We can help with your rent or mortgage We Pay Your Mortgage Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Do you rent or own Rent Mortgage How much is your monthly rent or mortgage? Describe Your HardshipDrop Files Here Drop files here or Select files Max. file size: 50 MB. · Letter summarizing the situation and the financial hardship created by it · The amount of the need · The amount being requested · What the market center has done to provide financial and other assistance to the applicant · The market center’s plans for continued assistance, if needed · Two most recent signed federal income tax returns in their entirety with 1099s and/or W-2s attached · Copies of most recent statement(s)/bill(s) for assets and liabilities · Copies of most recent statement(s)/bill(s) for income and monthly expenses · Copies of bills for medical (or other) and/or living expenses which have been incurred as a result of the situation · Signed physician’s statement (if this a medical situation) · If the applicant has health insurance, please submit a summary of all claims from the insurance provider indicating the patient’s responsibility for the charges, if applicable · If the applicant has homeowner’s flood or wind insurance, please submit limits of coverage, if applicable
