(941) 749-3029
This form is only an entry form for the order in which we will be able to serve applicants with funding. Submitting this form does not guarantee that you will be assisted.
Assistance is based on funding availability. Assistance will be in the form of a 0% deferred loan; this is not a grant.
Did you receive any damage to your home due to Hurricane Ian or Nicole? FEMA or insurance claim(s) will be required at intake appointment.
Are there any liens or judgements against homeowner or property?
You may not be eligible to participate in this program. Please do not continue with the application.
Is the current mortgage a balloon, adjustable rate or reverse mortgage?
Is there currently a line of credit open against this property
Have you received any County housing assistance in the past 5 years?
Who is completing this application?
Homeowner's Name
Homeowner's Birthdate
Co-Owner's Name (if applicable)
Co-Owner's Date of Birth (if applicable)
Is property in the name of the owner or co-owner?
Is the homeowner aware that you are submitting an entry form on their behalf?
IMPORTANT INFORMATION
Property Address
Is mailing address different from property address?
Mailing Address
Do you currently have homeowner's insurance on the property?
Are taxes current?
Is mortgage current?
Have you ever been married?
Are you currently
Are all members of the household U.S. Citizens or legal U.S. Resident Aliens? (Proof will be required)
Is anyone in the household eligible to receive Child Support?
Proof that Child Support has been applied for or is being received will be required before we can assist you
Has the Head of Household, or a household member, been determined disabled and/or receiving Disability? Proof of Disability will be required at intake appointment.
What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)
