 844-281-0023 Fax: 518-314-3981 patientaccounting@cvph.org Dear Applicant, Thank you for choosing
More informationP.O. Box 649 Marietta, GA Phone Check off list and Application for a Health Spa License
Cobb County P.O. Box 649 Marietta, GA 30010-0649 Phone 770-528-8410 Applications should be submitted in person at: 1150 Powder Springs Street, Suite 400 Marietta, Georgia 30064 Website Address www.cobbcounty.org
More informationThe following information is required for all borrowers to process your loan request: Employment and Income Verification
Credit Application The following information is required for all borrowers to process your loan request: Employment and Income Verification Copies of your most recent paystub(s) covering a 30 day period
More informationHousing Choice Voucher Program: Waiting List Information
2605 S Oneida St., Suite 106 Green Bay, WI 54304 (920) 498-3737 Housing Choice Voucher Program: Waiting List Information Income Limits 1 Person 2 Person 3 Person 4 Person 5 Person 6 Person 7 Person 8 Person
More informationHOME IMPROVEMENT INTAKE FORM
1 Minneapolis Office: 1930 Glenw ood Ave Minneapolis, MN 55405 Neighborhood Housing Services of Minneapolis, NMLSR#394817 Community NHS, dba NeighborWorks Home Partners, NMLSR#363923 Donna Corbo Lending
More informationR E S I D E N T I N F O R M A T I O N :
1 R H o m e P r o p e r t y M a n a g e m e n t, L L C A p p l i c a t i o n f o r R e s i d e n c y ( M a r y l a n d / T a x C r e d i t ) Please Print Clearly: Fill in form completely to the best of
More informationRural Housing, Inc. 1
Rural Housing, Inc. 1 Application for Assistance: Property Taxes General Guidelines: Must be under 50% County Median Income by family size, call for specific $ limit Housing costs must be affordable, less
More informationCHESTERFIELD TOWNSHIP MACOMB COUNTY HARDSHIP EXEMPTION APPLICATION TAX YEAR 2015
B.O.R. Mar Jul Dec Letter / Appt Date: Time: Petition #: Parcel No. Name: CHESTERFIELD TOWNSHIP MACOMB COUNTY HARDSHIP EXEMPTION APPLICATION TAX YEAR 2015 A. DEADLINE YOU MUST COMPLETE THIS APPLICATION
More informationMICROLOAN APPLICATION
MICROLOAN APPLICATION Send Completed Application To: Wyoming Women s Business Center Attn: Waldo Smith PO Box 764 Laramie, WY 82073 Or via Fax or Email to: Fax: 307-460-3945 Email: wsmith34@uwyo.edu Questions?
More informationRENTAL APPLICATION APPLICATION TO RENT PROPERTY AT: SINGLE MARRIED SEPERATED DIVORCED LENGTH OF TIME CURRENT LANDLORD LANDLORD S PHONE #
RENTAL APPLICATION Please fill out the form COMPLETELY and sign where indicated. Every occupant over the age of 18 MUST fill out an application (even if married) APPLICATION TO RENT PROPERTY AT: APPLICANTS
More informationPLEASE READ EVERYTHING COMPLETELY BEFORE FILLING OUT THE ELIGIBILITY QUESTIONNAIRE
Homebuyer Eligibility Questionnaire Packet The Habitat for Humanity program is one in which you purchase a Habitat house or rehab that you also help build! The qualifications are that you have a need for
More informationFIRST TIME HOMEBUYER PROGRAM APPLICATION FOR PURCHASE ASSISTANCE
FIRST TIME HOMEBUYER PROGRAM APPLICATION FOR PURCHASE ASSISTANCE 2017-2018 THE CITY OF PLANTATION The Grass is always Greener The primary purpose of the City of Plantation is to provide purchase assistance
More informationESCORT INFORMATION SHEET
ESCORT INFORMATION SHEET The materials listed below are needed to file all applications except Alcohol Applications. 1. Duplicate Applications Answer all questions appropriately and in detail, legibly,
More informationeéu Ç fv{äéxááxü Dear Applicant,
Dear Applicant, Thank you for your interest in Mirota Senior Residence! Please take time to carefully review and fill out this rental application. The application must be completed fully, or it will be
More informationPoint Below Market Rent Qualification Guidelines
NV@Harbor Point Below Market Rent Qualification Guidelines Charter Oak Communities complies with the Federal Fair Housing Act. Charter Oak Communities does not discriminate based on race, color, religion,
More informationCDBG HOME OWNER REPAIR PROGRAM APPLICATION CHECKLIST
CDBG HOME OWNER REPAIR PROGRAM APPLICATION CHECKLIST City of LaPorte Office of Community Development & Planning 801 Michigan Ave., LaPorte, IN 46350 Phone: (219) 362-8260 FAX: (219) 325-0656 CDBG Home
More informationCalHome Homeowner Rehabilitation Loan Program Information
CalHome Homeowner Rehabilitation Loan Program Information 333 W Ocean Blvd., 3rd Floor Long Beach CA 90802-4430 (562) 570-6949 Fax (562) 570-6215 lbcic.org Thank you for your interest in the Cal-Home Homeowner
More informationP E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles
P E N N S Y L V A N I A Application for Payment of Medicare Premiums, Coinsurance and Deductibles If you have a disability and need this form in large print or another format, please call our helpline
More informationThe Grand Forks Housing Authority An Equal Housing Opportunity Provider
The Grand Forks Housing Authority An Equal Housing Opportunity Provider **IMPORTANT INFORMATION** READ & KEEP THIS PAGE To be eligible to receive housing assistance, the applicant must meet the following
More informationRECEIVED BY THE HRA Date: Time: APPLICATION FOR PUBLIC AND SECTION 8 NEW CONSTRUCTION HOUSING ASSISTANCE Equal Housing Opportunity
RECEIVED BY THE HRA Date: Time: APPLICATION FOR PUBLIC AND SECTION 8 NEW CONSTRUCTION HOUSING ASSISTANCE Equal Housing Opportunity Applicant Name: First Middle Initial Last Co-Applicant: First Middle Initial
More informationRENTAL APPLICATION FOR RESIDENTS AND OCCUPANTS
APPLICANT INFORMATION RENTAL APPLICATION FOR RESIDENTS AND OCCUPANTS (Each co-applicant and each occupant 18 years old and over must submit a separate application.) Date when filled out: Full Name (Exactly
More informationCHINA TOWNSHIP ST. CLAIR COUNTY HARDSHIP EXEMPTION APPLICATION TAX YEAR 2016
B.O.R. Mar Jul Dec Letter / Appt Parcel No. Name: Date: Time: Petition #: A. DEADLINE CHINA TOWNSHIP ST. CLAIR COUNTY HARDSHIP EXEMPTION APPLICATION TAX YEAR 2016 YOU MUST COMPLETE THIS APPLICATION IN
More informationApplication Instructions
Colorado CLT Application Instructions You must submit a completed application with all the required documentation prior to signing a contract for purchase. To ensure your application is complete, please
More informationAffordable Homeownership Program Application: Instructions
Affordable Homeownership Program Application: Instructions Habitat reviews applications on a first come, first served basis. Please expect the entire application process to take between 1 3 months. Instructions
More informationHousing Authority for the City of Amery 300 North Harriman Avenue Amery, WI (phone) (fax)
Housing Authority for the City of Amery 300 North Harriman Avenue Amery, WI 54001 715-268-2500 (phone) 715-268-7700 (fax) aha@amerytel.net Office Use Only: (/Time stamp) Programs Applying For: (Check all
More informationRESIDENTIAL APPLICATION- HUD Properties
Please complete this application and return to: 188 Warburton c/o The Community Builders, Inc. 43 Ashburton Ave. Management Yonkers NY 10701 Application No. Interviewer Applicant s Last Name Date Received
More informationHOUSING AUTHORITY OF THE CITY OF PRICHARD Application for Admission Public Housing
For Office Use only. Applicants should not write in this section. Date/Time: Received by: Special Assistance required by this applicant: Bedroom Size Interview Date: TO BE FILLED OUT BY APPLICANT (IN INK).
More informationWHEN FILLING OUT THE APPLICATION: All information must be complete and signed by each applicant. The non-refundable application fee is $20.
WHEN FILLING OUT THE APPLICATION: All information must be complete and signed by each applicant. The non-refundable application fee is $20.00 per person. Processing will not begin until the application
More informationHubbard County HRA Down Payment Assistance Application
MEMO TO: FROM: SUBJECT: Interested Applicant Levi Haar, Lending and Accounting Specialist Hubbard County HRA Down Payment Assistance Application Thank you for your interest in the Hubbard County HRA Down
More informationHousing Assistance Application Check Sheet
Housing Assistance Application Check Sheet In order to determine eligibility, the following items are required for all household members: [ ] Application update required annually [ ] Degree of Indian Blood-copy
More informationProgressive Personal Auto Application
Progressive Personal Auto Application Upon completion please fax application to our office at 866-433-4331 Allied General Agency 1100 Locust Street, Dept 2002, Des Moines, IA 50391-2002 Phone: 888-364-3434
More informationSSN Birth Date / / Spouse s Name: Legal Address: City State Zip Country. Mailing (or secondary) Address: City State Zip Country
Client Profile Form Establish a new client Update an existing client* * All sections required for new client relationships. For client updates, please complete the applicable sections only. The signature
More informationCrafton Heights Townhomes
** Application must be completed in full in order to process. **Must have a valid ID of applicant and co-applicant, copies of social security cards and birth certificates for all occupants, verification,
More informationAmerican River Commons Application Criteria Conventional
American River Commons Application Criteria Conventional Thank you for choosing American River Commons as your potential new home. We are pleased that you have chosen to reside in our community, and the
More informationWinnebago County Housing Authority 3617 Delaware Street Rockford, IL Phone: (815) Fax: (815)
Winnebago County Housing Authority 3617 Delaware Street Rockford, IL 61102 Phone: (815) 963-2133 Fax: (815) 316-2860 Winnebago County Rental Housing Support Program efficiency-3 bedroom units, which applicants
More informationRed Fox Realty, Inc.
PROPERTY MANAGEMENT RESIDENT SELECTION CRITERIA 1. All Adult applicants 18 or older must submit a fully completed, dated and signed residency application and fee. Applicant must provide proof of identity.
More informationPrairie Harvest Mental Health Occupancy Application **IMPORTANT INFORMATION** READ & KEEP THIS PAGE
Prairie Harvest Mental Health Occupancy Application 1 An Equal Housing Opportunity Provider To qualify for housing from Prairie Harvest Mental Health, the applicant must meet the following criteria: Applicants
More informationAPPLICATION FOR AFFORDABLE HOUSING
APPLICATION FOR AFFORDABLE HOUSING WELCOME! We are very happy you are interested in Our Family Services affordable apartments. Our units are spacious, comfortable with a washer and dryer in each unit.
More informationApplication for Legal Assistance
Application for Legal Assistance 1. What Brought You Here. (Please print clearly). Date: Briefly state your legal issue: Are you (or have you been) represented by an attorney in this matter? If so, who?
More information(603) Completed applications can be hand delivered or mailed to CHT **DO NOT FAX APPLICATIONS**
Dear Applicant, (603) 357-7603 Please review all steps below and the box once you have completed each step to ensure your application is complete. If you have any questions, call CHT. Completed applications
More informationLPC QUICK CHECK APPLICATION
LPC QUICK CHECK APPLICATION The most recent 2 years resident history required. Must provide dates of residency, landlord names and phone numbers for all addresses. The application cannot be submitted for
More informationApplication Requirements & Screening Criteria (PLEASE READ CAREFULLY)
Application Requirements & Screening Criteria (PLEASE READ CAREFULLY) 1. We need a completed and signed application for each person 18 years or older that will be occupying the unit. Pictures of any pets
More informationDEPENDENT VERIFICATION WORKSHEET V5 (AGGREGATE)
2019 2020 DEPENDENT VERIFICATION WORKSHEET V5 (AGGREGATE) A. Dependent Student s Information Student s Last Name Student s First Name Student s M.I. Student s YU ID Number Student s Street Address (include
More informationPROGRAM INSTRUCTION. Texas Department of Aging and Disability Services (DADS) Access and Intake Division. Transportation Voucher Service
PROGR INSTRUCTION Texas Department of Aging and Disability Services (DADS) Access and Intake Division TITLE: Transportation Voucher Service NUMBER: AAA-PI 318 SECTION: Area Agencies on Aging APPROVAL:
More informationIncome Guidelines for PRIVATE Client Assistance
Income Guidelines for PRIVATE Client Assistance 33% ABOVE FEDERAL POVERTY GUIDELINES 34% - 50% ABOVE FEDERAL POVERTY GUIDELINES 100% Write-Off 75% Write-Off Minimum Yearly Minimum Yearly 1-0 - 14,856.10
More informationAMERICAN FIRST FINANCIAL Fax Loan Application
PERSONAL AMERICAN FIRST FINANCIAL 602-230-0900 Fax 602-532-7335 Loan Application Date: Last Name: First: M: Add: Unit # Parking Space# City: State: Zip: How Long: County: Nickname? Live With: SS#: DOB:
More informationBARANOF ISLAND HOUSING AUTHORITY General Housing Application 245 Katlian Street, Sitka, AK
BARANOF ISLAND HOUSING AUTHORITY General Housing Application 245 Katlian Street, Sitka, AK 99835 907-747-5088 HOUSING APPLICATION INTERVIEW AND CERTIFICATION CHECKLIST APPLICANT INTAKE INTERVIEW COMPLETED
More informationHousing Authority of the Town of Beaufort 716 Mulberry Street Beaufort, NC (252)
EQUAL HOUSING OPPORTUN!TY Housing Authority of the Town of Beaufort 716 Mulberry Street Beaufort, NC 28516 (252)-728-3226 Applicants MUST have ALL reguired documents listed below at interview or the application
More informationVETERANS ASSISTANCE PROGRAM ELIGIBILITY CERTIFICATION
VETERANS ASSISTANCE PROGRAM ELIGIBILITY CERTIFICATION Assistance requested: Rent: Veteran must have rental agreement and/or eviction notice. Number of bedrooms Utilities: Veteran must have a disconnect/final
More information