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Universal Application for Housing Rehabilitation Programs

Neighborhood Improvement Development Corporation Programs (NIDC)

Programs include: STRONG Homes Loan, Home Rehabilitation Targeted Investment Neighborhood, Home Rehabilitation Program Expansion and Tax Incremental District.

Would you like to receive periodic emails about City of Milwaukee programs, relevant community resources, and other updates? *

Yes

No

Applicant and Co-Applicant Information

APPLICANT INFORMATION

First Name *

Last Name *

Date of Birth (mm/dd/yyyy) *

Social Security Number (xxx-xx-xxxx) *

Primary Phone Number *

Secondary Phone Number

Email Address *

Applicant's Address *

Zip Code *

Number of years living at this address *

Are you (select one): *

Do you have a co-applicant/co-owner of the property/spouse? *

Yes

No

How many co-applicants/co-owners are there (including yourself)? *

Two

Three

Four

CO-APPLICANT INFORMATION

Section to be completed by any co-applicants, this includes co-owners of the property and spouses.

First Name *

Last Name *

Date of Birth (mm/dd/yyyy) *

Social Security Number (xxx-xx-xxxx) *

Primary Phone Number *

Secondary Phone Number

Email Address *

Number of years living at this address *

Applicant's Address *

Zip Code *

Is the co-applicant (select one): *

ADDITIONAL CO-APPLICANT INFORMATION

Section to be completed by any co-applicants, this includes co-owners of the property and spouses.

First Name *

Last Name *

Date of Birth (mm/dd/yyyy) *

Social Security Number (xxx-xx-xxxx) *

Primary Phone Number *

Secondary Phone Number

Email Address *

Applicant's Address *

Zip Code *

Number of years living at this address *

Is the co-applicant (select one): *

ADDITIONAL CO-APPLICANT INFORMATION

Section to be completed by any co-applicants, this includes co-owners of the property and spouses.

First Name *

Last Name *

Date of Birth (mm/dd/yyyy) *

Social Security Number (xxx-xx-xxxx) *

Primary Phone Number *

Secondary Phone Number

Email Address *

Applicant's Address *

Zip Code *

Number of years living at this address *

Is the co-applicant (select one): *

Authorized Representative

Complete if there is an organization or person helping you complete this application.

Name of Authorized Representative

Relationship to Applicant

Organization

Phone Number

Email Address

I, [pipe:5] [pipe:15], received assistance in completing this application. I certify providing information to our authorized representative that is true and complete. I herby authorize the City of Milwaukee to request, receive and share information with my authorized representative to verify the accuracy and completeness of my application. Furthermore, I authorize my personal representative to request, receive and share information with the City of Milwaukee to verify the accuracy and completeness of my application.

clear

I, [pipe:5] [pipe:15] & [pipe:19?] [pipe:20?], received assistance in completing this application. We certify providing information to our authorized representative that is true and complete. I herby authorize the City of Milwaukee to request, receive and share information with my authorized representative to verify the accuracy and completeness of my application. Furthermore, I authorize my personal representative to request, receive and share information with the City of Milwaukee to verify the accuracy and completeness of my application.

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I, [pipe:5] [pipe:15] & [pipe:19?] [pipe:20?] & [pipe:159?] [pipe:160?], received assistance in completing this application. We certify providing information to our authorized representative that is true and complete. We herby authorize the City of Milwaukee to request, receive and share information with my authorized representative to verify the accuracy and completeness of my application. Furthermore, we authorize my personal representative to request, receive and share information with the City of Milwaukee to verify the accuracy and completeness of my application.

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I, [pipe:5] [pipe:15] & [pipe:19?] [pipe:20?] & [pipe:159?] [pipe:160?] & [pipe:180?] [pipe:181?], received assistance in completing this application. We certify providing information to our authorized representative that is true and complete. We herby authorize the City of Milwaukee to request, receive and share information with my authorized representative to verify the accuracy and completeness of my application. Furthermore, we authorize my personal representative to request, receive and share information with the City of Milwaukee to verify the accuracy and completeness of my application.

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Household Members

Please list all people who live in the home at least 50% of the time (including children):

	Name	Birth Date	Relationship to You
1	Name	Birth Date	Relationship to You
2	Name	Birth Date	Relationship to You
3	Name	Birth Date	Relationship to You
4	Name	Birth Date	Relationship to You
5	Name	Birth Date	Relationship to You
6	Name	Birth Date	Relationship to You

Do you have more than 6 household members? *

Yes

No

Please list additional household members *

+-

Has any household member recently passed away? *

Yes

No

Please list the name of the deceased (list one person per box, click the green plus sign to add more boxes):

+-

Is any member of your household disabled? *

Yes

No

Please list the names of all members of your household who are disabled (list one person per box, click the green plus sign to add more boxes):

+-

Is any member of your household a full-time student? *

Yes

No

Please list the names of all members of your household who are full-time students (list one person per box, click the green plus sign to add more boxes):

+-

Household Income

Please list all sources of income for your household below. You may need to submit proof for all sources of income after your application has been reviewed. You will be notified directly if additional documentation is required.

Acceptable proof of income includes, but is not limited to: most recent income tax returns, W2 forms, two most recent paycheck stubs, pension statements, SSA & SSI award letters, rental income, or annuity statements.

APPLICANT INCOME

Employer *

Employer Address *

Position *

Length of employment *

Do you have additional sources of income? *

Yes

No

	Source of Income	Income Amount (indicate per month or per year)
Source 1	Source of Income	Income Amount (indicate per month or per year)
Source 2	Source of Income	Income Amount (indicate per month or per year)
Source 3	Source of Income	Income Amount (indicate per month or per year)
Source 4	Source of Income	Income Amount (indicate per month or per year)
Source 5	Source of Income	Income Amount (indicate per month or per year)
Source 6	Source of Income	Income Amount (indicate per month or per year)

CO-APPLICANT INCOME

Employer *

Employer Address *

Position *

Length of employement *

Do you have additional sources of income? *

Yes

No

	Source of Income	Income Amount (indicate per month or per year)
Source 1	Source of Income	Income Amount (indicate per month or per year)
Source 2	Source of Income	Income Amount (indicate per month or per year)
Source 3	Source of Income	Income Amount (indicate per month or per year)
Source 4	Source of Income	Income Amount (indicate per month or per year)
Source 5	Source of Income	Income Amount (indicate per month or per year)
Source 6	Source of Income	Income Amount (indicate per month or per year)

HOUSEHOLD MEMBERS INCOME

Please list all sources of income for other household members below.

Example:

Household Member Name: Jane Smith

Source of Income: Johnson Controls Salary

Income Amount: $25,342 per year

	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 1	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 2	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 3	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 4	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 5	Household Member Name	Source of Income	Income Amount (indicate per month or per year)
Source 6	Household Member Name	Source of Income	Income Amount (indicate per month or per year)

Does your household have more than 6 sources of income? *

Yes

No

Please list any additional income information here

+-

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant
	Yes	No
Do you file Federal and State Income taxes?	Yes	No
Do you receive pension or annuity income?	Yes	No
Are you a partner in any business?	Yes	No
Are you self-employed?	Yes	No
Do you receive child support?	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant
	Yes	No	Yes	No
Do you file Federal and State Income taxes?	Yes	No	Yes	No
Do you receive pension or annuity income?	Yes	No	Yes	No
Are you a partner in any business?	Yes	No	Yes	No
Are you self-employed?	Yes	No	Yes	No
Do you receive child support?	Yes	No	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant 1		Co-Applicant 2
	Yes	No	Yes	No	Yes	No
Do you file Federal and State Income taxes?	Yes	No	Yes	No	Yes	No
Do you receive pension or annuity income?	Yes	No	Yes	No	Yes	No
Are you a partner in any business?	Yes	No	Yes	No	Yes	No
Are you self-employed?	Yes	No	Yes	No	Yes	No
Do you receive child support?	Yes	No	Yes	No	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant 1		Co-Applicant 2		Co-Applicant 3
	Yes	No	Yes	No	Yes	No	Yes	No
Do you file Federal and State Income taxes?	Yes	No	Yes	No	Yes	No	Yes	No
Do you receive pension or annuity income?	Yes	No	Yes	No	Yes	No	Yes	No
Are you a partner in any business?	Yes	No	Yes	No	Yes	No	Yes	No
Are you self-employed?	Yes	No	Yes	No	Yes	No	Yes	No
Do you receive child support?	Yes	No	Yes	No	Yes	No	Yes	No

Is your property a duplex? *

Yes

No

Do you receive rental income from this property? *

Yes

No

How much rental income do you receive per month? *

Financial Obligations

Please list all of your financial obligations below (including first and second mortgages, auto loans, credit cards, student loans, etc.):

For example:
Creditor: Student loan- Nelnet
Monthly Payment: $50.00
Total Amount Owed: $25,000

	Creditor	Monthly Payment	Total Amount Owed
1	Creditor	Monthly Payment	Total Amount Owed
2	Creditor	Monthly Payment	Total Amount Owed
3	Creditor	Monthly Payment	Total Amount Owed
4	Creditor	Monthly Payment	Total Amount Owed
5	Creditor	Monthly Payment	Total Amount Owed
6	Creditor	Monthly Payment	Total Amount Owed

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant
	Yes	No
Are there any outstanding judgements against you?	Yes	No
Have you been declared bankrupt within the past 7 years?	Yes	No
Have you had property foreclosed upon or given deed in lieu thereof in the last 3 years?	Yes	No
Are you party to a lawsuit?	Yes	No
Do you currently have homeowner's insurance?	Yes	No
Has your homeowner's insurance recently been cancelled?	Yes	No
Are you late or behind on any debt?	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant
	Yes	No	Yes	No
Are there any outstanding judgements against you?	Yes	No	Yes	No
Have you been declared bankrupt within the past 7 years?	Yes	No	Yes	No
Have you had property foreclosed upon or given deed in lieu thereof in the last 3 years?	Yes	No	Yes	No
Are you party to a lawsuit?	Yes	No	Yes	No
Do you currently have homeowner's insurance?	Yes	No	Yes	No
Has your homeowner's insurance recently been cancelled?	Yes	No	Yes	No
Are you late or behind on any debt?	Yes	No	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant 1		Co-Applicant 2
	Yes	No	Yes	No	Yes	No
Are there any outstanding judgements against you?	Yes	No	Yes	No	Yes	No
Have you been declared bankrupt within the past 7 years?	Yes	No	Yes	No	Yes	No
Have you had property foreclosed upon or given deed in lieu thereof in the last 3 years?	Yes	No	Yes	No	Yes	No
Are you party to a lawsuit?	Yes	No	Yes	No	Yes	No
Do you currently have homeowner's insurance?	Yes	No	Yes	No	Yes	No
Has your homeowner's insurance recently been cancelled?	Yes	No	Yes	No	Yes	No
Are you late or behind on any debt?	Yes	No	Yes	No	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant		Co-Applicant 1		Co-Applicant 2		Co-Applicant 3
	Yes	No	Yes	No	Yes	No	Yes	No
Are there any outstanding judgements against you?	Yes	No	Yes	No	Yes	No	Yes	No
Have you been declared bankrupt within the past 7 years?	Yes	No	Yes	No	Yes	No	Yes	No
Have you had property foreclosed upon or given deed in lieu thereof in the last 3 years?	Yes	No	Yes	No	Yes	No	Yes	No
Are you party to a lawsuit?	Yes	No	Yes	No	Yes	No	Yes	No
Do you currently have homeowner's insurance?	Yes	No	Yes	No	Yes	No	Yes	No
Has your homeowner's insurance recently been cancelled?	Yes	No	Yes	No	Yes	No	Yes	No
Are you late or behind on any debt?	Yes	No	Yes	No	Yes	No	Yes	No

Housing Improvements Needed

Please check all that apply: *

Is this a major emergency? *

Yes

No

Other Repairs (please list below):

0/200 characters

Assets

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant
	Yes	No
Do you own real estate other than the address listed above?	Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

	Applicant			Co-Applicant
	Yes	No		Yes	No
Do you own real estate other than the address listed above?	Yes	No		Yes	No

Please answer the questions below. A "yes" answer may require NIDC to request additional information to determine eligibility. *

Please provide the addresses below (list one address per box, click the green plus sign to add more boxes):

+-

Do any household members maintain multiple vehicles or boats at the property? *

Yes

No

If yes, please provide further details below:

Equal Credit Opportunity and Fair Housing Law Questions

The following information is requested by the Federal Government in order to monitor the lender's compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of the information, nor on whether you choose to furnish it. If you choose to not furnish it, under Federal regulations this lender is required to note race and sex on the basis of visual observation or surname.

Applicant: *

Co-Applicant: *

Co-Applicant 2: *

Co-Applicant 3: *

Conflict of Interest Statement

*

	Applicant
	Yes	No
Are you an employee of the City of Milwaukee, the Department of City Development (DCD), or one of its affiliate agencies?	Yes	No
Are you married to an employee of the City of Milwaukee including DCD or one of it's affiliate agencies?	Yes	No
Are you the brother, sister, parent or child of an employee of the City of Milwaukee, DCD, or one of its affiliate agencies?	Yes	No

*

	Applicant		Co-Applicant
	Yes	No	Yes	No
Are you an employee of the City of Milwaukee, the Department of City Development (DCD), or one of its affiliate agencies?	Yes	No	Yes	No
Are you married to an employee of the City of Milwaukee including DCD or one of it's affiliate agencies?	Yes	No	Yes	No
Are you the brother, sister, parent or child of an employee of the City of Milwaukee, DCD, or one of its affiliate agencies?	Yes	No	Yes	No

*

	Applicant		Co-Applicant		Co-Applicant 2
	Yes	No	Yes	No	Yes	No
Are you an employee of the City of Milwaukee, the Department of City Development (DCD), or one of its affiliate agencies?	Yes	No	Yes	No	Yes	No
Are you married to an employee of the City of Milwaukee including DCD or one of it's affiliate agencies?	Yes	No	Yes	No	Yes	No
Are you the brother, sister, parent or child of an employee of the City of Milwaukee, DCD, or one of its affiliate agencies?	Yes	No	Yes	No	Yes	No

*

	Applicant		Co-Applicant		Co-Applicant 2		Co-Applicant 3
	Yes	No	Yes	No	Yes	No	Yes	No
Are you an employee of the City of Milwaukee, the Department of City Development (DCD), or one of its affiliate agencies?	Yes	No	Yes	No	Yes	No	Yes	No
Are you married to an employee of the City of Milwaukee including DCD or one of it's affiliate agencies?	Yes	No	Yes	No	Yes	No	Yes	No
Are you the brother, sister, parent or child of an employee of the City of Milwaukee, DCD, or one of its affiliate agencies?	Yes	No	Yes	No	Yes	No	Yes	No

If you answered "yes" to any of the questions, please explain below:

Additional Notes or Documents

Would you like to add any additional notes, comments or document uploads to your application? *

Yes

No

Would you like to upload notes/comments or upload a document?

Notes/Comments

Document Upload

Add your notes or comments here

Upload documents here

Signatures

I certify that the information provided herein is true and complete. I authorize the Department of City Development (DCD), the Neighborhood Improvement Development Corporation (NIDC), and the Department of Neighborhood Services (DNS) to review this application, to request, receive and share information with lender(s), the above-named translator, and others to verify it's accuracy and completeness. I understand that my project may be funded all or in part utilizing Federal funds and City agencies may review the information contained in this application to verify its accuracy. By signing this application, I am authorizing the DCD/NIDC/DNS, to pull a credit report and, if deemed appropriate by DCD/NIDC/DNS staff, to refer all personal information contained within this application, and information obtained during the underwriting process, to other loan programs or homeowner education counseling for which I may be eligible, as well as provide said personal information to a third-party loan servicing online software provider and/or third-party loan servicing online software platform.

Please read the two statements below and acknowledge by clicking the checkboxes: *

I understand that I am submitting an application to help me fix my home. A representative from the City of Milwaukee will complete a thorough review of my application and determine the program that would best address my housing rehabilitation needs.

Staff may request additional documentation based on program funding requirements to complete a financial eligibility assessment of your application. Some examples of documents include, but not limited to, mortgage statement(s), pay stubs and WE Energies statement.

Applicant Signature *

clear

Date * +

Co-Applicant Signature *

clear

Date * +

Co-Applicant 2 Signature *

clear

Date * +

Co-Applicant 3 Signature *

clear

Date * +

Roof	Insulation	Interior Walls	Exterior / Siding / Painting
Furnace	Water Heater	Plumbing	Foundation
Doors	Wiring / Electrical	Windows	Porch
Chimney Repair

Black/African-American	Hispanic	White
Asian	Black/American-American and White	American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander	American Indian/Alaska Native and White	American Indian/Alaska Native and Black/African-American
Asian and White	Other/Multi-racial	I do not wish to furnish this information

Black/African-American	Hispanic	White
Asian	Black/American-American and White	American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander	American Indian/Alaska Native and White	American Indian/Alaska Native and Black/African-American
Asian and White	Other/Multi-racial	I do not wish to furnish this information

Black/African-American	Hispanic	White
Asian	Black/American-American and White	American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander	American Indian/Alaska Native and White	American Indian/Alaska Native and Black/African-American
Asian and White	Other/Multi-racial	I do not wish to furnish this information

Black/African-American	Hispanic	White
Asian	Black/American-American and White	American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander	American Indian/Alaska Native and White	American Indian/Alaska Native and Black/African-American
Asian and White	Other/Multi-racial	I do not wish to furnish this information