Form 1-Ro - Rebuild Ohio - Severe Weather Relief For Ohio Homeowners - 2012

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Form 1-RO
2012 Rebuild Ohio - Severe Weather Relief for Ohio Homeowners
Homeowner Application – Part 1
Instructions: this form should be completed by the Homeowner loan applicant. A complete application for the Rebuild Ohio
interest rate reduction program has two forms: 1) The Homeowner Form 1-RO and 2) The Lender/Banker Form 2-RO.
Complete applications consisting of both forms must be submitted by the lender. Please note that all information
submitted to the Ohio Treasury is a matter public record. If you have questions about this application contact the Ohio
Treasury by calling 1-800-228-1102, option #3 or email economicdevelopment@tos.ohio.gov. Note: Call the Treasurer’s
office to obtain a list of eligible banks.
Applicant information
:
_______________________________________________________________________________________
Name
_______________________________________________________________________________________
Street Address
_______________________________________________________________________________________
City
State
Zip Code
County
_______________________________________________________________________________________
Area Code & Phone Number
Email Address
1.
The above Applicant is an Ohio resident:
Yes ( ) No ( )
2.
Is the Homeowner a Veteran or a spouse or surviving spouse of a Veteran?
Yes ( ) No ( )
*Please include a Form DD214 (Member 4) indicating the branch of service, character of discharge and enlistment
dates.
3.
What loan will the interest rate reduction be applied to and what is the current interest rate?
_________________________________________________________________________________________________
4.
Description of affected property: Please submit a copy of the insurance claim or quote from a contractor.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
5.
Describe the effects that the severe weather has had on the property described above. (Include the severity of loss,
loan repayment ability, and other factors the Treasurer of State should take into consideration in the approval process.)
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
6.
Additional Circumstances – Please include information pertaining to additional circumstances that have caused
hardship to you or your family. List financial reasons as well as specific circumstances that should be considered. For
example, a loss of employment, home, or other circumstance that directly impacts your need. Continue on another sheet of
paper, if necessary
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
7.
How will the benefits of the Rebuild Ohio program help you recover from the effects of the severe weather? Continue
on another sheet of paper, if necessary
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Form 1-RO
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