Rural Preservation Company of Clinton County - General Application Form
Date of Birth (Head of Household)
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Number of people living in household
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Ages of others in the household
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Do you have homeowner’s insurance? | | |
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Are there any liens on your property? | | |
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Is your home a mobile home? | | |
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Do you own the property where the home is located? | | |
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Do you have a life lease? | | |
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Do you need accessibility modifications for a member of the household? | | |
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Is anyone in your household a Veteran? | | |
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Total Combined Household Income (Select the one your combined income falls below)
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Repairs Needed (Check all that apply)
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Please describe the issues you are having in detail below