The Texas Association of REALTORS® has set up a relief fund for persons who have suffered losses due to natural disasters in Texas. This application is for Texas residents who have suffered property damage to their primary residence as a result of the severe weather and flooding event which began June 18, 2018. Relief assistance is limited to a maximum of $1,000 per applicant, and is restricted to those located within the jurisdiction of a participating local REALTOR® association and counties for which the governor has declared a state of disaster. To apply for assistance, complete this form in full and attach any required documentation. If you have any questions, you may call 800-873-9155 or email disasterrelief@texasrealtors.com.

Application deadline: July 27, 2018

Applicants who do not respond to each question and who do not provide the required supporting documentation will not be considered.
Primary residence address

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* 2. Primary residence address

Applicant information

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* 3. Applicant information

Current mailing address

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* 4. Current mailing address

Do you own or rent your property?

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* 5. Do you own or rent your property?

Monthly mortgage payment or rent:

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* 6. Monthly mortgage payment or rent:

Describe the damage to your property as a result of the natural disaster
You are required provide proof to support your answers. Refer to “Supporting documentation” to see examples of the documentation required.

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* 7. Describe the damage to your property as a result of the natural disaster
You are required provide proof to support your answers. Refer to “Supporting documentation” to see examples of the documentation required.

Answer only if you own your residence:
Describe the financial loss relating to damages to your primary residence
Give a full description of the damages to the structure only. You must provide proof to support your answers. Refer to “Supporting documentation” to see examples of the documentation accepted.

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* 8. Answer only if you own your residence:
Describe the financial loss relating to damages to your primary residence
Give a full description of the damages to the structure only. You must provide proof to support your answers. Refer to “Supporting documentation” to see examples of the documentation accepted.

Describe in detail how you will use the funds from the Texas REALTORS® Relief Fund to make repairs, obtain shelter, or pay for other expenses not cover by insurance

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* 9. Describe in detail how you will use the funds from the Texas REALTORS® Relief Fund to make repairs, obtain shelter, or pay for other expenses not cover by insurance

Are you displaced from your property?

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* 10. Are you displaced from your property?

How long have you been displaced?

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* 11. How long have you been displaced?

How long do you anticipate being displaced?

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* 12. How long do you anticipate being displaced?

If you have been displaced, where are you currently residing?

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* 13. If you have been displaced, where are you currently residing?

Describe the financial loss and/or costs associated with your displacement as a result of the damage to your property
You must provide proof to support your answers. Refer to “Supporting Documentation" to see the types of documents accepted. 

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* 14. Describe the financial loss and/or costs associated with your displacement as a result of the damage to your property
You must provide proof to support your answers. Refer to “Supporting Documentation" to see the types of documents accepted. 

Are your losses covered by an insurance policy?

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* 15. Are your losses covered by an insurance policy?

Enter your insurance information

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* 16. Enter your insurance information

Did you claim additional living expense reimbursement?

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* 17. Did you claim additional living expense reimbursement?

If so, what amount has been paid/reimbursed or will be paid/reimbursed?

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* 18. If so, what amount has been paid/reimbursed or will be paid/reimbursed?

Enter the total uninsured loss to your primary residence

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* 19. Enter the total uninsured loss to your primary residence

If you received or will receive financial assistance from any other sources, list them (including amounts)

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* 20. If you received or will receive financial assistance from any other sources, list them (including amounts)

Are you a current Texas REALTOR® member?

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* 21. Are you a current Texas REALTOR® member?

Supporting documentation

You must include proof of residency (e.g., a copy of your driver’s license or other government documentation evidencing residency) with this application. Your application cannot be processed without it.

You must provide proof to support your answers. The following are examples of documents that may be used to support your claim:
  • Photographs of damage to property structure of primary residence (no more than 5 photographs, please)
  • Copies of repair estimates from contractors
  • Copies of written claims, settlement proceeds, or claim status reports
  • Copies of hotel/motel receipts
  • Copy of your current mortgage statement or other documentation that provides proof of monthly mortgage payment amounts (if you own) or copy of your current lease or other documentation that provides proof of monthly rental and security deposit amounts (if you rent)
  • Copy of new lease or other documentation, which provides proof of monthly rental and security deposit amounts
Applicants who do not respond to each question and who do not provide the required supporting documentation will not be considered.

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* 22. Supporting documentation

You must include proof of residency (e.g., a copy of your driver’s license or other government documentation evidencing residency) with this application. Your application cannot be processed without it.

You must provide proof to support your answers. The following are examples of documents that may be used to support your claim:
  • Photographs of damage to property structure of primary residence (no more than 5 photographs, please)
  • Copies of repair estimates from contractors
  • Copies of written claims, settlement proceeds, or claim status reports
  • Copies of hotel/motel receipts
  • Copy of your current mortgage statement or other documentation that provides proof of monthly mortgage payment amounts (if you own) or copy of your current lease or other documentation that provides proof of monthly rental and security deposit amounts (if you rent)
  • Copy of new lease or other documentation, which provides proof of monthly rental and security deposit amounts
Applicants who do not respond to each question and who do not provide the required supporting documentation will not be considered.

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By signing this application, I attest that I have answered all questions truthfully and to the best of my ability.
Please type your full name as a digital signature:

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* 32. Please type your full name as a digital signature:

Please enter today's date

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* 33. Please enter today's date

Date 

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