City of Burton - Project Heat's On
Event Date: Saturday, October 17th
Application Deadline: Wednesday, October 7th
Home Owner Info
Homeowner's Name
Address
Phone Number
Cell Number
Do You Own Home?
Number of Years
Is this a Rental Home?
Current Estimated Value of Home
Mortgage Company Name
Borrower(s) names
Are you delinquent 30 days or more on your mortgage?
Yes
No
Are the homes Property Taxes paid up to date?
Yes
No
How many live in the household?
Adults
Children
Seniors
Employment Info
Employer
Date Hired
Has there been an income change in the past 12 months?
Yes
No
Total Household Income
Other income Sources?
Furnace Info
Do you have a Furnace, Boiler, or Electric Heat?
Gas or Oil?
Gas
Oil
Date of last service?
Reason for service
Is your furnace in working condition now?
Yes
No
If no, please explain:
Average heating bill?
Does the home contain Smoke or Carbon Monoxide Detectors?
Yes
No
Are they working?
Yes
No
Submit Application
