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Rehabilitation Loan Inquiry Checklist

Please complete and submit this form. If it appears you may be eligible for this program we will mail you an application packet.

Name Phone
Address Email
City State     Zip

Household Size
1
2
3
4
5
6
7
8
Income Limit 39,900 45,600 51,300 56,950 61,550 66,100 70,650 75,200

1. How did you hear about this program?
2. Do you live in Clackamas County?    Yes     No
3. Do you currently live in the home that you want to repair?    Yes     No
4. Type of dwelling?    House     Duplex     Manufactured home on land    Manufactured home in park
5. What year was your home built?
6. How many people live in the house?
7. What is the current monthly gross income for ALL persons living in the home over age 15?
8. What are the sources of that income?
9. Do you have income from any assets or other property?    Yes     No

If yes, amount and source:

10. When did you purchase the house?
11. What is the total county assessed Real Market Value of your property? $
12. Are you buying the home on a mortgage or contract?    Mortgage     Contract     N/A
    If contract, is seller willing to sign consent to lien?    Yes     No (Note: If TD recorded, not necessary to have seller sign consent)
13. What is the balance of the loan? $
14. Is there a second mortgage or line of credit?    Yes     No

If yes, amount and source:

15. Are there any other liens against your property?    Yes     No

If yes, amount and who:

16. Are the property taxes paid?    Yes     No
17. Are the property taxes included in your payment? Yes     No
18. Do you have homeowners insurance on this home? Yes     No
19. Are there any other names on the title?    Yes     No

If yes, who:

20. Do you file federal income tax returns?    Yes     No
21. Would you like your application packet e-mailed or mailed?    Email    US Postal Mail
Describe repairs needed: (some improvements may be done with repairs)
Questions/comments