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2. Department of Housing and Neighborhoods
4. Homeownership Program Pre-Application
6. First Name*
7. Last Name*
9. Email Address
10. Phone Number*
11. Birth Date*
    Birth Date
13. Address1*
15. Address2
17. City*
18. State*
19. Zip*
21. Have you utilized City of Lima Services in the past?*

    1. Yes
    2. No
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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