Instructions

Welcome to the City of Emeryville's 2023 Annual Monitoring online form. We have created this online form which allows each household to submit the self-certification information and upload supporting documents online. Once you submit your self-certification information and documents, they will transfer into our client management system. Please be assured your information is treated as strictly confidential and is never shared beyond Hello Housing and the City of Emeryville.

If you have any questions or concerns about submitting this information, please email emeryville@hellohousing.org or call (925) 495-0015.

Thanks!
Hello Housing Team

Self-Certification of Owner Occupancy

Please provide the requested information below, if you feel that this request has been made in error, please let us know by email or leaving a comment in the section provided at the end of this form. Return your completed form and attached documents by no later than October 27, 2023.

*Indicates a required field.

Step 1: Please provide your contact information

Please provide your Monitoring Id. This is the 18 digit code from your monitoring email or letter (e.g. a0F0W00000r487wAU4).

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Postal Code

Email

Do you have a Co-Owner?

Yes

No

Co-Owner contact details

First Name

Last Name

Phone

Email

Step 2: Please answer the following questions

Are you living in this home as your principal residence?

YesNo

Is your home currently in good repair?

YesNo

Have you contracted to sell, transferred or conveyed any of your interest in your home to any person or entity? (Please note, this includes obtaining a HELOC, a refinance, loan payoff, or any other additional lien.)

YesNo

Have you added or subtracted a co-owner, put the home into a trust or changed title in any manner?

YesNo

Step 3: Upload documents

Copy of your most current Mortgage Statement

Copy of your most current HOA Statement

Copy of your most recent property tax bill

Copy of most recent utility bill (PG&E, Water, Trash or Cable bill are acceptable)

Copy of most recent homeowner's insurance policy (declarations page)

Acknowledgement & Submit

By checking the box and writing my/our name(s) below, I/we herby certify to the City of Emeryville under penalty of perjury that I/we occupy the home as my/our principal place of residence, acknowledge that the information provided and any documents or information I/we provide to the City is true and correct to the best of my/our knowledge, and that I/we have occupied the home for at least 10 months out of the past 12.

YesNo

First Name

Last Name

First Name

Last Name

If no, please explain:

Comments/Questions/Concerns? Let us know in the box below. (Max length is 255 characters.)

When you hit the Submit button below, you should receive an email confirming your submission. If you do not receive an email, please reach out to emeryville@hellohousing.org.

Instructions

Self-Certification of Owner Occupancy

Homeowner Demographics

Acknowledgement & Submit