Ontario Renovates Application

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1 For Office Use Only Date Received: Time Received: Date and time that all required documents were provided: Ontario Renovates funding is limited. Complete and submit your application as soon as possible. Applications are assessed and approved chronologically based on the date the application is determined complete and subject to funding availability. Any repairs or modifications already in progress, or completed prior to project approval are not eligible for Ontario Renovates funding. Applicant Information: Homeowner s full name(s): Government issued photo identification, copied front and back that includes date of birth must be provided for all homeowners. Address: Number Street Unit/Suite/P.O. Box City/Town Province Postal Code Telephone Number Alternate Telephone Number Is this the sole and principal residence of all homeowners? Alternate contact in the event that you cannot be reached: Name Telephone Number January 2013; Rev. October 2013; April 2015 Page 1 of 6

2 Income and asset information must be provided for all household members over the age of 18, regardless who owns the home. Gross Household Income: Report gross income amounts for all sources of income for all household members. Gross income means income before taxes and other deductions. Sources of income may include employment, pensions, WSIB, Employment Insurance Benefits, other insurance payments, social assistance, child/spousal support, Canada Child Tax Credits, investment or business income. Total Gross Annual Income for all Household Members: Is any household member reporting income above over the age of 18 enrolled full-time in postsecondary education? If yes, please name the individual and the school name they are attending: Verification of income (i.e. pay stubs, pension and benefit statements) Prior year tice of Assessment (NOA) from the Canada Revenue Agency. Effective July 1 st, the NOA for the year immediately preceding the current year is required. April 2015 Page 2 of 6

3 Household Assets: List all household assets including investments and business interests, recreational vehicles, and boats. Household member: Type and Description of Asset: Value of Asset: () Verification of assets (i.e. bank and investment statements showing current account balances, vehicle ownership, recreational vehicles such as boats, snowmobiles, camper, etc.). Do not provide RRSP, RDSP, RRIF and RESP statements. Proposed Project Information: Ontario Renovates funding is only available for applicants/projects that have not received other government funding specified below. Funding may be allowed for a unit that previously received funds under another federal and/or provincial repair-type program (e.g. Residential Rehabilitation Assistance Program, repairs under Community Homelessness Prevention Initiative, Ontario Renovates), provided that the repair addresses a need or condition of work which has not been previously funded, and is for a different program subcomponent (e.g. home repair project or accessibility repair). Have the applicant(s) and/or this property or project received previous government funding through any of the projects listed below? Ontario Renovates funding cannot be used for units that have received funding under the Affordable Housing Program (2005), AHP extension (2009), or IAH funding under the Rental and Supportive or Rental Housing Component. Residential Rehabilitation Assistance Program (RRAP) (assistance for home repairs previously administered by Canada Mortgage and Housing Corporation (CMHC)) Affordable Housing Program (AHP) (i.e. Home Ownership program) If yes to any of the above, provide the project reference number, details of the work completed, and the date of approval. April 2015 Page 3 of 6

4 Property Description: Semi-detached Detached Townhouse/Row house Other Age of house: Value of House: Number of Bedrooms: Is your home a mobile home? If you have a mobile home, are land lease payments paid up to date? NA Property Clearance: Mortgage paid up to date? Insurance paid up to date? Property taxes paid up to date? Supporting documents to verify that payments for mortgage, land lease for mobile home, insurance and property taxes are current. House value can be verified by the property tax bill or a Municipal Property Assessment Corporation (MPAC) assessment notice. ( or ) Scope of Work: (check all that apply) Home Repairs: Estimated cost (if known) Heating Systems Chimneys Doors and Windows Foundations Vents/Louvres Roof Walls Floors Ceilings Electrical System (solar panels are not eligible) Plumbing Septic system Well water/well drilling Other: Please specify Scope of Work (continued): (check all that apply) Accessibility Repairs: Estimated cost (if known) Accessibility repairs must be reasonably related to a household member s disability. Additional medical information may be required to support your request. Mobility equipment such as walkers, wheelchairs, and scooters and supportive care are not eligible for accessibility funding. Ramps Handrails Grab bars Chair and bath lift Height adjustment to countertops, upper cabinets Other: Please specify Cues for doorbells Fire alarms Please note: Two written quotes from an arm s length contractor will be required after a home inspection has been completed by Counties staff. Arm s length means the buyers and sellers of a product or service act independently and have no relationship to each other. The quotes are not required to be submitted with this application. April 2015 Page 4 of 6

5 Applicant Declaration: I/we hereby confirm that I/we are the owners of the house and property located at the address identified in this application and that no other person is an owner. I/we hereby grant permission to the United Counties of Leeds and Grenville to make any necessary inquiries to verify my/our income, assets, and any other eligibility criteria. I/we hereby acknowledge that if this application is approved it will not apply to any prior work completed. I/we hereby acknowledge that if this application is approved, I/we cannot apply for any provincial tax rebate programs for these repairs. I/We hereby authorize the inspection of this property as required by the United Counties of Leeds and Grenville. I/We understand any inspections conducted are for administrative and assessment purposes only. These inspections do not determine compliance with by-laws or building codes, and provide no guarantees. I/We authorize a representative of the United Counties of Leeds and Grenville to take digital photographs of the property/home for the purpose of documenting the project for Ontario Renovates funding. I/we hereby certify that all information contained in this application, including the declared income and assets is true and complete in every respect. I/we acknowledge that in the event that the United Counties of Leeds and Grenville discovers that a false declaration has been made on this application, the Counties shall have the right to cancel the approval and I/we will be liable for repayment of all funds issued under the Ontario Renovates program on my/our behalf. Print Name Signature Dated Print Name Signature Dated Print Name Signature Dated April 2015 Page 5 of 6

6 Ontario Renovates Application Document Checklist: Your application will be delayed if required supporting documentation is missing. Copies of the following documents must be attached to your application: Item: Government issued photo identification (e.g. passport, drivers licence, photo health card) copied front and back that includes date of birth must be provided for all homeowners. Proof of income for each source of income (e.g. pay stubs, pension and benefit statements). tice of Assessment from Canada Revenue Agency for the most recent tax year (i.e. after July 1 st, the year immediately preceding the current year). Verification of all assets, e.g. current bank statements, vehicle ownership, statements of investments and business interests. t Applicable Verification of any other government funding received (e.g. Investment in Affordable Housing (IAH), Residential Renovations Assistance Program (RRAP), Affordable Housing Program (AHP), or other), if applicable. Verification that mortgage payments or land lease statements for mobile home owners are paid up-to-date. Verification that house insurance for the property is paid upto-date. Verification that property taxes are paid up-to-date. Copy of the Municipal Property Assessment Corporation (MPAC) notice if house value is not included on the property tax assessment. Submit your completed application with all supporting documentation to: The United Counties of Leeds and Grenville Human Services Division Housing Department 25 Central Avenue West, Suite 200, Brockville, ON K6V 4N6 For more information or assistance in completing your application, please call: or extension 2401 April 2015 Page 6 of 6

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