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Housing Rehabilitation Program Preliminary Application

  1. Address must be within the City limits to qualify.
  2. Enter a phone number by which you can be contacted.
  3. If the person completing this form is not the homeowner, please provide your name, address, and relationship to the owner.

    Communication regarding program applications can only be made with the homeowner or authorized representative. 

  4. Do you own the property?*

    i.e., Is your name on the deed?

    NOTE- THIS PROGRAM IS NOT FOR LEASED PROPTERIES.

  5. Do you live in the property as your permanent place of residence?*
  6. Are your property taxes current?*
  7. Is there a mortgage (1st or 2nd) on the property?*
  8. Are your mortgage payments current?
  9. Is the home covered by property insurance?*
  10. Do you own any other properties?*
    This includes vacant land or out of state properties.
  11. This includes Supplemental Security Income (SSI), social security benefits, retirement pension, workers' comp, alimony, child support, unemployment benefits, and wages.

  12. This includes all sources of income from all household members.

  13. Please specify which program you are applying for

    Rehabilitation Program- provides a loan up to $75,000 for homes requiring moderate repairs to bring them up to minimum housing standards. 

    OR

    Energy Efficiency and Weatherization Program - provides a loan up to $40,000 for homes requiring minimal improvements to make the home more energy efficient and weather resistant for Florida climate. 

  14. Please explain the repairs you believe are needed for the program you have selected.  Please be advised that the program only provides repairs that make the home meet minimum Housing standards or improves its energy efficiency; it does not address cosmetic issues that do not affect the safety or welfare of the occupants.

  15. Have you ever requested assistance from the city before?*
  16. Have any additions or alterations been made to your home that are not original to the home?*
  17. Please provide us your email address for confirmation purposes. This email will be used to communicate with you regarding your application.
  18. Do all owners listed on the deed reside at the residence?*
  19. Are there any household members that are considered a special needs person or are disabled and receiving Supplemental Security Income (SSI) or Social Security (SS) disability?*
  20. Have you received notice of foreclosure on your property?*
  21. Are you aware of any outstanding liens on your property other than your mortgages?*
    (e.g. Internal Revenue Services (IRS), City, County, Code Enforcement fines, etc.)
  22. Do you have any outstanding citations issued by the code enforcement department?*
  23. Are you and any co-applicant US citizens?*
  24. Leave This Blank:

  25. This field is not part of the form submission.