• Small Cities Development Program
    HOMEOWNER APPLICATION

    Northwest Minnesota Multi-County HRA
    PO Box 128 | Mentor, MN 56736 | Phone: 218-309-0024

    The information on this application will be used to determine your eligibility for a Rehabiliation Loan. All fields must be completed.

  • APPLICANT INFORMATION

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Marital Status*
  • Race*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you have a co-applicant to add to the application?*

  • CO-APPLICANT INFORMATION

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Marital Status*
  • Race*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • OTHER HOUSEHOLD OCCUPANTS

    Please provide the following information for each member of the household NOT listed as the applicant or co-applicant
  • How many other household occupants, not including the applicant and co-applicant, do you have to add to the application?*

  • Household Member #1

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Household Member #2

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Household Member #3

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Household Member #4

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Household Member #5

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • INCOME INFORMATION

    "Income" means any amount received from the following sources by ANY member of the household age 18 or over.
  • Does anyone in the household receive Public Assistance including: MFIP, SSI, GA, Child Support, and Unemployment Compensation?*
  • Does anyone in the household earned a salary including: wages, commissions, bonuses, tips, and overtime pay?*
  • Does anyone in the household receive estate or trust income?*
  • Does anyone in the household receive rental income?*
  • Does anyone in the household receive gains from the sale of property or securities?*
  • Does anyone in the household receive income from pensions or annuities including: PERA, Social Security, and Railroad Retirement?*
  • Does anyone in the household receive income from business profit (for self-employed individuals, including farmers)?*
  • Does anyone in the household receive income from interest and dividends?*
  • Does anyone in the household receive contract for deed payments?*
  • Does anyone in the household receive child support or alimony?*
  • How many incomes do you have to list?*

  • INCOME #1

  • INCOME #2

  • INCOME #3

  • INCOME #4

  • INCOME #5

  • PROPERTY INFORMATION

  • Do you have an outstanding mortgage on the property?*
  • Do you have any outstanding Contracts for Deed on the property?*
  • Do you have a life estate deed?*
  • What type of house is it?*
  • Do you have homeowner's insurance?*
  • Are there unpaid property taxes on this property?*

  • Before continuing, please click the following links and read through the information:

    • Fair Housing Act of 1966
    • Protect Your Family From Lead in Your Home

  • Please read and check each box by the following statements

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • WARNING: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willingfully makes or uses a document or writing containing any false, fictious statement or entry, in any matter within the jurisdiction of any department or agency of the United States shall be fined no more than $10,000 or imprisoned for not more than five (5) years, or both.

  • Conflict of Interest Interview

  • Interest of Members of City: No member of the governing body, officer, employee, or agent of the City who exercises any function or responsibilites in connection with carrying out the project or program to which this proposal pertains, shall have any personal interest, financial or otherwise, direct or indirect, in the property or the loan agreement.

     

    Are you or have you been in one of the following positions during the last 12 months:

  • Are you or have you been in one of the following positions during the last 12 months:*
    Rows
  • Are you, or is any member of your family, currently engaged in a business relationship with any of the above-named businesses or individuals?*

  • Note: If a conflict exists, it may be possible for the grantee and its agents to request an exception of the conflict from the funding agency.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Walk Away Policy

  • This walk-away policy will be institued by NW MN Multi-County HRA (hereafter HRA) staff for one or more of the following reasons:

    1. When it is determined that the unit is not suitable for rehabilitation.
    2. If a property is offered for bid on two separate occasions and no finacially acceptable bid is received, or is the housing inspector confirms that the property cannot feasibly be rehabilitaed to HQS and lead based paint standards, within the maximum allowable funding level, the HRA may elect to "walk-away" from that property and take no futher action regarding its renvoation. The property owner will be notified in writing within two weeks of the deteremination to "walk-away".
    3. If the property to be inspected or rehabilitated is in an "unkempt" state which could present health or safety hazards to HRA personnel or a Rehabilitation Contractor who would be performing the work, the property owner will be notified in writing given thirty (30) days to bring the property up to an acceptable standard of cleanliness as determined by the inspector. If, within that thirty-day period, the property is not brought up to an acceptable standard, the HRA reservces the right to :walk away" from that property and take no futher action regarding its inspection or rehabilitation. The property owner will be notified by wiriting within two weeks of this decision. "Unkempt" may include, but would not be limited to, unsanitary conditions, the presence of general clutter or undisposed household garbage, either inside or outside of the property to be rehabiltated.
    4. If it becomes apparent that the property owner, or tenants in the case of rental rehabiliation, at any phase of the project are not willing to comply or accept standard [ractices of the rehabilitation program that are outlined in the "Owners Responsibilities and Expectations" and the "What Can a Property Owner Expect information sheets provided.
    5. If the HRA staff or the rehabilitation contractor decides that continued presence on the job site may constitute a liability to their company due to the owner, or tenant's personal behavior or threatening manner.

    If the project is cancelled due to items number 3, 4, or 5, or if you choose to withdraw from the program after either the initial inspection or lead risk assessment/inspection has been conducted, a fee of $500.00 per inspection, up to $1,000.00, will be charged to the owner of the property if inspections have occured. If you continue with the home repairs, the costs of the initial inspection will be charged to the program and the cost of the lead testing will be part of the program costs or loan, depending on the program.

    Payments shall be made to the HRA no later than thirty (30) days following the action that requires repayment. If such payment is not made within 30 days, collection preceedings will begin to recapture these funds, Collection proceedings include submitting unpaid loan balance plus unpaid interest to Minnesota Department of Revenue Recapture Program.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • Comprehensive Rehabilitation Program

  • WHAT CAN A HOMEOWNER EXPECT?

    The Homeowner's Repsonsibilities in the Building Rehabilitation Program

    1. The housing program staff (HRA) will help homeowners during the building rehab improvement process, but homeowners are responsible for making choices and doing the work listed below.
    2. Homeowners provide the program staff with necessary information promptly.
    3. Homeowners, not the program staff, choose contractors to put together bids.
    4. Homeowners, not the program staff, select the contractor to do the work on the building.
    5. Homeowners sign building rehab improvement contracts with the selected contractor.
    6. Homeowners request and approve payments to their contractors.
    7. Homeowners are part of inspecting and approving work performed by their contractors.
    8. Homeowners work with contractors to settle disagreements during the job.
    9. Homeowners contact their contractors to ask them to correct probelms covered by contractor warranties during the first year after the job is completed.

    Things Owners Should Consider Before Taking out a Building Rehab Improvement Loan

    1. Not all work that homeowners want to be done can always be done.
    2. Repairs will correct health and safety problems, but they may not solve all problems in your bulding rehab.
    3. Don't expect all floors, walls, ceilings, doors, windows, etc. to be complete plumb, level, and square when work is done.
    4. It can be stressful licing in a building while a contractor is performing the work.
    5. Very few times in life is anyone completely satisfied with the things they buy or have repaired. Buying a building or having a building repaired is no different.
    6. Buildings always need improvements after a project is done. It would be a good idea to save at least $100 a month to help cover the cost of future repairs and maintenance.
    7. Finally, the program staff is not the contractor and cannot gaurantee that homeowners will be satisified with the work done by the contractors. We certainly work with all parties to ensure that the work specified is completed to satisfaction.
    8. After the loan is finalized, you will not be allowed to take cash out with a loan refinancing or take out a reverse mortgage without penalties.

     

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Is there another homeowner that needs to sign this form?*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year

  • File Upload

    The following items MUST be submitted with the application. You can either submit them below or email them to kara@nwmnhra.org.
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