2016 Social Infrastructure Fund Investment in Affordable Housing (2016 SIF IAH) ONTARIO RENOVATES APPLICATION

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1 1. Do you own your own home in the City of Greater Sudbury? 2. Is it your sole and principal residence? 3. Is your annual gross household income at or below $85,200? 4. Is your house valued at or below $253,068 per the 2016 Municipal Property Tax Assessment (MPAC)? Yes 5. Do you have $20,000 in equity in your home? 6. Are you renting or leasing any part of your home? 7. Have you received down payment assistance under the AHP Northern Homeownership Program for your home? You must have answered YES to questions 1 to 5, and NO to questions 6 and 7, in order to be eligible. If you answered as such, you may proceed and complete the application. If not, you do not qualify for the Ontario Renovates Program. Please ensure all required documents listed on page 6 of the application are enclosed with the application. Incomplete applications will not be processed. Mail or drop off completed applications and supporting documentation until December 31, 2017 to: City of Greater Sudbury Housing Services 199 Larch Street, Suite 603 Sudbury, ON P3A 5P3-1-

2 ABOUT THE OWNER(S) OF THE PROPERTY Client Type Senior Citizen Family Single (non-senior) Please list all owner(s) registered on title to the property First Name Household Size (total # persons living in the house) Last Name First Name Last Name ABOUT THE PROPERTY Street No. Street name or legal description (include Lot, Concession, Township, if applicable) City/Municipality Province Postal Code Mailing Address (if different from above) City/Municipality Province Postal Code Home Telephone Number ( ) Address (optional) Work Telephone Number (optional) ( ) Cell Number ( ) Check ( ) the type of house you live in Number of Bedrooms: Single Semi-detached Duplex Row/Townhouse Other Age of House Value of property (based on 2016 MPAC Notice of Assessment) $ Mortgage Payments up-to-date? Yes No N/A Insurance Payments up-to-date? Yes No Property Tax paid up-to- date? Yes No Has this property previously received government funding for home repairs (e.g. Home Repair Program, Residential Rehabilitation Assistance Program (RRAP), March of Dimes, etc.? Yes No If yes, provide details below. Program: Year funding received: Type of repair: -2-

3 HOUSEHOLD COMPOSITION AND INCOME INFORMATION LIST THE NAMES OF ALL THE PEOPLE WHO LIVE IN THE HOME INCLUDING HOMEOWNER(S) # First Name Last Name Relationship to Applicant (Applicant/Spouse/Partner/Son/ Daughter/Other-specify) Enrolled Full-Time in School (yes or no) TOTAL ANNUAL GROSS HOUSEHOLD INCOME (enclose copies of 2016 CRA Notice of Assessment for all household members over the age of 18 years or older who are not full-time students along with proof of source of income (e.g. cheque stubs, pension and/or benefit statements) SOURCES OF INCOME TYPE OF INCOME (Indicate Gross Current Year s Income - before deductions) Old Age Security APPLICANT (A) SPOUSE/ PARTNER (B) CHILDREN/ DEPENDENTS (C) OTHER HOUSEHOLD MEMBERS (D) Pensions and Allowances GAINS A Canada Pension Plan Other Pensions (employer, RRSP, RRIF, etc.) specify Employment Employment Income Social Assistance Employment Insurance (EI) Workplace Safety Insurance Board (WSIB) Other Employment (e.g. Self-Employment) Ontario Works Ontario Disability Pension (ODSP) Support Payments/Alimony Other Interest income Other (specify) - TOTAL INCOME FROM ALL SOURCES $ $ $ $ Columns (A) + (B) + (C) + (D) = TOTAL ANNUAL GROSS HOUSEHOLD INCOME = $ -3-

4 TYPES OF REPAIRS (MODIFICATONS) REQUIRED URGENT HOME REPAIR Check ( ) all that apply Structural Foundation Building Envelope Doors and windows Plumbing Electrical Briefly describe the repair work identified in the list above: Roof Heating Fire Safety Other ACCESSIBILITY MODIFICATIONS Check ( ) all that apply Ramps Chair and Bath Lifts Fire Safety Cues for Doorbells Handrails Height Adjustments to Countertops Briefly describe the repair work identified in the list above: Other SECONDARY DWELLING (Contact Building Services at (705) extension 4278 to ensure your project meets criteria for secondary dwelling) Purpose of Secondary Dwelling Affordable Housing Unit Secondary Dwelling for Senior Secondary Dwelling for Disabled Briefly describe the dwelling unit you want to create. Include number of bedrooms, square feet, estimated total cost and how you will finance any amount over $20,000. With the application, please include construction plans, an estimated operating budget and the proposed rent revenue, if applicable. The guidelines for this type of project include a 15-year forgiveness and additional annual reporting by the homeowner to Housing Services. -4-

5 DECLARATION I/We hereby confirm that I am/we are the owner(s) of the house and no other person is an owner. I/We hereby grant permission to the City of Greater Sudbury to carry out any necessary inquiries for the purpose of determining my/our income, homeownership status, including a title search on the property. I/We hereby authorize inspections of my/our property as required. I/We acknowledge that any work carried out before I/we receive written confirmation of the loan approval is not eligible. I/We acknowledge that inspections that are completed by the City of Greater Sudbury are not a guarantee that construction or renovations comply with building codes or standards. I/We hereby certify and declare that all the information contained in this application, including income, is true and complete in every respect. I/We acknowledge that in the event that a false declaration is knowingly made, the City of Greater Sudbury shall have the right to cancel the approval and recover any paid funds. I/We have read, understand and agree to the terms and conditions listed above. NOTICE AND CONSENT (Access to Information Act, Privacy Act, Freedom of information and Protection of Privacy Act and Personal Information Protection and Electronic Documents Act) Personal Information contained in this form is collected on behalf of the Ministry of Municipal Affairs and Housing (the Ministry ) for the purpose of Section 4 of the Ministry of Municipal Affairs and Housing Act, R.S.O. 1990, c.m. 30. The information will be used to determine eligibility under the Northern component of the Canada-Ontario Affordable Housing Program (AHP) and in connection with the administration and delivery of the AHP. The information may be disclosed to any persons, entities and/or government authorities involved in the administration or delivery of the AHP and this includes sharing of such information with Canada Mortgage and Housing Corporation. Any questions regarding the collection, use, or disclosure of the information should be directed to Manager, Ontario Renovates, at the Ministry of Housing at 777 Bay Street, 2nd Floor, Toronto, Ontario M5G 2E5. The undersigned consents to such collection, use and disclosure of the information. -5-

6 CHECKLIST OF REQUIRED DOCUMENTS CHECK REQUIREMENT ACCEPTABLE DOCUMENTS ( ) Ontario Renovates Application Please fill in all applicable information, enclose all required documents and sign both the declaration and consent areas on page 5 of the application Photo Identification For each homeowner, attach a copy of two pieces of photo ID (e.g. Driver s Licence, Passport, Health Card) Proof of Canadian Citizenship For each homeowner, attach a copy of Birth Certificate or Citizenship documents Proof of Income For each member of the household over 18 years of age, attach copies of 2016 Notice of Assessment from Canada Revenue Agency For each member of the household over 18 years of age, not in full-time attendance in school, attach copies of current paystubs, pension and/or benefit statements Proof of Mortgage in good standing and current balance Contact your bank or mortgage company for a letter confirming that your mortgage is in good standing and the current balance of mortgage (if applicable) Proof of Current Value of Property Copy of the 2016 Municipal Property Assessment Corporation (MPAC) Notice of Assessment for your property Proof of Property Insurance Copy of your current home insurance policy Coverage Accessibility Verification (if applicable) Form completed by a health care professional indicating accessibility modifications are required Please ensure all documents listed above are enclosed with the application. Incomplete applications will not be processed. Mail or drop off completed applications and supporting documentation until December 31, 2017 to: City of Greater Sudbury Housing Services 199 Larch Street, Suite 603 Sudbury, ON P3A 5P3 If you have any questions regarding the Ontario Renovates Program or the application, you can send an to onrenovates@greatersudbury.ca or you can call: Wanda Eurich Program Development Officer City of Greater Sudbury Housing Services (705) , extension