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<br /> Harry KimNeil S. Giyotoku <br />MayorHousing Administrator <br />Lance M. Niimi <br />County of Hawai‘i Assistant Housing <br />Administrator <br />Office of Housing and Community Development <br />1990 Kino‘ole Street, Suite 105 • Hilo, Hawai‘i 96720 <br />V/TT (808) 959-4642 • Fax (808) 959-9308 <br />KONA: 74-5044 Ane Keohokalole Highway • Kailua-Kona, Hawai‘i 96740 <br />(808) 323-4300 • Fax (808) 323-4301 <br />RESIDENTIAL REPAIR PROGRAM APPLICATION (RRP) <br />Application must be filled out COMPLETELY. Please use BLACK Ink to complete application. If any question does NOT <br />apply, please acknowledge by writing NONE or NOT APPLICABLE. Do not leave any section unanswered. Be reminded <br />that questions asked apply to ALL Household members. Please print or type. <br />PART 1: GENERAL INFORMATION: <br />APPLICANT <br />(Head of Household): _________________________________________ Phone:________________________ <br />Legal Last Name First Name MI <br />CO-APPLICANT <br />(Spouse or Co-Head): _________________________________________ Other Phone:___________________ <br />Legal Last Name First Name MI <br />Current Address: ____________________________________________________ Apt. No._______________ <br />City: ___________________ State:________________________ Zip:___________ Yrs. at Residence:___________ <br />Previous address if less than 2 yrs. at above ________________________________________ Yrs. at Residence:___________ <br />Check here if mailing address is the same as current address. <br />Mailing Address: ____________________________________________________ Apt. No.__________ <br />City: _________________________________ State:________________________ Zip:______________ <br />PART 2: HOUSEHOLD MEMBERS: <br />Starting on first line for the Head of Household, please supply the information for all adults and children that will live in the housing unit to be assisted. <br />List the adults first, then children. Enter one of the following codes in the “Relation” box to identify the household relationship of each adult and child <br />listed.H = Head of Household K = Co-Head (Not Married) Y = Youth Under 18 L = Live In Aide <br /> S = Spouse (Married) F = Foster Child/ Adult E = Full Time Student Over 18 A = Other Adult <br />Last Name & Sr, Jr, etc. First Name MI Date of Birth SexRelation <br />H (Head of Household) <br />1 <br />Single Race (select one or more) Ethnicity (check one box) <br />\[ \] White \[ \] Asian \[ \] Black or African American \[ \] Hispanic or Latino <br />\[ \] Native Hawaiian or Other Pacific Islander \[ \] Not Hispanic or Latino <br />\[ \] American Indian / Alaska Native <br />Multi Race (select one or more) <br />\[ \] Asian and White \[ \] Other Multi-Racial <br />\[ \] Black or African American and White <br />\[ \] American Indian / Alaska Native and White <br />\[ \] American Indian / Alaska Native and Black <br /> EQUAL HOUSING OPPORTUNITY <br />“HAWAI`I COUNTY IS AN EQUAL OPPORTUNITY <br />PROVIDER AND EMPLOYER” <br />7209rbla <br /> <br />