Dear Homeowner: Sincerely, Mary Dwyer Community Development Coordinator. City of Leavenworth Home Repair Program Page 1 of Program Year

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1 Dear Homeowner: Here is the application packet for the Home Repair Program The City of Leavenworth will determine what is needed for safety standards and to bring the house up to code. Each grant amount will be determined by the Community Development Coordinator; the maximum grant under this program is $5,000 depending on income guidelines. Those in the low income tier can receive up to $5,000; those in the moderate tier can receive up to $3,000. Please complete the application, attach required documents as listed on page 7, and contact the Community Development Clerk ( ) to schedule an appointment to review your application packet. (The rest of the pages are informational. They are included so that you will be familiar with them and know what documents you will be required to sign throughout the process.) The application cannot be processed until staff verifies receipt of all documentation required. You are not required to obtain bids at this time. Following receipt of your application and verification of your eligibility, City staff will inspect your property, go over the problem areas with you, and complete a work write-up. The work write up will be used to solicit bids. Please note that if your application is approved, all work must be performed in accordance with applicable zoning and building code regulations and appropriate permits must be obtained by the contractor(s) AND THAT ACCORDING TO Federal guidelines, we must accept the lowest bid. Please call our office at if you have any questions pertaining to the application or required attachments. We look forward to working with you. Sincerely, Mary Dwyer Community Development Coordinator City of Leavenworth Home Repair Program Page 1 of Program Year

2 HOME REPAIR ASSISTANCE PROGRAM PROGRAM GUIDELINES The purpose of this program is to assist low and moderate income homeowners, within the corporate bounds of the City of Leavenworth, to make safety or sanitary repairs or handicap accessibility improvements to their residences. Our first concern is safety standards and code issues. The program is funded by the Community Development Block Grant program, a federal program administered through the Department of Housing & Urban Development (HUD) and is subject to federal guidelines and rules. Guidelines for the program are as follows: 1. The applicant must meet the income guidelines adopted by HUD for low/moderate income clients (see pg. 4). 2. The applicant must be the homeowner and occupant. 3. The applicant must have lived in the house for one year before any grant can be started. 4. Prior assistance from the City of Leavenworth to the homeowner or the property disqualifies the applicant from receiving further grant funds for 10 years. However, if the original grant is under $2,000, the applicant may apply for a grant up to the grant category balance before the 10-year period. 5. The property must meet program guidelines. 6. The property cannot be subject to a contract for deed sale agreement. 7. The property cannot be in flood plain. 8. The property must be attached to a permanent foundation located on private property and taxed as real property. This program can provide a maximum of $5,000 per applicant to assist with repairs based on income guidelines. Those in the low income tier can receive up to $5,000, those in the moderate tier can receive up to $3,000. Approved projects for funding: HOME WEATHERIZATION Weatherization repairs to increase the energy efficiency of their residences: insulation, doors, storm doors, window repair, and air infiltration techniques. This excludes window replacement. MINOR EXTERIOR REPAIR These are non-emergency repairs that will enable the structure to meet property maintenance standards and preserve the structure. SAFETY AND SANITARY UPGRADES The repair and/or replacement of heating, air conditioning, electrical and plumbing issues for low/moderate income households. EMERGENCY ASSISTANCE These are emergency repairs or handicap accessibility improvements to low/moderate income households. The repairs needed must be of a nature that if not accomplished future damage or safety concerns will occur to the property. City of Leavenworth Home Repair Program Page 2 of Program Year

3 Leavenworth, Kansas Home Repair Program Eligibility Self-Check Before you fill out the Home Repair Application, please read the Program Information in its entirety and complete the following self-check to determine if you are eligible for this program. QUESTIONS YOUR ANSWERS ELIGIBILITY CONSIDERATIONS Do you own a single-family home within Leavenworth corporate city limits? (Note: A Leavenworth address does not necessarily mean the home is within Leavenworth corporate city limits.) Have you owned your home for at least one year? Is this single-family home your primary residence now? If Yes above, will you remain the owner of this home for the next 3 years? Do you or any of your household members also own or co-own other real estate anywhere in the U.S.? Are you an owner or a co-owner of a business (including an online business)? Do any members of your household own a business? Are any of the needed repairs covered under your current homeowner insurance? Was your home built before 1978? Are you able to keep up with your mortgage payments and will you be able to do so within the next 3 years? Information above is not intended to be inclusive for eligibility determination. You are not eligible for this program if you do not own a single-family home located within Leavenworth city limits. It is a City of Leavenworth CDBG Home Repair Program requirement that you own your home for at least one year. If you have not owned your home for a year, you are advised to wait until you have owned the home 1 year. If you own multiple residential properties and the abovereferenced single-family residential unit is not your primary residence, you are not eligible for this program. If repairs are made to this home using the program funds, a 3-year lien is placed on the property. If there is a possibility of ownership change within the next 3 years, you are advised not to apply for the program funds. If you or any members of your household own/co-own other real estate, regardless of its location, you must report it as part of your household assets. If you own/co-own a business, business income must be included in the household income for eligibility determination. If any members of your household own/co-own a business, business income must be included in your household income for eligibility determination. If you don t know, contact your insurance company to find out first. If repairs are covered under your homeowner insurance, you should not apply for the Home Repair Program to pay for such repairs. If YES, your home is subject to Lead-based Paint regulation compliance, which means that a Lead-based Paint inspection will be required (at the program s expense) and Lead-based Paint abatement may be required. This normally translates to longer processing time and higher costs the program may or may not support. If it is very likely that you will not be able to make required mortgage payments within the next 3 years, it is likely that you may lose ownership of your home during that time period, in which case you are advised to give it a serious consideration whether to apply for funding or not. City of Leavenworth Home Repair Program Page 3 of Program Year

4 INCOME LIMITS Home Repair Program Household Size *Low Income *Moderate Income 1 Person $28,000 $ 44,800 2 Persons $32,000 $ 51,200 3 Persons $36,000 $ 57,600 4 Persons $40,000 $ 64,000 5 Persons $43,200 $ 69,150 6 Persons $46,400 $ 74,250 7 Persons $39,600 $ 79,050 8 Persons $52,800 $ 84,500 *Figures are adjusted annually by the Department of Housing and Urban Development; current rates effective May Notice: Department of Housing and Urban Development (HUD) program income limits and qualifications are subject to change without notice. Additional conditions and limitations to this program are in effect. This program is funded by HUD s Community Development Block Grant Program (CDBG) and is conducted and administered in conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d), the Fair Housing Act (42 U.S.C ), and implementing regulations. City of Leavenworth Home Repair Program Page 4 of Program Year

5 Home Repair Program City of Leavenworth Kansas Please read the program information packet thoroughly before completing this form. Official Use Only Do Not Write in This Box Application #: Status (If Approved) HUD Activity #: Important: Only single-family owner-occupied residential units qualify for this program. Duplexes, multi-family residential units, rental units and commercial buildings are not eligible. GENERAL INFORMATION Applicant Name: Co-applicant Name: Address: Last First Middle Initial Last First Middle Initial Applicant Telephone: Home: ( )- - Cell: ( )- - Do you own this residential unit? Yes No (If the answer is No, you are not eligible to apply) If Yes, year purchased: Have you or the property received a grant from the City of Leavenworth or the State of Kansas for home buying assistance or house repairs? Yes No If yes, what year? Do you own other property (land, business or residence), in the city or U.S. besides this house? Yes No If yes, what address? Number in Household: Female Head of Household? Yes No A household is defined as all persons occupying the same housing unit, regardless of their relationship to each other. The occupants could consist of one family, two or more families living together, or any other group of related or unrelated persons who share living arrangements Please note: Please select at least one from the following list that best describes your household racial characteristics. HUD requires the City of Leavenworth to report the following information for all grant recipients. HUD encourages self-reporting, but you are not required to furnish the following racial/ethnic information: One Race Household: White Black/African American Asian American Indian/Alaskan Native Native Hawaiian/Other Pacific Islander Multi-racial Household: American Indian/Alaskan Native and White Asian and White Black/African American and White American Indian/Alaskan Native and Black/African American Other Multi-Racial Are you also Hispanic? Yes No Is any member of your household currently working as a City of Leavenworth employee? Yes No Is any member of your household a relative of a City of Leavenworth employee? Yes No City of Leavenworth Home Repair Program Page 5 of Program Year

6 INCOME INFORMATION (Attach more paper if necessary) List all incomes of all adult persons in the household 18 years of age and older. Incomes should be a 12-month total from the most recent 12 months or from the most recent tax return filing period and all the incomes must be verifiable. Per federal requirement, this information will be used by the City to estimate your annual household income level for a period of 12 months immediately following the receipt of your application to determine your income eligibility. This means that the estimate of your total annual household income for the next 12 months is what determines your income eligibility for this program. Incomes from Household Social Child Unemployment Name Age Employment SSI Pension Disability AFDC Other Members Security Support Person #1 $ $ $ $ $ $ $ $ $ Person #2 $ $ $ $ $ $ $ $ $ Person #3 $ $ $ $ $ $ $ $ $ Person #4 $ $ $ $ $ $ $ $ $ Person #5 $ $ $ $ $ $ $ $ $ Person #6 $ $ $ $ $ $ $ $ $ Person #7 $ $ $ $ $ $ $ $ $ Subtotals $ $ $ $ $ $ $ $ $ For additional persons, please attach a separate sheet. Total Annual Household Income (add all the subtotals above together): $ Please list dollar value of all assets at time of application for all adults in the household: ASSETS APPLICANT CO-APPLICANT OTHER (18 yrs & older) OTHER (18 yrs & older) OTHER (18 yrs & older) Money, bank accounts Stock/bond value Vehicle #1 Vehicle #2 Other property in your name Business Assets City of Leavenworth Home Repair Program Page 6 of Program Year

7 Required Documentation: Verification papers are required for all forms of household income including: Proof of employment and/or income. If employed, please provide copies of check stubs for the most recent two months pay periods (three months periods if variable). Copy of most recent filed IRS Form 1040 for income verification. Award letters or Annual Benefits Statement for social security, supplemental security income (SSI), aid to families with dependent children (AFDC) Copy of eligibility letter for annuity or pension, unemployment insurance, disability/workmen s compensation, child support Other income Indicate below any changes of income status as a result of circumstances such as job loss, divorce, death, etc. Documentation is required. TYPE OF HOUSE REPAIRS REQUESTED (All repairs must be exterior or building systems.) Please select a maximum of 3 of the listed repairs needed to your property and rank them 1, 2 or 3 in order of importance: Heating System Code Violations Roofing Insulation Storm Door/Door Electrical Issues Sanitary Sewer (private) Plumbing Issues Handicap Accessibility Exterior Structural Repair Windows (repair only) I hereby submit this application to the City of Leavenworth, Kansas, for the Home Repair Program. I further certify that all ownership, occupancy and income information provided is true and correct. If the approving staff determines that the Home Repair Grant cannot be made for the purposes described herein, I understand that the City shall provide no assistance for this project. I agree not to discriminate upon the basis of race, color, creed or national origin in the future sales, lease, rental, use, improvement or occupancy of the real property rehabilitated with assistance from this grant. I understand that the employment and income information provided above is subject to verification by the City of Leavenworth, Kansas. I agree to submit to the City, upon request, any additional documentation for employment and income verification. I hereby grant permission to the City of Leavenworth s Home Repair Program supervisors, employees and contractors the City may use to enter the above-mentioned premises to perform work under the Home Repair Program. I also hereby agree to sign the legal agreement as required by the City and further certify that I have legal authority to authorize the City to perform said services. By my/our own signature(s), I/we acknowledge receipt of, have read, and understand the City s Home Repair Policy and I/we agree to abide by the terms of the policy, the rehabilitation contract documents, and applicable City codes. I/we, the undersigned, do hereby swear under penalty of perjury that all information contained on the application is true and correct to the best of my knowledge and belief. Applicant Signature Co-Applicant Signature Date: Date: City of Leavenworth Home Repair Program Page 7 of Program Year

8 GRANT AGREEMENT 1. The applicant agrees not to permit nor make any changes or additions to the Plans and Specifications for Housing Repair without the prior written approval of the Community Development Coordinator of the City of Leavenworth, Kansas. 2. The applicant agrees to permit the contractor and subcontractors (if any) to use, at no cost, existing utilities such as light, heat, power and water to the extent necessary to carry out and complete the work. 3. The applicant agrees to permit the Community Development Coordinator, or their representative, contractor and subcontractors access to the property during the workday or at other reasonable times to complete required inspections and all necessary work. 4. The applicant agrees to cooperate with the Community Development Coordinator, or their representative, contractor and subcontractors to facilitate the performance of the work, including (but not limited to) moving rugs, draperies and furnishings as necessary. 5. The applicant agrees to hold the City of Leavenworth, Kansas harmless of all responsibility and blame for any damage to real or personal property, and all physical injuries caused by contractor or subcontractors engaged in housing repair. 6. The applicant covenants and agrees: A. To continue to own and occupy the structures repaired with CDBG Grant Funds for a period of three (3) years after the issuance of a Certificate of Completion or the applicant agrees to repay the City of Leavenworth, Kansas a sum of money to be computed as follows: Years After Completion % of Amount of Grant /36ths /36ths /36th B. To maintain the rehabilitated property in a proper manner so as to prevent substantial destruction of the improvements due to the negligence of applicant; and upon breach of any of the aforesaid covenants, applicant agrees to repay the City of Leavenworth, Kansas a sum of money to be computed as spelled out above. C. To ensure compliance, the City of Leavenworth will require that a lien be filed with the Register of Deeds and applicant agrees to sign the lien at the completion of the project. D. The applicant further agrees that if the structure is totally destroyed by fire, natural disaster, public condemnation or through other causes within three (3) years after the issuance of a Certification of Completion, the applicant should repay to the City of Leavenworth, Kansas out of any insurance proceeds or other compensation received, a sum of money to be computed according to the schedule set forth in 6A above. However, if the applicant receives insurance proceeds or other compensation in an amount less than the fair market value of the structure after CDBG funded improvements, then the amount to be repaid shall be limited to the total insurance proceeds or other compensation received which is in excess of the fair market value of the structure prior to the CDBG funded improvements. City of Leavenworth Home Repair Program Page 8 of Program Year

9 7. The applicant agrees that the covenants herein contained shall be binding upon the applicant s heirs, devises, legatees, and legal representatives. SUBSCRIBED AND SWORN TO before me this day of, 20. Applicant Applicant Notary Public My Appointment Expires: City of Leavenworth Home Repair Program Page 9 of Program Year