Charlotte, NY · Chautauqua County
Charlotte Town Rehab Program Pre-Screening Form
This pre-screening form helps income-eligible homeowners in the Town of Charlotte express interest in Community Development Block Grant assistance for necessary home repairs.
What this form is
The form supports an application to the NYS Office of Community Renewal for Community Development Block Grant funds for necessary home repairs. It asks homeowners about their property, household, repair needs, and gross income, including income sources and amounts. The form says total annual household income must be below the listed limit for the household size.
Who needs it
Homeowners in the Town of Charlotte who are interested in repair assistance through the program should complete this pre-screening form.
How to submit it
Return the completed form to Town Hall or mail it to Chautauqua Home Rehabilitation and Improvement Corp (CHRIC), 2 Academy St., Mayville, NY 14757.
About notarization
This form is signed without a notary; the signer only needs to sign the form.
How to submit this form
- 1
Download The Form
Download the Charlotte Town Rehab Program pre-screening form.
- 2
Complete The Questions
Enter your contact and property details, repair concerns, household information, and gross income sources and amounts.
- 3
Review And Sign
Review your responses and sign the form.
- 4
Return The Form
Return it to Town Hall or mail it to CHRIC at 2 Academy St., Mayville, NY 14757.
Frequently asked questions
- What is the Charlotte Town Rehab Program form for?
- It is a pre-screening form to show interest and demonstrate need for Community Development Block Grant funds for necessary home repairs.
- Who should complete this form?
- Homeowners in the Town of Charlotte interested in repair assistance should provide property, household, repair, and gross income information.
- Do I need a notary for the Charlotte Town Rehab Program form?
- No. This form is signed without a notary; the signer only needs to sign the form.
- How do I submit the Charlotte Town Rehab Program form?
- Return it to Town Hall or mail it to CHRIC at 2 Academy St., Mayville, NY 14757.