Habitat for Humanity of East Polk County

Habitat for Humanity of EastPolkCountyRev. 3/08

APPLICATION FOR HOUSING

Applicant’s Name______Social Security #______

Co-Applicant’s Name______Social Security #______

Present Home Address (NOT A P.O. BOX): ______

City, Zip:______How long?______Home Phone (863)______

If less than 1 year, list previous address:______

Date of Birth:______Age:_____Co-App’s DOB______Age:______

Marital Status (Check one)

______Married, living with spouse Date Married:______

______Married, living apart from my spouse

______Divorced Date Divorce Final:______

______Single ______Widowed

Are you currently/or have you ever been in the military? Yes No

Please be advised that if you are married but not living your spouse, the law in the State of Florida requires that your spouse sign any mortgage documents. Your spouse is entitled to 50% property including your home and land. Applicant should provide a photocopy of their divorce certificate.

Dependents: (Those who live with applicant)

Name D.O.B. Male/Female

Authorization and Release

I understand that by completing 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 home ownership and my willingness to be a partner family. I understand that the evaluation will include personal visits, a credit check and verification of employment and other income. I have answered all questions on the application truthfully; I understand that if I have not answered the questions truthfully, my application may be denied and that even if I have 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 of East Polk County even if the application is not approved.

Applicant’s Signature______Date______

Co-Applicant’s Signature______Date______

Page 1 of 8

Present Housing Conditions

Do you rent______or own ______your present residence (check one)

Number of bedrooms (circle one) 1 2 3 4 5 Number of bathrooms 1 2 3

Your present residence also has (check all that apply) a kitchen ____, separate dining room ___, living

room___, family room or den___, laundry room ___, other: ______

Do you own a kitchen stove ___, refrigerator ___, freezer ___, washer ___, dryer ___

Do you own other property?______if yes, please describe: ______

How much is your monthly rent? ______Are utilities included? Water____, Electricity, ____ Gas ___

How much is your monthly mortgage______Unpaid balance ______

Is there a lien against your property other than the mortgage? Explain:______

______

Current landlord’s name: ______

Address: ______

City, State, Zip: ______

Phone: (863) ______

Describe the condition of your present residence and neighborhood: ______

______

Use the rest of this page to explain why you should be considered for Habitat housing:

Page 2 of 8

Applicant’s Employment Information

Employer’s Name: ______Months/Years on Job:______

Business Street Address: ______

City/State/Zip:______

Phone: (863)______Extension:______

Type of Business:______

Your Position:______

Full Time____ or Part Time____ How many hours/week_____ Wage/Month:______

2nd Employer’s Name: ______Months/Years on job:_____

Business Street Address: ______

City/State/Zip: ______

Phone: (863) ______Extension:______

Type of Business: ______

Your Position: ______

Full Time____ or part time____ How many hours/week_____Wage/Month:______

Co-Applicant’s Employment Information

Employer’s Name: ______Months/Years on Job:______

Business Street Address: ______

City/State/Zip:______

Phone: (863)______Extension:______

Type of Business:______

Your Position:______

Full Time____ or part time____ How many hours/week_____Wage/Month:______

Please list other sources and monthly amounts of household income:

Page 3 of 8

THE FOLLOWING SECTIONS APPLY TO BOTH APPLICANT AND CO-APPLICANT

Assets

Checking and Savings Accounts:

Name bank or credit union:______

Address:______

City, State, Zip:______

Account #:______Average balance $______

Name bank or credit union:______

Address:______

City, State, Zip:______

Account #:______Average balance $______

Do you own a car(s)? Yes______No______If yes, how many?______

#1 Car-Make and Year ______

#2 Car-Make and Year ______

Creditors

List all creditors with whom you and/or your co-applicant have an active account.

Credit Cards (Visa, Mastercard, Discover, Sears, Wards, etc.)

Credit Card Name:______

Address:______

Account #:______Phone #:______