Insurance claim declaration - Arizona Department of Housing: Fill out & sign online

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Begin by filling in your name at the top of the form, certifying your previous assistance from the Arizona Department of Housing. Ensure you provide accurate details regarding any financial assistance received.
In the 'Primary Residence' section, list the full address of your primary residence where you currently reside. This is crucial as it confirms your eligibility for assistance.
Next, indicate the amount received from your insurance claim and specify the name of the insurance company along with the date of payout.
Describe the situation that led to your insurance claim in detail. This helps clarify your circumstances and supports your request for funds.
Finally, outline how you plan to use the claim funds for repairs on your primary residence. Be specific about what repairs are needed.
Complete the certification section by signing, printing your name, providing an email address, and executing on today's date along with a phone number for contact purposes.

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