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Pre-Screening Intake Application for Housing Rehabilitation

  1. Marital Status (Estado Civil):*
  2. Do you have a mortgage? (¿Tiene Hipoteca?):*
  3. Is it current? (¿Es actual?):*
  4. Property Taxes and Insurance Current? (¿Tiene impuestos a la propiedad y aseguranza actual?):*
  5. Any liens against property? (¿Existen gravámenes contra su propiedad?):*
  6. Foreclosure in the past 2 - 3 years? (¿Ha tenido Ejecución Hipotecaria en los últimos 2-3 años?):*
  7. Any Collections or Judgments? (¿Ha tenido alguna cobranza o juicio?):*
  8. Bankruptcy in past 2 - 3 years? (¿Se ha ido a bancarrota en los últimos 2-3 años?):*
  9. Was home included in bankruptcy? (¿Estuvo la casa incluida en la bancarrota?):*
  10. Once you have completed the form, you may select "Receive an email copy of this form" to send yourself a copy of the form in email, then Submit or Submit and Print. If you select Submit and Print, when the screen appears, right-click and select Print. The form will be automatically routed to your printer.
  11. Leave This Blank:

  12. This field is not part of the form submission.