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2. I own and occupy my home in Cass County.*

   1. Yes
   2. No
4. Proof of household income eligibility for all occupants over 18 years of age*

   1. Yes
   2. No
6. I have read the program guidelines.*

   1. Yes
   2. No
8. Applicant's Name*
10. Co-Applicant's Name
12. Address*
14. City*
15. State*
16. Zip Code
18. Phone Number*
19. Contact Method*

    1. Mobile

    1. Home
21. Email address*
23. Signature of Applicant*
24. Date
    Date
26. Signature of Co-Applicant
27. Date
    Date
31. What kind of work are you hoping to complete on your home?
33. What is the emergency need?
37. Family Composition

    Please list everyone who live in your home. You will need to supply financial information for everyone who lives with you over the age of 18.

39. Name
40. Relationship
41. Age
43. Sex

    1. Male
    2. Female
44. Birthdate
    Birthdate
45. Legally Disabled/Handicapped

    1. Yes
    2. No
46. Student

    1. Yes
    2. No
50. Name
51. Relationship
52. Age
54. Sex

    1. Male
    2. Female
55. Birthdate
    Birthdate
56. Legally Disabled/Handicapped

    1. Yes
    2. No
57. Student

    1. Yes
    2. No
61. Name
62. Relationship
63. Age
65. Sex

    1. Male
    2. Female
66. Birthdate
    Birthdate
67. Legally Disabled/Handicapped

    1. Yes
    2. No
68. Student

    1. Yes
    2. No
72. Name
73. Relationship
74. Age
76. Sex

    1. Male
    2. Female
77. Birthdate
    Birthdate
78. Relationship
79. Age
83. Name
84. Relationship
85. Age
87. Sex

    1. Male
    2. Female
88. Birthdate
    Birthdate
89. Relationship
90. Age

92. In order to be considered, applicants must submit the following documents:

    • The deed to the home.
    • A paid mortgage statement.
    • A receipt showing taxes are paid.
    • A copy of paid home insurance.
    • Copy of the most recent year’s tax returns or W-2’s, pay stubs, etc.
    • Proof of child support received.
    • Proof of social security, disability or other income.

    These documents may be mailed or dropped off to:

    Cass County Treasurer's Office
    120 N. Broadway
    Cassopolis, MI 49031

    or scanned and emailed to cdbg@dowagiac.org

Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit Submit and Print

* indicates a required field