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This form serves as a preliminary qualification assessment for the City of Moline's housing assistance programs, including: Community Housing Services, Lead Paint Abatement, Neighborhood Stabilization Program, and the Washington Square Apartments sponsored by the Department of Housing and Urban Development (HUD) and the Single Family Owner Occupied Rehabilitation (SFOOR) Program and Homebuyer assistance program sponsored by the Illinois Housing Development Authority (IHDA).
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Required only if married.
Please fill out, save to your computer, and upload completed form (see right). Form may also be printed, filled, and scanned.
Check all that apply.
All applicants must read this document.
By electronically signing below, you are verifing that you have read the document attached above, "The Lead Safe Certified Guide to Renovate Right."
Further, you hereby authorize the City of Moline to verify your bank accounts, employment records, outstanding debts, including any present or previous mortgages, and to make other inquiries pertaining to your qualification for any City of Moline assistance from Community Development Services Programs administered by the City's Planning and Development Department. The City may make copies of this letter for distribution to any party with which you have a financial or credit relationship and such party may rely on such copy as if the same were an original.
Privacy Act Notice: All information collected by the City or its assignees shall be used in determining whether you qualify as a prospective recipient of a forgivable loan or other assistance under the City of Moline's Community Housing Services Programs. Such information will not be disclosed except as required and permitted by law. By providing your electronic signature below, you understand that you do not have to provide any such information, but that failure to do so may cause your application for approval as a recipient or borrower to be delayed or rejected.
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