City of Lawrenceburg

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* 1. What is your name (optional)

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* 2. What is the address of the property needing repairs?

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* 3. Are you the property owner? (mortgage or deed holder, life estate only, no land contracts)

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* 4. Do you occupy the property as your primary residence?

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* 5. (Check all the apply) I am:

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* 6. Rehabilitation Need (check all that apply)

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* 7. Do you have enough disposable income to pay for needed repairs?

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* 8. Are there hazards in your house which affect your safety?

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* 9. Would you have to move out if the issues are not rehabilitated?

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* 10. How old is your home?

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* 11. How long have you had issues with your home?

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* 12. Have you tried to get needed repairs paid for by other means?

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* 13. Do you have pictures of issues with your home you’d be willing to share with us?

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* 14. Do you support Lawrenceburg’s application for OOR funds? Why or why not?

Send pictures to Victoria Bechert, victoria.bechert@sirpc.org or mail copies to:

SIRPC
PO Box 765
Versailles, IN 47042

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