Ontario Renovates Application
For Office Use Only
Date Received:
Time Received:
Date and time that all required documents were provided:
Ontario Renovates funding is limited. Complete and submit your application as soon as possible.
Applications are assessed and approved chronologically based on the date the application is determined
complete and subject to funding availability. Any repairs or modifications already in progress, or
completed prior to project approval are not eligible for Ontario Renovates funding.
Applicant Information:
Homeowner’s full name(s):
1.
2.
3.
Required:
Government issued photo identification, copied front and back that includes date of birth must be
provided for all homeowners.
Address:
Number
Street
Unit/Suite/P.O. Box
City/Town
Province
Postal Code
Telephone Number
Alternate Telephone Number
Email
Is this the sole and principal residence of all homeowners?
Yes
No
Alternate contact in the event that you cannot be reached:
Name
January 2013; Rev. October 2013; April 2015
Telephone Number
Page 1 of 6
Ontario Renovates Application
Income and asset information must be provided for all household members over the age of 18,
regardless who owns the home.
Gross Household Income:
Report gross income amounts for all sources of income for all household members. Gross income
means income before taxes and other deductions. Sources of income may include employment,
pensions, WSIB, Employment Insurance Benefits, other insurance payments, social assistance,
child/spousal support, Canada Child Tax Credits, investment or business income.
Household Member:
Source of Income:
Household Member:
Source of Income:
Household Member:
Source of Income:
Household Member:
Source of Income:
Household Member:
Source of Income:
Household Member:
Source of Income:
Gross Annual Income:
$
Gross Annual Income:
$
Gross Annual Income:
$
Gross Annual Income:
$
Gross Annual Income:
$
Gross Annual Income:
$
Total Gross Annual Income for all Household Members: $ ____________________
Is any household member reporting income above over the age of 18 enrolled full-time in postsecondary education?
Yes
No
If yes, please name the individual and the school name they are attending:
Required:
Verification of income (i.e. pay stubs, pension and benefit statements)
Prior year Notice of Assessment (NOA) from the Canada Revenue Agency. Effective July 1st, the NOA
for the year immediately preceding the current year is required.
April 2015
Page 2 of 6
Ontario Renovates Application
Household Assets:
List all household assets including investments and business interests, recreational vehicles, and boats.
Household member:
Type and Description of Asset:
Value of Asset: ($)
Required: Verification of assets (i.e. bank and investment statements showing current account
balances, vehicle ownership, recreational vehicles such as boats, snowmobiles, camper, etc.). Do not
provide RRSP, RDSP, RRIF and RESP statements.
Proposed Project Information:
Ontario Renovates funding is only available for applicants/projects that have not received other
government funding specified below.
Funding may be allowed for a unit that previously received funds under another federal and/or
provincial repair-type program (e.g. Residential Rehabilitation Assistance Program, repairs under
Community Homelessness Prevention Initiative, Ontario Renovates), provided that the repair addresses
a need or condition of work which has not been previously funded, and is for a different program subcomponent (e.g. home repair project or accessibility repair).
Have the applicant(s) and/or this property or project received previous government funding through
any of the projects listed below?
Yes
No
Ontario Renovates funding cannot be used for units that have received
funding under the Affordable Housing Program (2005), AHP extension (2009),
or IAH funding under the Rental and Supportive or Rental Housing
Component.
Residential Rehabilitation Assistance Program (RRAP) (assistance for home
repairs previously administered by Canada Mortgage and Housing
Corporation (CMHC))
Affordable Housing Program (AHP) (i.e. Home Ownership program)
Required:
If yes to any of the above, provide the project reference number, details of the work completed, and the
date of approval.
April 2015
Page 3 of 6
Ontario Renovates Application
Property Description:
Semi-detached
Age of house:
Detached
Townhouse/Row house
Value of House:
Is your home a mobile home? Yes
Other
Number of Bedrooms:
No
If you have a mobile home, are land lease payments paid up to date? Yes
No
NA
Property Clearance:
Mortgage paid up to date?
Insurance paid up to date?
Property taxes paid up to date?
Yes
Yes
Yes
No
No
No
Required:
Supporting documents to verify that payments for mortgage, land lease for mobile home, insurance
and property taxes are current. House value can be verified by the property tax bill or a Municipal
Property Assessment Corporation (MPAC) assessment notice. (www.MPAC.on.ca or 1-866-296-6722)
Scope of Work: (check all that apply)
Home Repairs: Estimated cost (if known) $__________________________
Heating Systems
Chimneys
Doors and Windows
Foundations
Vents/Louvres
Roof
Walls
Floors
Ceilings
Electrical System (solar panels
are not eligible)
Plumbing
Septic system
Well water/well drilling
Other: Please specify ______________________________________________________________
Scope of Work (continued): (check all that apply)
Accessibility Repairs: Estimated cost (if known) $__________________________
Accessibility repairs must be reasonably related to a household member’s disability. Additional medical
information may be required to support your request. Mobility equipment such as walkers, wheelchairs,
and scooters and supportive care are not eligible for accessibility funding.
Ramps
Handrails
Grab bars
Chair and bath lift
Height adjustment to
countertops, upper cabinets
Cues for doorbells
Fire alarms
Other: Please specify ______________________________________________________________
Please note: Two written quotes from an arm’s length contractor will be required after a home
inspection has been completed by Counties staff. “Arm’s length” means the buyers and sellers of a
product or service act independently and have no relationship to each other. The quotes are not
required to be submitted with this application.
April 2015
Page 4 of 6
Ontario Renovates Application
Applicant Declaration:
•
I/we hereby confirm that I/we are the owners of the house and property located at the address
identified in this application and that no other person is an owner.
•
I/we hereby grant permission to the United Counties of Leeds and Grenville to make any
necessary inquiries to verify my/our income, assets, and any other eligibility criteria.
•
I/we hereby acknowledge that if this application is approved it will not apply to any prior work
completed.
•
I/we hereby acknowledge that if this application is approved, I/we cannot apply for any provincial
tax rebate programs for these repairs.
•
I/We hereby authorize the inspection of this property as required by the United Counties of Leeds
and Grenville.
•
I/We understand any inspections conducted are for administrative and assessment purposes only.
These inspections do not determine compliance with by-laws or building codes, and provide no
guarantees.
•
I/We authorize a representative of the United Counties of Leeds and Grenville to take digital
photographs of the property/home for the purpose of documenting the project for Ontario
Renovates funding.
•
I/we hereby certify that all information contained in this application, including the declared
income and assets is true and complete in every respect.
•
I/we acknowledge that in the event that the United Counties of Leeds and Grenville discovers that
a false declaration has been made on this application, the Counties shall have the right to cancel
the approval and I/we will be liable for repayment of all funds issued under the Ontario Renovates
program on my/our behalf.
Print Name
Signature
Dated
Print Name
Signature
Dated
Print Name
Signature
Dated
April 2015
Page 5 of 6
Ontario Renovates Application
Ontario Renovates Application Document Checklist:
Your application will be delayed if required supporting documentation is missing. Copies of the
following documents must be attached to your application:
Item:
Yes
No
Not
Applicable
Government issued photo identification (e.g. passport, drivers
licence, photo health card) copied front and back that includes
date of birth must be provided for all homeowners.
Proof of income for each source of income (e.g. pay stubs,
pension and benefit statements).
Notice of Assessment from Canada Revenue Agency for the
most recent tax year (i.e. after July 1st, the year immediately
preceding the current year).
Verification of all assets, e.g. current bank statements, vehicle
ownership, statements of investments and business interests.
Verification of any other government funding received (e.g.
Investment in Affordable Housing (IAH), Residential
Renovations Assistance Program (RRAP), Affordable Housing
Program (AHP), or other), if applicable.
Verification that mortgage payments or land lease statements
for mobile home owners are paid up-to-date.
Verification that house insurance for the property is paid upto-date.
Verification that property taxes are paid up-to-date.
Copy of the Municipal Property Assessment Corporation
(MPAC) notice if house value is not included on the property
tax assessment.
Submit your completed application with all supporting documentation to:
The United Counties of Leeds and Grenville
Human Services Division – Housing Department
25 Central Avenue West, Suite 200, Brockville, ON K6V 4N6
For more information or assistance in completing your application, please call:
613-342-3840 or 1-800-267-8146 extension 2401
April 2015
Page 6 of 6