CITY OF NORTH LAUDERDALE

HOME REPAIR PROGRAM

FACT SHEET

Program: If you are interested in completing repairs to your home, the City of North Lauderdale has funds available to assist low-income eligible applicants. This assistance will help homeowners complete aesthetic and health and safety improvements, to any home in the City of North Lauderdale**. This program can provide up to $2,000 in matching funds for repair assistance. The amount received is based on a 25% to 50% match. Three written estimates from licensed and insured contractors are required for any work for which matching assistance is requested.

Repair assistance is in the form of a grant, and does not require any repayment.

Eligibility: Your household may not exceed the income limits below.

Household-Size Income Eligibility

1	2	3	4	5	6	7	8
$39,850	$45,550	$51,250	$56,950	$61,500	$66,050	$70,600	$75,150

Application process: Call (954) 724-7065 for information about the application. As soon as your application is returned with all copies of the required documentation, it will be reviewed for eligibility.

** Health and safety related work – any repairs, which are necessary to ensure the health and safety of the inhabitants or neighboring homeowners. Aesthetic work – improvements that may be visible from the right of way, including but not limited to: repainting home, landscaping improvements, irrigation/sod, and driveway improvements.

(All requested home repair work is subject to staff review and approval.)

CITY OF NORTH LAUDERDALE

Home Repair Program

BORROWER APPLICATION

*Information contained herein shall be kept and disclosed in conformance with Section 119.07, Florida Statutes, and shall be used only for the purpose of determining eligibility in the City of North Lauderdale’s Home Repair Program. All information supplied will be verified at a later date through supporting documentation, including income tax returns and bank statements. PLEASE PRINT CLEARLY.

THE APPLICANT IS THE PERSON WHO WILL OWN THE HOUSE AND BE RESPONSIBLE FOR THE MORTGAGE PAYMENT. IF YOU OWN THE HOUSE WITH SOMEONE ELSE, CO-APPLICANT INFORMATION MUST BE PROVIDED.

-------------------------------------

PERSONAL INFORMATION

LIST DEPENDENTS OR MEMBERS OF HOUSEHOLD WHO WILL RESIDE IN PROPERTY WITH YOU AND CO-APPLICANT:

Full Name Relationship Age S.S.# Occupation

1.________________________________________________________________________________

2.________________________________________________________________________________

3.________________________________________________________________________________

4.________________________________________________________________________________

5.________________________________________________________________________________

6.________________________________________________________________________________

FINANCIAL INFORMATION

Note: Be sure to include ALL SOURCES OF INCOME RECEIVED within the last 24 months.

APPLICANT	CO-APPLICANT
EMPLOYER NAME: _______________________ _______________________________________	EMPLOYER NAME: _______________________ _______________________________________
EMPLOYER ADDRESS:______________________ _______________________________________ _______________________________________	EMPLOYER ADDRESS:______________________ _______________________________________ _______________________________________

POSITION HELD:__________________________	POSITION HELD:__________________________
LENGTH OF EMPLOYMENT:_________________	LENGTH OF EMPLOYMENT:_________________
GROSS MONTHLY SALARY:_________________	GROSS MONTHLY SALARY:_________________

PREVIOUS EMPLOYER’S NAME & ADDRESS: _______________________________________ _______________________________________ _______________________________________	PREVIOUS EMPLOYER’S NAME & ADDRESS: _______________________________________ _______________________________________ _______________________________________

POSITION HELD:__________________________	POSITION HELD:__________________________
LENGTH OF EMPLOYMENT:_________________	LENGTH OF EMPLOYMENT:_________________
GROSS MONTHLY SALARY:_________________	GROSS MONTHLY SALARY:_________________

LIST ANY OTHER HOUSEHOLD INCOME (If any, include Child Support, Alimony, Interest, Dividends)

NAME EMPLOYER/SOURCE GROSS MONTHLY INCOME

1.________________________________________________________________________________

2.________________________________________________________________________________

3.________________________________________________________________________________

4.________________________________________________________________________________

OTHER INCOME NOT SHOWN ABOVE __________________________________________

(social security, child support, alimony, etc.) __________________________________________

__________________________________________

WHAT IS YOUR HOUSEHOLD’S TOTAL GROSS MONTHLY INCOME: $__________

(Attach copy of latest Income Tax Returns.)

TOTAL ANNUAL INCOME $________

ASSETS

Checking or Savings Accounts

Bank Name Account No. Type Balance

____________________________ ________________ __________ _________

OUTSTANDING LOANS OR OTHER DEBTS (Including all charge cards):

Lender/Creditor Account No. Monthly Pmt Balance

____________________________ ________________ __________ _________

LIST ANY ADDITIONAL NAMES UNDER WHICH CREDIT HAS PREVIOUSLY BEEN RECEIVED:

APPLICANT:______________________

CO-APPLICANT:____________________

THESE QUESTIONS APPLY TO BOTH APPLICANT AND CO-APPLICANT. IF YOU ANSWER YES TO ANY OF THESE QUESTIONS, PLEASE EXPLAIN ON SEPARATE SHEET.

APPLICANT	YES	NO	CO-APPLICANT	YES	NO

Are there any outstanding judgments against you?	( )	( )	Are there any outstanding judgments against you?	( )	( )
Have you declared bankruptcy within the past seven years?	( )	( )	Have you declared bankruptcy within the past seven years?	( )	( )
Been party to a lawsuit?	( )	( )	Been party to a lawsuit?	( )	( )
Are you obligated to pay alimony, child support, or separate maintenance?	( )	( )	Are you obligated to pay alimony, child support, or separate maintenance?	( )	( )
Are you a co-maker or endorser on a note?	( )	( )	Are you a co-maker or endorser on a note?	( )	( )

REPAIR CHECKLIST

Please specifically indicate what type of work will be completed, for which matching funds are requested.

Repair Work

__________________________________________________________________________________

Please note once you are pre-qualified, you will be required to provide three bids from contractors for any eligible work.

CITY OF NORTH LAUDERDALE

COMMUNITY DEVELOPMENT DEPARTMENT

APPLICATION SUPPORTING DOCUMENTATION LIST

_______________________________________________________

Dear Applicant,

You have shown interest in the North Lauderdale Home Repair Program. In addition to filling out the application, you will need to bring us some copies of additional information. The faster we receive this information the quicker we can act on your application. The list below is designed to serve as an outline.

Income category: This information is needed to document your income.

1. Tax Return for each working individual and/or adult in the home.

2. W-2 Forms from each employer for each working individual that covers the last tax year.

Members of your household: This information is needed to verify your household size and number of dependents so that we can correctly determine your ability to qualify for the program.

1. Driver’s License (any state) or State ID card (any state) and copy of social security card, from all members of your household that are of age to have these documents.

2. Birth certificates for all children whether adult or minor that you intend to claim as a member of your household.

3. If you have an elderly member of your household that you will be claiming as a dependant we will need proof of age and retirement status. This can be done through a State ID, Driver’s License, Passport, Birth Certificate, Social Security Payment (if applicable) and Social Security card.

4. Passports and/or Alien Registration cards will also be needed if this is applicable to your household for each member.

Repair Category: This information is needed to determine the amount of assistance you are eligible for.

1. Three written estimates, from licensed and insured contractors, are required (after your file has been pre-qualified).

Should you have any questions, please call the Community Development Department at 724-7065.

APPLICANT	CO-APPLICANT
NAME: ________________________________	NAME: _________________________________
DATE OF BIRTH:_________________________	DATE OF BIRTH: _________________________
SOCIAL SECURITY NUMBER:________________	SOCIAL SECURITY NUMBER:________________
ADDRESS:_______________________________ _______________________________________ _______________________________________	ADDRESS:_______________________________ _______________________________________ _______________________________________
PHONE (WORK):__________________________	PHONE (WORK):__________________________
PHONE (HOME):__________________________	PHONE (HOME):__________________________
How long at present address:_______________	How long at present address:_______________
Previous Address:_________________________ _______________________________________ _______________________________________	Previous Address:_________________________ _______________________________________ _______________________________________
How long at previous address:_______________	How long at previous address:_______________
MARITAL STATUS:	MARITAL STATUS:
Married ( ) Single ( ) Divorced ( )	Married ( ) Single ( ) Divorced ( )
Widower ( ) Separated ( )	Widower ( ) Separated ( )
Relationship to Co Applicant________________	Relationship to Co Applicant________________
Race___________________________________	Race___________________________________