Home Loan Application

Application instructions:

Please fill out the following form in its' entirety. A comprehensive list of acceptable documents required can be found on our website at https://www.co.greene.pa.us/Department-HOME-Program. If you have any questions while completing the form, please call the HOME Program office at (724) 852-5260. Please note: only income eligible applicants who own their home are eligible. Mobile homes may be eligible if you own the home and have a land contract for a period of not less than 5 years from application date. Please refer to the website for specific requirements.
Equal Opportunity Statement:

This program is provided on an equal opportunity basis. Discrimination based on race, color, national origin, sex, age, or handicap is against state and federal laws. All residents are notified that any complaints regarding a discriminatory action may be filed with the Pennsylvania Human Relations Commission and the U.S. Department of Housing and Urban Development.
Greene County HOME Program

Homeowner Application
Full Name *

First Name Middle Name Last Name
Date of Birth

Month Day Year
Date
Primary applicant social security number *
Driver's License or State ID Number *
Co-Applicant Name

First Name Middle Name Last Name
Date of Birth

Month Day Year
Date
Co- applicant social security number
Please enter "N/A" if there is no co-applicant
Driver's License or State ID Number
E-mail *
example@example.com
Phone Number *

Area Code Phone Number
Street Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address(if different from the street address) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you own or co-own your home? *

Own Rent
Do you have homeowners insurance? *

Yes No
Is there a mortgage on the property? *

Yes No
Is this property a mobile home? *

Yes No
How many people (including yourself) reside in the home?: (If there is a joint custody agreement in place, please only county children who reside in this residence 15 days or more per month). *
No. of people living in home
Please list each person by name, age, gross monthly income, and source of income (Ex: Jane Homeowner/ Age 35/ cashier for ABC store/$1,500): *

Example: Jane Homeowner, 35, $1,000 0/300
Please provide a summary of repairs being requested. *
Please upload proof of ownership (deed or other legal instrument proving ownership)

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Please upload proof of proof of monthly income for the preceding 2 months. Acceptable proof can include 4 weeks of pay stubs, bank statements showing deposits and sources (please redact account number before uploading), benefits determination letters. Self employed persons should upload a copy of most recent tax return with Schedule C included.

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Please upload proof of payment of most recent property taxes

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Please upload proof of homeowner's insurance.

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GREENE COUNTY HOME Program
Owner-Occupied Home Rehabilitation
Income Certification

I hereby certify that the household income as stated on my application is true and correct. I understand that all income information stated on the Application is subject to source verification by the Greene County HOME Program.
Further, I understand that under Title 18, Section 1001 of the U.S. Code "a person is guilty of a Felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government”.
If it is discovered that any information provided by the Applicant was materially misstated, then the homeowner will be required to reimburse the Greene County HOME Program for the full amount of any rehabilitation assistance received, plus 5% interest, in addition to other felony penalties.
Signature *

Clear

End of Application

The application will not be considered complete until all sections are completed, documents are uploaded(or otherwise delivered to Greene County HOME Program). If you would prefer to mail, hand deliver, or email the documents, please call (724)852-5300 or email nmickens@co.greene.pa.us . It is acceptable to upload documents on hand with this online application and deliver remaining required documents by other methods as described above.
Signature *
Should be Empty:

Application instructions:

Equal Opportunity Statement:

Greene County HOME Program

End of Application