Gross Income Estimate List all income sources for all household members living in the home and all income sources before taxes. Household Household Household Owner Member # 2 Member # 3 Member # 4 Name Salary Tips, bonuses, Commissions, fees and or Overtime Pay Social Security Income Retirement or Pension Funds payments Unemployment Benefits Worker's Compensation Net income from a business Alimony, Child Support Welfare Payments for Rent or Utilities Cash gifts/stipends exceeding $200 a month Assets Savings Account Checking Account Do you own any rental or additional properties? Stocks, Annuties Other income Circle One monthly / monthly / monthly / monthly / weekly weekly weekly weekly bi-weekly Household Total If needed, attach additional income information using a copy of the application. Upon preliminary approval, additional Information will be required. Signature acknowledges applicant has read and agrees to The Program Information and Assistance Policy for Safe Home and LeadSafe Charlotte.
Gross Income Estimate List all income sources for all household members living in the home and all income sources before taxes. Owner Household Member # 2 Household Member # 3 Household Member # 4 Name Salary Tips, bonuses, Commissions, fees and or Overtime Pay Social Security Income Retirement or Pension Funds payments Unemployment Benefits Worker's Compensation Net income from a business Alimony, Child Support Welfare Payments for Rent or Utilities Cash gifts/stipends exceeding $200 a month Assets Savings Account Checking Account Do you own any rental or additional properties? Stocks, Annuties Other income Circle One monthly / weekly monthly / weekly monthly / weekly bi-weekly monthly / weekly Household Total If needed, attach additional income information using a copy of the application. Upon preliminary approval, additional Information will be required. Signature acknowledges applicant has read and agrees to The Program Information and Assistance Policy for Safe Home and LeadSafe Charlotte.
Pre%20Qualification%20Application.docx