Home Repair Survey Download PDF Click Here Date(Required) MM slash DD slash YYYY Name(Required)Property Address(Required)City(Required)Zip(Required)County(Required)Email(Required) Phone(Required)Have you owned & occupied your single family home for one year or more?(Required) Yes No Do you have the deed in your name(Required) Yes No Is your home a Mobile Home?(Required) Yes No Is it on your own land ?(Required) Yes No Do you have current Homeowners Insurance?(Required) Yes No Are your property taxes current?(Required) Yes No How many people live in your household?Total(Required)How many over 60(Required)How many disabled(Required)What is the TOTAL household gross income from all household members? month or year?(Required)Do you have more than $15,000 in assets (checking, savings, IRA, 401K, CDs, etc)(Required) Yes No Please provide a description of the repairs / accessibility modifications needed. (i.e. roofing, plumbing, electrical, etc.)(Required)PO Box 460, Bloomfield, NY 14469 T (585)657-4114 F (585)657-4167 ApplicationIntake@SheenHousing.org TDD: 1-800-662-1220 WWW.SHEENHOUSING.ORG Bishop Sheen Ecumenical Housing Foundation, Inc. is an equal opportunity provider and employer serving housing needs in the counties of Allegany, Cayuga, Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Tioga, Tompkins, Wayne and Yates Contact us contact us
