Housing Application Step 1 of 7 14% Applicant's Name* First Last Applicant's Phone Number*Marital Status Married Separated Unmarried (incl. Single, divorced, widowed) Dependents and others who will live with you (not listed by co-applicant)Present Address (Street, City, State, Zip code)Please list name, age and gender.Own/Rent Own Rent Number of Years If Living at Present Address for Less Than Two Years Complete the FollowingLast Address (street, city, state, zip code)Own/Rent Own Rent Number of Years Co-Applicant's Name* First Last Co-Applicant's Phone Number*Marital Status Married Separated Unmarried (incl. Single, divorced, widowed) Dependents and others who will live with you (not listed by co-applicant)Present Address (Street, City, State, Zip code)Please list name, age and gender.Own/Rent Own Rent Number of Years If Living at Present Address for Less Than Two Years Complete the FollowingLast Address (street, city, state, zip code)Own/Rent Own Rent Number of Years To be considered for a Habitat home, you and your family must be willing to complete a certain number of "Sweat Equity" hours. Your help in building your home and the homes of others is called "sweat equity,' and may include clearing the lot, painting, helping with construction, working in the Habitat office, or other approved activities.I AM WILLING TO COMPLETE THE REQUIRED SWEAT EQUITY HOURS Yes No Applicant Co-Applicant PRESENT HOUSING CONDITIONSNumber of Bedrooms (Please Check) 1 2 3 4 5 Other rooms in the place where you are currently living: Kitchen Bath Room Livingroom Diningroom Other If you rent your residence, what is your monthly rent payment? (Please supply a copy of your lease or a copy of a money order receipt or cancelled rent check.)Please attach copies here.Max. file size: 50 MB.Name, address and phone number of current landlord:In the space below, describe the condition of the house or apartment where you live. Why do you need a Habitat home?Property InformationIf you own your residence, what is our monthly mortgage payment? Unpaid Balance: Do you own land? Yes No If you do own land please describe here, including location:Is there a mortgage on the land? Yes No If yes: Monthly Payment $ Unpaid Balance: $ If you are approved for a Habitat home, how should your name(s) appear on the legal documents? 6. Employment Information ApplicantName and Address of Current EmployerYears On This Job Monthly (Gross) Wages Type of Business Business Phone Number If Working at Current Job Less Than One Year, Complete the Following InformationName and Address of Current EmployerYears On This Job Monthly (Gross) Wages Type of Business Business Phone Number Employment Information Co-ApplicantName and Address of Current EmployerYears On This Job Monthly (Gross) Wages Type of Business Business Phone Number If Working at Current Job Less Than One Year, Complete the Following InformationName and Address of Current EmployerYears On This Job Monthly (Gross) Wages Type of Business Business Phone Number 7. MONTHLY INCOME AND COMBINED MONTHLY BILLS Gross Monthly Income: ApplicantBase Employment Income Food Stamps SSI Alimony AFDC/TANF Social Security Disability Child Support Other Total Monthly Bills: ApplicantRent Car Payment Child Care Average Credit Card Payment Utilities Insurance School Lunch Student Loan Alimony/Child Support Total 7. MONTHLY INCOME AND COMBINED MONTHLY BILLS Gross Monthly Income: ApplicantBase Employment Income Food Stamps SSI Alimony AFDC/TANF Social Security Disability Child Support Other Total Monthly Bills: Co-ApplicantRent Car Payment Child Care Average Credit Card Payment Utilities Insurance School Lunch Student Loan Alimony/Child Support Total Monthly Income: Others in HouseholdBase Employment Income Food Stamps SSI Alimony AFDC/TANF Social Security Disability Child Support Other Total: Monthly Bills: Others in HouseholdRent Car Payment Child Care Average Credit Card Payment Utilities Insurance School Lunch Student Loan Alimony/Child Support Total: 1 Self-employed applicant(s) may be required to provide additional documentation such as tax returns and financial statements.2. List additional household members over 18 who receive income:Please list name, age and Monthly Wages.Please attach copies of last month's bills.Max. file size: 50 MB.Where will you be getting the money to pay the down payment and closing costs?(for example: savings, parents)? If you are borrowing money to pay these costs, explain how and from whom.9. AssetsList Checking and Savings Accounts BelowName and Address of Bank, Savings & Loan, Or Credit Union Balance Name and Address of Bank, Savings & Loan, Or Credit Union Balance Name and Address of Bank, Savings & Loan, Or Credit Union Balance Name and Address of Bank, Savings & Loan, Or Credit Union Balance Name and Address of Bank, Savings & Loan, Or Credit Union Balance Name and Address of Bank, Savings & Loan, Or Credit Union Balance Do you own the following (Check all that apply) Stove StoveRefrigerator Washer Dryer Do you own a car (#1) if so whats the year make and model? Do you own a car (#2) if so whats the year make and model? 10. DEBTTo whom Do You and the Co-Applicant Owe Money? CarMonthly Payment Unpaid Balance Months Left To Pay Name and Address of the CompanyMonthly Payment Unpaid Balance Months Left To Pay Name and Address of the CompanyTo whom Do You and the Co-Applicant Owe Money? FurnitureMonthly Payment Unpaid Balance Months Left To Pay Name and Address of the CompanyMonthly Payment Unpaid Balance Months Left To Pay Name and Address of the CompanyCredit CardMonthly Payment Unpaid Balance Months Left To Pay MedicalMonthly Payment Unpaid Balance Months Left To Pay Subtotal of Payments for: Car, Furniture, Credit Card, Medical Alimony/Child Support (Per Month) Job Related Expenses(Per Month) Child Care, Union Dues, etc. (Per Month) Subtotal of Payments for: Car, Furniture, Credit Card, Medical Subtotal of Payments for: Alimony, Job Related, Child Care Expen. Total Monthly Expenses 11. DECLARATIONSPlease Check the Box That Best Answers the Following Questions For You and the Co-Applicant ApplicantDo you have any debt because of a court decision against you? Yes No Have you been declared bankrupt within the past 7 years? Yes No Have you have property foreclosed on in the last 7 years? Yes No Are you currently involved in a lawsuit? Yes No Are you paying alimony or child support? Yes No Are you a U.S. citizen or permanent resident? Yes No Answering “yes”to these questions does not automatically disqualify you. If you answered“yes”to any questions however, please explain on a separate sheet of paper.Co-ApplicantDo you have any debt because of a court decision against you? Yes No Have you been declared bankrupt within the past 7 years? Yes No Have you have property foreclosed on in the last 7 years? Yes No Are you currently involved in a lawsuit? Yes No Are you paying alimony or child support? Yes No Are you a U.S. citizen or permanent resident? Yes No Answering “yes”to these questions does not automatically disqualify you. If you answered“yes”to any questions however, please explain on a separate sheet of paper.12. AUTHORIZATION AND RELEASEI understand that by filing this application, I am authorizing Habitat for Humanity to evaluate my actual need for a Habitat home, my ability to repay the no-interest loan and other expenses of homeownership and my willingness to be a partner family. I understand that the evaluation will include personal visits, a credit check, and employment verification. I have answered all the questions on this application truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that even if I have already been selected to receive a Habitat home, I may be disqualified from the program. The original or a copy of this application will be retained by Habitat for Humanity even if the application is not approved I, the applicant and/or co-applicant for this Habitat for Humanity Lake City/Columbia County Housing Applicant, warrant the truthfulness of the information provided in this application.Applicant Signature (Type Name) Date DD slash MM slash YYYY I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. Co-Applicant Signature (Type Name) Date DD slash MM slash YYYY I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. 13. INFORMATION FOR GOVERNMENT MONITORING PURPOSESPlease Read This Statement Before Completing the Box Below: The following information is requested by the federal government for loans related to the purchase of homes,in order to monitor the lender’s compliance with equal credit opportunity and fair housing laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it or not. However, if you choose not to furnish it, under federal regulations this lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information below, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the loan applied for.)Applicant I do not wish to furnish this information Race/National Origin Please Select One From The Following List:Ethnicity: Hispanic Non-Hispanic Sex: Male Female Date DD slash MM slash YYYY Marital Status: Married Separated Unmarried (Inc. Single, divorced, widowed) Co-Applicant I do not wish to furnish this information Race/National Origin Please Select One From The Following List:Ethnicity: Hispanic Non-Hispanic Sex: Male Female Date DD slash MM slash YYYY Marital Status: Married Separated Unmarried (Inc. Single, divorced, widowed) Interviewer's Name (Print or Type) Interviewer's Signature Date DD slash MM slash YYYY I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. CAPTCHA 58356
