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2. Owner's Name*
3. Email Address
5. Property Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Cell Number
14. For assistance with completing this application please call Urban Programs at 603-589-3085.
16. Best way to contact

    1. Phone
    2. Cell
    3. Email

    Please check the box for the best method to contact you
18. Select one or both

    1. Lead Paint Program
    2. Home Improvement Program (1-4 Family Properties Only)
20. In order of priority briefly list which home improvements are needed:
22. Tenant Income Limits (the income of only those who reside at the property is considered)
    Occupants residing at the property must meet certain income percentages for investor-owned properties. In general the following conditions apply:
24. Multi-family properties:
    Half of the units must be rented to tenants whose income does not exceed 50% area median income (AMI); the remaining units must be rented to tenants whose income does not exceed 80% AMI; if the property has five or more units, 20% of the units may be rented to tenants whose income exceed 80% AMI
26. Single-family properties:
    Tenants annual household income cannot exceed 80% AMI.
28. Examples:
    A 4 unit building must have 2 units with tenants at or below 50% AMI and 2 units with tenants at or below 80% AMI. A 10 unit property must have 4 units with tenants at or below 50% AMI, 4 units with tenants at or below 80% AMI and 2 units at any income (exceeding the limits).
30. 2020 HUD Income Limits (Based on household size) City of Nashua, NH
    Effective April 2020. Income limits are published by HUD on an annual basis and subject to change.
32. 
34. List Household Members: Name / Age / DOB
    List the names, ages and dates of birth for each person residing in your home. Include non-relative residents as well.
36. How did you hear of this program?
38. Documents and attachments:

    1. Pay stubs, SSI Award Letters, Unemployment statements, etc for each adult in the household
    2. Non working adults must complete a "Zero Income Form". Ask staff for more information and assistance.
    3. A copy of the deed (this may be available to us online, please check with program staff)
    4. Proof you do not reside at property, such as vehicle Registration or utility bill
    5. Proof property insurance is up-to-date (Declaration Page)
    6. Copy of current mortgage statement or bill, including second mortgage, if applicable
    7. If property is an LLC, list of members and verification you are authorized to apply
    8. Provide any violation notices or "Order to Correct Violations"

    Please attach the following documentation for your property and your household members. Note: A separate application must be summitted for each Rental Unit in the building.
40. Names and addresses of each person listed on deed:
42. Total # of property units:
43. Year property was built:
45. List Occupied Units Profile: Example: Unit 1: Owner Unit / Unit 2: Rented/family of 4 / Unit 3; Vacant
47. # of kitchens:
48. # of living rooms:
49. # of bathrooms:
50. # of bedrooms:
52. Are your mortgage payments up-to-date?

    1. Yes
    2. No
    3. None
54. Are the real estate taxes on all Nashua properties which you have financial in interest in up-to-date?

    1. Yes
    2. No
56. Are the water and sewer bills for all Nashua properties which you have financial in interest up-to-date?

    1. Yes
    2. No
58. Are there any liens against this or any Nashua property you have financial interest in?

    1. Yes
    2. No
    3. If yes, explain: _______________________________________________
60. Have you been ordered to correct lead hazards by the State?

    1. Yes
    2. No
62. Do you authorize us to communicate with the State regarding the status of this property?

    1. Yes
    2. No
64. Please upload documents below.
    Use only one field for each attachment. If you need to submit more documents than space permits, please email additional documents to Stephen Vega: vegas@nashuanh.gov (include RE: "Additional Attachments" and the address of the property in the subject line.) If you require assistance contact Steve Vega @ 603-589-3071
66. Document 1
67. Document 2
68. Document 3
69. Document 4
71. Document 5
72. Document 6
73. Document 7
74. Document 8
76. Document 9
77. Document 10
78. Document 11
79. Document 12
81. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
83. Electronic Signature
Leave This Blank:


85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit

* indicates a required field