Lead Stabilization Program Grant

Owner Name*

First Last

Primary Contact Name (if different from owner)

First Last

Business Entity (if any)

Business Tax ID (if any)

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Other Phone

Primary Email Address*

Other Email Address

Do you or any immediate family members work for the City of Toledo?*

Which department?

Property Address*

Include Unit # if applicable.

Street Address Address Line 2 City State ZIP Code

Parcel #

Available on AREIS website

Lead-Safe Certificate #*

Expiration Date*

Property Description*

If rental, attach proof of rent within Fair Market Rates*

Proof of rent may include active lease agreement or rent schedule. Fair Market Rates can be found under Program Guidelines.

Max. file size: 50 MB.

Is this unit currently occupied?*

Are you part of our current Lead Hazard Control (LHC) grant*

If occupied, attach proof of occupant's 80% AMI income*

Max. file size: 50 MB.

Upload Occupant Income Verification Form*

You can download the form at this link.

Max. file size: 50 MB.

Make reimbursement check payable to:*

Description of Itemized Expenses*

Full Costs*

Please provide the sum of all itemized expenses. Note: Total reimbursement grant award will be 50% of approved costs, up to $5,000 per unit.

Upload Proof of Payment*

Proof of Payment should include any invoices and receipts for itemized expenses, such as invoices from contractors and any copies of checks or credit card receipts showing the same expense paid in full.

Max. file size: 50 MB.

If ownership is an LLC, Corp, or Trust, attach documentation identifying authorized signatories

Max. file size: 50 MB.

Certification*

I understand that intentionally false or misleading information submitted on this application may result in being permanently banned from Department of Neighborhood’s programs. I understand I may be asked for permits, licenses, or other information to verify work has been completed in accordance with applicable laws.

I certify that my answers are true and complete to the best of my knowledge.

Owner E-Signature*

First Last

Today's Date*

Lead Stabilization Program Grant – No longer accepting applications.