Burlington County CARES ACT Application
Preliminary Application for Burlington County CARES Act Mortgage/Utility Assistance Program
Please select which type of assistance you are applying for.
Assistance with Mortgage
Assistance with Mortgage & Utilities
Please provide the following information about your household:
Street Address (including unit # if applicable)
Alternate Phone Type
How many people live in your household?
What is the gross annual income combined for all adult household members?
Income includes, but is not limited to: Gross wages, salaries, tips, commissions, overtime, alimony, child support, pensions, and social security, unemployment and disability benefits.
If you do not want to provide your gross annual income at this time, is your total gross annual income of all adult household members combined less than income listed for your household size on
this program flyer
Are you a home-owner or a renter?
Is the unit your full-time, year round residence?
Was the mortgage bill paid up-to-date as of March 1, 2020?
Are the property taxes for this home paid up to date?
Do you have an active bankruptcy?
Do you receive federal assistance?
How did you hear about Program?
I certify that the information provided herein is true and complete and that any misrepresentation of income or household size reported herein
may be cause for program disqualification. I also understand that this information is to be used only for determining my preliminary eligibility
and does not obligate me in any way.
You will receive notification that your Preliminary Application was successfully submitted. If you do not receive this notification, please resubmit your Preliminary Application.