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* 1. What is your name/name of deed holder?

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* 2. What is your address/the address of the home you are submitting this application for?

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* 3. What is the phone number at which we can best reach you?

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* 4. What is your email address? If you do not have one, please leave blank or type N/A.

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* 5. How many people live in this home?

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* 6. What is the age of the oldest person who lives in this home?

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* 7. What do you estimate your gross (pre-tax) household income will be in 2020?

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* 8. How long have you owned this home?

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* 9. What is your current living arrangement?

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* 10. Do you have homeowners insurance?

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* 11. Are your property taxes up to date?

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* 12. Please list the features most in need of repair in your home:

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* 13. Thank you for your time.  If you have any questions, please type them into the box below or contact Rana Scarlett by email (scarlett@sicog.com) or by phone (641-782-8491).

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