Section 1 of 1 in this document

Manatee County's Housing Rehabilitation/Replacement Program Random Selection Process Form

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.

Priority will be given to those households impacted by Tropical Storm Debby, Hurricane Helene and Hurricane Milton.

THIS APPLICATION IS FOR SHIP REHABILITATION AND REPLACEMENT PROGRAM

THIS PROGRAM CANNOT SERVE MOBILE HOMES – IF YOU ARE IN A MOBILE HOME AND HAVE RECEIVED STORM DAMAGE, PLEASE VISIT https://www.mymanatee.org/departments/government-relations-department/cdbg-dr

Has the Head of household or household member been determined Disabled and/or receiving Disability? Proof of disability will be required at intake appointment.

Yes

Did you receive any damage to your home due to Tropical Storm Debby, Hurricane Helene or Hurricane Milton? FEMA or Insurance claim will be required at intake appointment.

Yes

Are there any liens or judgements against homeowner or property?

Yes

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?

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Is there currently a line of credit open against this property

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Have you received any County housing assistance in the past 20 years?

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Who is completing this application?

Homeowner

Other

What is your name and relationship to homeowner?

Homeowner's Contact Number

* Please be sure that the phone number provided is valid, it will be answered, and staff are able to leave a voicemail message. Staff will make two attempts to contact the applicant by phone prior to issuing a response deadline letter.

Homeowner's Email Address

Co-Owner's Contact Number

Co-Owner's Email Address

Is property in the name of the owner or co-owner?

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Is the homeowner aware that you are submitting an entry form on their behalf?

Yes

Property Information

IMPORTANT INFORMATION

The property must be in the name of owner or co-owner. The property must be located in Unincorporated Manatee County or City of Palmetto (not in the city limits of Bradenton). If you pay your water bill to the City of Bradenton, you are not located in unincorporated Manatee County and are not eligible.

Is mailing address different from property address?

Yes

Do you currently have homeowner's insurance on the property?

Yes

Are taxes current?

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Is mortgage current?

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Have you ever been married?

Yes

Are you currently

Married

Widowed

Divorced (If divorced, proof of divorce decree will be required)

Separated (If separated, spouse must be willing to sign all legal documents required by County)

Are all members of the household U.S. Citizens or legal U.S. Resident Aliens? (Proof will be required)

Yes

You may not be eligible to participate in this program. Please do not continue with the application.

Is anyone in the household eligible to receive Child Support?

Yes

Proof that Child Support has been applied for or is being received will be required before we can assist you

Annual Gross Household Income

What is your annual gross (before any deductions) household income? (Includes Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

How many people are in your household?

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$37,700 or less (Very Low Income)

$37,701 - $60,300 (Low Income)

More than $60,300

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$43,050 or less (Very Low Income)

$43,051 - $68,900 (Low Income)

More than $68,900

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$48,450 or less (Very Low Income)

$48,451 - $77,500 (Low Income)

More than $77,500

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$53,800 or less (Very Low Income)

$53,801 - $86,100 (Low Income)

More than $86,100

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$58,150 or less (Very Low Income)

$58,151 - $93,000 (Low Income)

More than $93,000

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$62,450 or less (Very Low Income)

$62,451 - $99,900 (Low Income)

More than $99,900

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$66,750 or less (Very Low Income)

$66,751 - $106,800 (Low Income)

More than $106,800

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

$71,050 or less (Very Low Income)

$71,051 - $113,700 (Low Income)

More than $113,700

You may not be eligible to participate in this program. Please do not continue with the application.

Manatee County's Housing Rehabilitation/Replacement Program Random Selection Process Form

Has the Head of household or household member been determined Disabled and/or receiving Disability? Proof of disability will be required at intake appointment.

Did you receive any damage to your home due to Tropical Storm Debby, Hurricane Helene or Hurricane Milton? FEMA or Insurance claim will be required at intake appointment.

Are there any liens or judgements against homeowner or property?

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 20 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?

Property 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?

Annual Gross Household Income

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)

What is your annual gross (before any deductions) household income? (Includes: Wages, Social Security, Disability, Alimony, Child Support, Retirement for The Entire Household)