BLUE VALLEY COMMUNITY ACTION PARTNERSHIP
620 5th Street, P.O. Box 273, Fairbury, NE 68352-0273
Phone: 402-729-2278 Fax: 402-729-2801
OWNER OCCUPIED HOUSING REHABILITATION PROGRAM APPLICATION
My/Our signature(s) below certifies that the information contained in this application is accurate and complete to the best of my/our knowledge. I hereby grant permission to Blue Valley Community Action Partnership, Inc. (BVCA) to verify any or all information contained herein with respect to this application for assistance. I understand the information in this application is strictly confidential, and is provided solely for the purposes of determining my/our eligibility for assistance under the Owner-Occupied Housing Rehabilitation program. No information contained herein will be released to any other local, state, or federal agency for any purpose without my express written consent, except as it may pertain to my receipt of the funding resources made available through this application. I/We do certify that all information written or verbal that is remitted to Blue Valley Community Action Partnership, Inc. now or in the future, for the purpose for obtaining funds from the Owner-Occupied Housing Rehabilitation program the I/We are applying for are true to the best of my/our knowledge. I/We understand that any knowingly and/or willfully falsified documentation or statement(s) may be grounds for denial for participation in the Owner-Occupied Housing Rehabilitation program applied for, and that any and all Rehabilitation construction in progress will cease immediately. I/We understand and agree that any program funds obtained under knowingly and/or willfully falsified documentation or statement(s) will be reimbursed immediately and if full to Blue Valley Community Action partnership, Inc.