Homeowner Signup

This program is for low-income senior citizens, living in a single family, owner occupied residence.
No trailers, mobile homes, condominiums or rental homes can qualify for this program.
If you need assistance filling out this application, please call 248-618-7433

 

This form can also be downloaded and filled out

 

First Name:
Last Name: 		Date of Birth: 
Address:
City: State:
Zip: 		Phone:           
Marital Status:

 

Names and ages of individuals living in the house with the applicant:
Name: Relationship: Age:
Name: Relationship: Age:
Applicant's salary per month: $ Monthly House Payment: $
Co-applicant's salary per month: $ Are Property Taxes and House Insurance
included in the House Payment? Yes No
Other individual's contributions to
household income $

If not what are annual Property Taxes?
$

Pensions, Annuities, Social Security,
A.D.C, Public Assistance, Food Stamps, etc. $ 		If not, what is annual House Insurance
Premium? $
Earnings from savings, interest, rent, etc: $
List All Assets: Bank Accounts, Saving Bonds, Securities, Real Estate, etc.:
 List All Liabilities: Car Loans, Charge Cards, Personal Loans, etc:

 

Length of time in present home: Name and address of Mortgage Co. /Land Contract Holder:
Age of present home: Name:
Are your property taxes current? Yes No Address:
City: State:
Zip:
Description of home:
Style (Ranch, colonial, etc) 		Account Number:
Number of Bedrooms Number of Bathrooms
Basement? Yes No Garage? Yes No
Do you have any physical disabilities that we should be aware of?
Are there any unusual circumstances pertaining to this application?
What home repairs would you like made to your home?
Have you applied for this program before? Yes No
Will your family members volunteer to help accomplish the repairs to your home? Yes No
Emergency Contact Information:  
Name: Name:
Email: Email:
Address:
City: State:
Zip: 		Address:
City: State:
Zip:
Phone: Phone:

 

Copies of the following Supplemental Documentation are required and will be picked up during the home inspection. If you have questions or problems please contact us.
  • Copy of Recorded Deed or Land Contract
  • Copy of last year's Federal Income Tax Return
  • Copy of Social Security Check or Award Letters
  • Copy of Pension Check
  • Copy of Welfare Assistance (Food Stamps, ADC, etc)
  • Copy of Spouse's Recorded Death Certificate
  • Most recent Mortgage Statement
  • Employment Verification
  • Copy of Bankruptcy Documents
  • Verification that Home Owners Insurance has been paid
  • Verification that Property Taxes have been paid
  • Copies of information regarding all Assets or Liabilities