2020 Urgent Repair Program
Request for Assistance
Moore County Planning & Transportation Department
Pre-Application due to Planning & Transportation Department by 4:30pm on Wednesday, Sept. 30, 2020
Homeowner Name: ___________________________________________________________________
Physical Address of Home: ______________________________________________________________
Mailing Address: ______________________________________________________________________
Point of Contact (If different than homeowner): _______________________________________________
Telephone Number(s): __________________________________________________________________
Monthly Income (Social Security, SSI, Pension, Wages from Job, etc.) =_____________________
First and last names of persons living in home (including homeowner) | Date of Birth | Disability - including physical or mental but not related to substance abuse (Yes/No) | Military Veteran (Yes/No) | Child with elevated blood lead levels living in the home? (Yes/No) | Race | Received prior housing rehab assistance from Moore County? (Yes/No) |
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Mail completed form to: Carlis P. Sweat
Moore County Planning & Transportation Department
PO Box 905
Carthage, NC 28327
Information provided above will be used to rate and rank applicants based on the Priority system outlined within the programs Assistance Policy. Failure to complete all areas may cause the inability to be ranked.
All program information is kept confidential. Please call Moore County Planning & Transportation Department with questions at 910-947-5010.