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PART 10: REPAIR WORK NEEDED: <br />Give a brief description of the repair work needed: <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />__________________________________________________________________________________ <br />PART 11 <br />GIVING TRUE AND COMPLETE INFORMATION <br />I (We), the undersigned, certify that all of the information provided in this application is true and correct to the best of <br />my (our) knowledge and is submitted for the purpose of the Residential Repair Program. I/We understand that the <br />above information is being collected to determine my (our) eligibility and is submitted for the purpose of obtaining a <br />County rehabilitation loan. I (We) authorize the County of Hawai`i to verify all information contained herein and agree <br />that this application and related verification and statements shall remain the property of the County of Hawai`i. <br />___________________________________________ _____________________________ <br />(Signature of Applicant) Date <br />___________________________________________ _____________________________ <br />(Signature of Other Household Adult Member) Date <br />___________________________________________ _____________________________ <br />(Signature of Other Household Adult Member) Date <br />___________________________________________ _____________________________ <br />(Signature of Other Household Adult Member) Date <br />