Housing Rehab Wait List Application

Housing Authority of Yamhill County & Yamhill County Affordable Housing Corporation (YCAHC) Housing Rehabilitation Waiting List Application

135 NE Dunn Place, McMinnville, OR 97128 Phone: (503) 883-4324 Fax: (503) 472-4376
Name:

First NameLast Name
Direct Phone Number:

Area CodePhone Number
Physical Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Message Phone Number:
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Household Members:
Age of Adults:
Email Address:
example@example.com
Age of Children:
Minor Children Currently living in the home:
Are you...? (Check all That Apply)
Have you ever served in the US Armed Services?
Head of Household Ethnicity:
Race:
MONTHLY Total Household Gross Income:
ANNUALLY Total Household Gross Income:
Approximate year your home was built:
Estimated assessed value of your home:
Estimated amount owed on your home:
Is your home a manufactured home?
If yes, do you own the land the home is on?
Home repairs you need (describe the repair in detail):
Primary repair item:
Siding:
Foundation:
Dry Rot:
Electrical:
Plumbing:
Roof/Gutters:
Septic/Sanitation:
Insulation:
Doors/Windows:
Special Needs:
Painting:
Structural:
Mechanical:
Flooring:
Other:
This information may be used to apply for funding from Federal, State, or Private Sources.

Equal Housing Opportunity
Should be Empty:

Housing Authority of Yamhill County & Yamhill County Affordable Housing Corporation (YCAHC) Housing Rehabilitation Waiting List Application