DE Housing OpportunityFund Inc. Homeowner Application

DE Housing OpportunityFund Inc. Homeowner Application
Homeowner Information
Name

First NameLast Name
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Is this your primary residence?

YesNo
You are

SingleMarriedDivorsedWidowed
How long have you lived in your home?
Total Monthly Income
Source of Income
Are you or anyone in the home disabled

NoYes
Briefly describe the disability

Please describe your living conditions and whyyou need assistance
Have you applied to DE Housing Opportunity Fund Inc. in the past?

NoYes
Please list other times you have applied
Do you have homeowners insurance?

NoYes
How did you hear about DE Housing Opportunity Fund Inc.?
Has the owner received notification or is aware of any pending foreclosure or other actions threatening their ownership

NoYes
Please describe any pending foreclosures or other actions threatening your ownership.

Please list any other individuals living in the house:

	Name	Age	Male/Female	Do they live with you? (Y/N)	Can they provide assistance? (Y/N)
Person 1
Person 2
Person 3
Person 4
Person 5

Property Description
Your home is a:

Single FamilyTwo FamilyTriple FamilyOther
Number of floors in the house (do not include basement or attic):
Is there a basement?

NoYes
Is there an attic?

NoYes
How many bedrooms?
How many bathrooms?

Documents required for proof of ownership, income and residence
Please submit copies of the following documents when you return the application. Applications submitted without these documents will not be considered. If you must send originals, we will copy and return the originals to you.
1. Proof of Ownership (submit only one) ⁯
  - a copy of your current property taxbill;
  - or ⁯a copy of the deed to your property
2. Proof of Income (submit only one) for all residents in your home
  - A copy of your (and/or their) W2 or benefit/retirement statement(s);
  - or a copy of your (and/or their) last year’s Federal tax return (1040);
  - or a copy of your (and/their) SSI statement.
3. Proof of Residence (submit only one)
  - a copy of a recent telephone bill;
  - or a copy of a recent cable TV bill
Proof of ownership*

Browse Files

Cancelof
Proof of Income*

Browse Files

Cancelof
Proof of Residence*

Browse Files

Cancelof

Homeowner’s Statement of Eligibility
I / We
have asked DE Housing Opportunity Fund Inc. to provide funding for repairs to my / our home. I / We understand that DE Housing Opportunity Fund Inc. is funded by charitable donations and grants to provide assistance to the low- moderate income individuals who have no other means to afford home repairs.

I / We also understand that DE Housing Opportunity Fund Inc. is obligated to use its charitable donations and government funds only for the assistance to eligible homeowners. In addition, I / we understand that to knowingly submit false information is considered fraud and punishable by law. By signing my / our name(s) to this statement, I / we guarantee that I / we are eligible to receive this assistance, as follows:
All the information submitted on my / our Homeowner Application is complete and correct*
I / we am (are) the sole owner of the home at the above address, or I / we share ownership with persons who are also eligible to receive assistance*
This same house is my full-time residence*
I / we will not sell, rent or transfer ownership of this house for five years after completion of repairs*
I / we or any other owners of this house have no other financial resources to afford the services that I / we have requested*
I / we authorize DE Housing Opportunity Fund Inc. and its representatives to complete paperwork required to obtain building permits necessary to repair my / our home.*
Homeowner 1

Clear
Date of signature (1)

MonthDayYear
Date
Homeowner 2

Clear
Date of signature (2)

MonthDayYear
Date
Witness

Clear
Date of witness signature

MonthDayYear
Date
Printed name of witness

First NameLast Name

Homeowner Acknowledgements
In accepting DE.HOFI financial assistance you agree to; hold DE.HOFI harmless for work done by all third party contractors, to participate in discussions, photographs and ceremonies of the grant where reasonable accommodations have been made for your time and the location of these events. You are granting NON-EXCLUSIVE rights to pictures, written descriptions and audio presentations relating to the awarding of this DE.HOFI Grant. Credit to DE.HOFI: In any forum or medium in which this grant is discussed or presented subsequent to signing this Agreement, you will ensure that a credit is given to DE.HOFI (in mutually agreeable language) on the air in the case of broadcast media, or in print otherwise. This provision is to help create awareness and identity for DE.HOFI, so that others may take advantage of the resources and or contribute to DE.HOFI.
Homeowner 1

Clear
Date of signature (1)

MonthDayYear
Date
Homeowner 2

Clear
Date of signature (2)

MonthDayYear
Date
Witness

Clear
Date of witness signature

MonthDayYear
Date
Printed name of witness

First NameLast Name
Should be Empty:

DE Housing OpportunityFund Inc. Homeowner Application

Homeowner Information

Property Description

Documents required for proof of ownership, income and residence

Repairs Needed

Homeowner’s Statement of Eligibility

Homeowner Acknowledgements