1) If employed – two most current and consecutive paystubs, and the name and address of employer.
2) Other income – if you are disabled and receiving SSI or VA compensation provide a copy of your statement of benefits.
3) Current mortgage statement if applicable.
4) Liquid assets: If liquid assets exceed $5,000, provide account names and amounts.
IMPORTANT – READ CAREFULLY BEFORE SIGNING
I certify that I do not have the financial means (savings, investments, etc.) to perform the repairs for which I am applying. I certify that the above statements are true, accurate, and complete to the best of my knowledge and belief. This application shall remain the property of Rebuilding Together, to which it is submitted for the purpose of obtaining assistance.I hereby consent to and authorize Rebuilding Together, after giving reasonable notice, to enter the property for the purpose of determining the need and scope of the repair(s)specified above. I authorize the disclosure of the above information to only those persons or agencies as necessary to secure the assistance for which this application is submitted.
Warning!! It is a federal crime, punishable by fine and/or imprisonment, to knowingly make false statements concerning any of the above facts as applicable under the provisions of Title 18, US Code, Section 1014.