Home Repair Loan Program

Please enter your current address. *

This application will take an average of 30 minutes to complete. You need to create an account to save progress. You can return to the application later if needed. If you do not create an account, your information will not be saved. *

Do you see your name at the top right-hand side of the screen? *

Do you need a repair to your side sewer? *

You will need digital copies of the following documents to complete this application. *

Please enter your first and last name *

Please enter your 10 digit phone number. *

Email address *

What are your preferred gender pronouns? *

Please select your marital status. *

Please enter your Social Security Number *

What is the name of your current employer *

Are there any additional legal owners of this property? *

Are there any other legal owners of this property? Please list their full name. *

Please upload proof of current homeowner’s insurance for the property applying for the loan. *

Do you have a mortgage on this property? *

Are your property taxes and homeowner’s insurance included in your mortgage payment? *

We are now going to ask you questions about your household.
Please list the full legal names of everyone permanently living in the home, whether they are part of your family or not. Include  yourself, other adults, and children. *

Please list the full legal name of each household member starting with yourself. *

What is your race?

What is your preferred language?

If we need to communicate with you about the status of your application, will you need language assistance?

I certify I have received and read a copy of Protect Your Family from Lead Based Paint. *

The applicant specifically acknowledges(s) and agree(s) that:
 

1. the loan requested by this application will be secured by a mortgage or deed of trust on the property described herein;
2. the property will not be used for any illegal or prohibited purpose or use;
3. all statements made in this application are made for the purpose of obtaining the loan indicated herein.
4. occupancy of the property will be as indicated above;
5. verification or re-verification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved;
6. if any of my/our circumstances change prior to closing, I/we understand we must provide updated information;
7. in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency;
8. ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me;
9. the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
    

I give the Seattle Office of Housing (City) permission to submit requests or release information to other non-profit organizations or government agencies for the purpose of providing assistance to me. Such information may include but is not limited my application, income and related documents, results of inspections conducted by the property rehabilitation specialist, the home repair scope of work and completed repairs. Such information may result in my receiving or being denied other City assistance. I authorize the City to enroll me in all City or King County assistance programs for which I am eligible.
 

You are hereby authorized to release to the City of Seattle, The Office of Housing (OH), and The Department of Human Services (DHS), any information which you may have in your files concerning the applicant, including, but not limited to: employment records, bank accounts, loan accounts, credit and financial reports, and mortgage and contract amounts.
 

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. And liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made in this application. *

Please enter the date you signed this form in the format month/day/year. *

If you included a second homeowner to this application, please have them sign their name and date on this form as well.

Please enter the date you signed this form in the format month/day/year.