home improvement grant

Anderson Windows

patio door

french door

anderson window

home improvement grant, Anderson Windows, patio door, french door, anderson window, home improvement

home improvement grant, Anderson Windows, patio door, french door, anderson window, home improvement

KitchenWorks.HOME IMPROVEMENT GRANT

APPLICATIONHIP#______________APPLICANT INFORMATION

Date:________________Applicant Name _____________________________ SS# ___________ DOB ______________Co-Applicant Name __________________________SS# ___________ DOB ______________Address _______________________ Town ____________________Home Telephone ___________________ Marital Status ___________ US Citizen? Yes No (Circle one)Names of DependentsAges of DependentsSS#_______________________________________________________Amt. Mo. mortgage pmt. $ _________ Yrs of residence: _____ Property's Assessed Value: $ _________Are there any liens on the property: YES NO (Circle one)If yes, please explain _________________________________________________________________Property Section/Lot/Block #_____________Amt. of Annual Property/School Taxes $ ______________ Renewal Date of Property Insurance _______Name and address of Mortgage Holder:________________________Previous Address if less than three years at present address:__________________________________________Applicant: Name and Address of Employer: ________________________________________________Occupation: __________________________ Yrs. Employed _______ Work Telephone:______________Previous Employer if less than 3 years in present position:______________________________________Co-Applicant: Name and Address of Employer: __________________Occupation: _______Yrs. Employed _______ Work Telephone:______________Previous Employer if less than 3 years in present position:__________________
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Grant Amount Requested: $_____________ Please describe the anticipated improvements/repairs:_______________________Everything I have stated in this application is correct to the best of my knowledge. I understand that KitchenWorks will retain this application whether or not it is approved. KitchenWorks is authorized to check myemployment history to obtain credit reports concerning me in connection with my application, to answerquestions about KitchenWorks 's credit experience with me. If KitchenWorks obtains credit reports regarding me, it will,upon my request, tell me the name and address of the consumer reporting agency that furnished thereports._____________________________________DateSignature of Applicant_____________________________Date Signature of Co-Applicant (if any)ATTACH THE FOLLOWING ITEMS TO THIS APPLICATION1)Copy of homeowner's deed2)Copy of proof of income for all family members(include previous month's pay stubs AND last year's tax return)3)Current school and county tax record showing payment4)Certificate of Insurance for home owners insurance5)Copy of most recent bank statement(s)6)Copy of household budget sheet (see attached)Verification of EligibilityThis form has been received and determined to be complete and, based on the enclosed information, theapplicant(s) is/are eligible to receive assistance from the Home Improvement Program.Conflict of InterestNo person who is a member of the governing body of the KitchenWorksoration(KitchenWorks) nor a person who is a member of the administrative body, an officer, or an employee or theimmediate family members of such a person, will have a personal interest in any contract necessary toeffect KitchenWorks's Home Improvement Program.DateSignature, KitchenWorks Representative
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Please read before signingI/we____________hereby state that i/we are the owner andoccupant of the property to be repaired.I/we understand that no work is to be started under the home improvement program until I/weare given written authorization from the KitchenWorksoration. I/we furtheracknowledge that the Home Improvement Program and the KitchenWorks are in no way responsible for any debts resulting from work commenced prior toreceiving this written authorization.I/we understand that should I/we not continue to live in my/our home for * years after receivingassistance from the KitchenWorksoration, that all of the assistance will besubject to repayment in full. I/we understand that I/we must sign a * year note and mortgageagainst our property before work can begin and funds are disbursed.I/we understand that a building permit must be obtained form the local building code officialbefore any work may commence. My signature below authorizes the local building official tohave access to my property in the performance of his/her duties.I/we agree that the KitchenWorksoration may provide financial and/orhousehold information about me/us to other funding sources only if those agencies ororganizations are funding a part of the above mentioned repairs.I/we understand that all applications will be received and processed by the KitchenWorks staff. In the event of a disagreement between an applicants and staff, athird party reviewer will be hired at KitchenWorksoration's expense and attheir sole discretion to mediate the disagreement and ensure the completion of the project inaccordance with HIP rules and regulations. If the applicant and mediator cannot agree about the project's implementation, KitchenWorks reserves the right to withdraw the application and terminate the relationship.All information set forth in this application is declared to be a true representation of facts made for the purpose of obtaining a Home Improvement grant and I/we fully understand that anywillful misrepresentation on this application could result in criminal action.__________________DateSignature_______________DateSignature