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About
Give
Programs
- Residential
- Downtown Revitalization
  - New York Main Street Program
  - Economic Development Community Development Block Grant (CDBG)
Community Development
Preservation
- Awards Granted to PRIDE
- Recognition
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Contractors
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Opportunities
Contact

Essex County’s CDBG Home Rehabilitation Program

Essex County’s Community Development Block Grant (CDBG) Home Rehabilitation program for 2023-25 will fund six owner-occupied home rehabilitations for low to moderate-income residents of Essex County. This grant is administered through a partnership with the Essex County Board of Supervisors.

Below is our online application. If you need any assistance with the online application, please call our office at 518-585-6366. We are also happy to mail you a paper copy!

New York State’s Community Development Block Grant (CDBG) Program supports community development activities to build stronger and more resilient communities. To support community development, activities are identified through an ongoing process. Activities may address needs such as infrastructure, economic development projects, public facilities installation, community centers, housing rehabilitation, public services, clearance/acquisition, microenterprise assistance, code enforcement, homeowner assistance, etc.

Application Form

Before you begin

Applications will be reviewed for program eligibility on a first-received basis. Applications not funded through this program will be added to the PRIDE’s waiting list, which is based on a first come first served basis, so you want to make sure that you get your completed application in as soon as possible.

In order to complete this form you must be prepared to upload the documents listed below. You cannot submit the form without them. Please take the time to assemble the necessary documentation before you begin. If you have any questions, don’t hesitate to contact us.

Also, please fill out this form on a PC (not your phone) where you have access to the required documents.

NOTE: if you don’t need a copy of a document (mortgage, for example) you MUST upload an empty file.

This CDBG Program will be utilizing the HUD Approved – IRS Form 1040 Definition of Income to determine household income eligibility. The following documents must be submitted with your application:

Required Documents

A SIGNED copy of your last 2 years Federal Income Tax return and all applicable schedules with the W-2s.
Proof of any other income (including but not limited to annual social security statement from the Social Security Office, annual SSI statement from SSI office, pensions, unemployment benefits, welfare, child support, alimony, etc.).
The deed or recorded life use document to your poperty.
Latest property tax bills & receipts showing paid (County, City, School). (Property taxes must be current)
Proof of homeowner’s insurance.
Bank Books and latest bank statements for all checking and savings accounts, stocks and bonds, and certificates of deposit, and proof of all asset income for all household members.
Mortgage Statement, if mortgage/s on property as applicable.

Privacy Act Notice

This information in this application is to be used by the entity collecting it or its assignees in determining your qualifying for rehabilitation assistance under its program(s). It will not be disclosed outside the agency except as rquired by law. You do not have to provide this informatio, but if you do not your application for approval as a recipient under its program(s) may be delayed, limited, or rejected.

Non-Discrimination Policy

Federal and State Law prohibit discrimination on the basis of age, sex, race, national or ethnic origin, handicap or familial status. The Village of Tupper Lake is committed to serving its community without discrimination, and will comply with all rules and regulations regarding Fair Housing, Equal Opportunity, and Minority and Small Business Participation. The following data is for statistical purposes only and will not be used by any local, state or federal agency in making decisions regarding assistance.

AHC App - Community Development Block Grant (CDBG)

Applicant Info

Applican'ts Full Name

Year of Birth

Co-Applicant's Name *

Co-Applicant's Year of Birth *

Sex of Head of Household *

Male

Female

Age of Head of Household *

Is any member of household handicapped *

Yes

Is any member of household disabled *

Yes

Dependents (Name, Age, Relationship)

Other Adult Members of Household (Non-Dependent) (Name, Age, Relationship)

Street Address *

Township & Zip *

Work, Home, or Cell Phone *

How long at the above address? *

Earned Income (Include employment and self-employment income for all household members for the last tax year).

Primary Applicant's Name *

Employer *

Annual Gross Wages *

Date of Commencement *

Other income sources (Veterans, SSI, Pension, Rental Income, Interest, Child Support, Alimony, etc.)

Assets

Bank CHECKING Account *

Yes

Amount $ *

Name/Address of Bank

Bank SAVINGS Account *

Yes

Amount $ *

Name/Address of Bank

Other Assets - Please list your assets and estimate the value of : home, car(s), other real property, mutual funds, stocks, bonds, etc.Other Assets - Please list your assets and estimate the value of : home, car(s), other real property, mutual funds, stocks, bonds, etc.

Debts - Please list your debts and amounts: mortgage installment accounts, auto and other loans.

Debtor Payment Name/Type #1 *

Purpose

Date Incurred

Amount

Balance

Debtor Payment Name/Type #2

Purpose

Date Incurred

Amount

Balance

List Purpose, Date Incurred, Amount, and Balance of additional debtors.

About the House

Have you owned and occupied your residence for one year or longer? *

Yes

Number of Rooms *

Number of Bedrooms *

Number of Baths *

Type of Home (i.e., single, multi-family, mobile, farm, etc.) *

Year Built (approximate) *

Date of Mortgage (approximate) *

Name of Title/Deed Holder(s) *

Foundation *

Foundation's Condition *

Good

Fair

Poor

Roof *

Roof's Condition *

Good

Fair

Poor

Exterior *

Exterior's Condition *

Good

Fair

Poor

Exterior Doors *

Door Condition *

Good

Fair

Poor

Windows *

Window Condition *

Good

Fair

Poor

Plumbing *

Plumbing Condition *

Good

Fair

Poor

Electrical *

Panel Type *

Fuse

Breaker

Heating *

Age *

What do you need done most?

How would you typify yourself

The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This informatin will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.

White

Black/African American

Hispanic

Asian

Asian/Pacific Islander

Native Hawaiian/Other Pacific Islander

American Indian/Alaskan Native

Asian & White

Black/African American & White

American Indian/Alaskan Native & White

American Indian/Alaskan Native & Black/African American

Other Multi-Racial

Agreement

I (we) hereby apply for Rehabilitation financial assistance from PRIDE of Ticonderoga, Inc. for funds toward the cost of improvements to our existing owner-occupied home. I (we) have read the accompanying Handbook and if selected, agree to sign a note and mortgage for the amount of the grant provided to me (us) for (our) home. *

I Agree

Authorization & Consent

I (we) hereby certify that the above statements are true, accurate, and complete to the best of my (our) knowledge and belief. False statements made knowingly by the applicant will disqualify the applicant from participation in the program and may be subject to prosecution. I (we) hereby consent and authorize PRIDE of Ticonderoga and its authorized agent(s) to: (a) obtain verification of information required for compliance with the regulations of this program, including expenses, employment, property appraisal, and contractor estimates; (b) upon giving reasonable notice, to enter the applicant’s property for the purpose of determining what improvements are needed and to inspect completed work. (c) to disclose the information contained in my/our confidential file to nonprofit organizations or unaffiliated third parties involved in community development, that this information may be used in an attempt to secure funding for my home. *

I Acknowledge that the information is accurate

Required Documentation Checklist

The following documents MUST be submitted with your application as outlined in the Rehabilitation Handbook, Section H.

Federal Income Tax Returns

A SIGNED copy of your last 2 years Federal Income Tax return and all applicable schedules with the W-2s. *

Maximum file size: 516MB

Payroll Stubs

Payroll stubs for the two most recent pay periods - showing year-to-date earnings. *

Maximum file size: 516MB

Proof of any other income

Proof of any other income (including but not limited to annual social security statement from the Social Security Office, annual SSI statement from SSI office, pensions, unemployment benefits, welfare, child support, alimony, etc.). (If no other income, upload an EMPTY file) *

Maximum file size: 516MB

Property Deed

The deed or recorded life use document to your poperty. *

Maximum file size: 516MB

Tax Bills

Latest property tax bills & receipts showing paid (County, City, School). (Property taxes must be current) *

Maximum file size: 516MB

Homeowner's Insurance

Proof of homeowner's insurance. *

Maximum file size: 516MB

Bank Statements

Bank Books and latest bank statements for all checking and savings accounts, stocks and bonds, and certificates of deposit, and proof of all asset income for all household members. *

Maximum file size: 516MB

Mortgage Statement

Mortgage Statement, if mortgage/s on property as applicable. (If no other income, upload an EMPTY file) *

Maximum file size: 516MB

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Office Hours: 9-4 M-F

Pride of Ticonderoga

PO Box 348 / 111 Montcalm Street
Ticonderoga, NY 12883

E: info@prideofticonderoga.org

T: (518) 585-6366

This is an Equal Opportunity Program. PRIDE of Ticonderoga does not discriminate against, nor exclude from participation, any applicant for assistance on the grounds of their race, color, religion (creed), age, disability, sexual orientation, ancestry, national origin, or any other bias prohibited by applicable law.

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PRIDE of Ticonderoga is a non-profit 501 (c)(3) tax exempt organization.