Clark County Washington
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Community Services > Housing Preservation

Program Inquiry - Homeowner's Rehabilitation Loan

Please complete and submit this form. If it appears you may be eligible, we will mail you an application packet.

Name Telephone A value is required.Invalid format.
Physical Address
City ZipCode A value is required.Invalid format.
E-Mail Address  
Do you own and live in the home that you want to repair? Yes No
Does anyone else own the property with you? Yes No
What are the names on the property deed?
Do you live in a stick-built home? Yes No
What year was the house built? How many people live in the household?
How many are age 18 or over?
What is the total household monthly gross income? Include income of all persons age 18 and over.
What are the sources of income?  
Do you own any other real estate? Yes No
Do you have other assets such as stocks, bonds, certificates of deposit, individual retirement accounts? Note: This does not include the value of the home and one vehicle. Yes No
What is the value of your assets? What is the amount of interest income you receive monthly?
What are the repairs that need to be made to the home?  
When did you purchase the home? What is the current assessed value of the property?
Do you have equity available for a loan? Yes No
Do you have a mortgage? Yes No
What is the balance owed on the mortgage?
Do you have a home equity loan or a second mortgage? Yes No
What is the balance owed on the loan?
Are there any other liens against your property? Yes No
What is the amount?
Are you buying the home on contract? Yes No
If so, will the owner consent to approving an additional loan? Yes No
Are the property taxes paid? Yes No
Are the taxes included in your mortgage? Yes No
Do you have homeowner's insurance on the home? Yes No
Do you file federal income tax returns? Yes No

If you have any questions, contact:
Samantha Whitley
360-397-2075, ext. 7842




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Clark County Community Services: Vanessa R. Gaston, Director
Street address: 1601 East Fourth Plain Boulevard, Bldg 17, Suite A419, Vancouver, WA 98661
Mailing address: P.O. Box 5000, Vancouver, WA 98666-9810
Main phone: (360) 397-2130 | FAX: (360) 397-6028
Community Services Fraud and Abuse Hotline
The Fraud and Abuse Hotline number is (360) 397-8030 and is for the reporting of suspected fraud or abuse related to payment for services. Messages may be left anonymously. To speak directly with the Department Compliance Officer, call (360) 397-2075 ext. 7819.
Responsible Elected Official: Board of Clark County Commissioners

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