Buyout Assistance Survey
Description:
This survey is designed to notify the county of your interest in having your home considered for a future buyout. Information provided from this survey may be used by the following entities for potential home buyout programs: Montgomery County, HUD, GLO, and FEMA. Keep in mind that filling out the survey is not a guarantee that your home will be bought out. If you own more than one property that you would like considered for a buyout, a separate survey will need to be completed for each address
First Name *
Your answer
Last Name *
Your answer
Current Mailing Street Address *
Your answer
Current Mailing City *
Your answer
Current Mailing State *
Your answer
Current Mailing Zip Code *
Your answer
Current Phone Number *
Your answer
Alternate Phone Number
Your answer
Email
Your answer
Date of Birth
Must be born before 2002.
MM
/
DD
/
YYYY
Number of Household Members
Your answer
Total Household Income
Your answer
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