Habitat for Humanity of East Polk County

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.

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

Credit Card Name:______

Address:______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Credit Card Name:______

Address:______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Page 4 of 8

Credit Card Name:______

Address:______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Auto Loan Company Name:______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

2nd Auto Loan Company Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Medical Accounts

1)Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

2)Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

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Store accounts (appliances, furniture, electronics, etc.)

1)Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

2)Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Other Accounts You Pay Monthly

Name______

Address______

Account #:______Phone #:______

Monthly amount paid :$______Balance:$______

Please circle the following which best describes your credit status:

  1. all bills paid regularly each month
  1. some bills are overdue
  1. some accounts are in collection; repossession
  1. bankruptcy in last three years with more than $2000 in outstanding debts

Page 6 of 8

Income and Expense Summary

ApplicantCo-ApplicantOther*

Monthly Gross Income______

AFDC______

Food Stamps______

SS/SSI______

Disability______

Child support (court ordered)______

Other______

INCOME TOTALS______

*Name of household members over 18 who receive income______

Household Monthly Expenses

Rent______

Utilities (electric, water, gas)______

Telephone (circle one) line phone, cell______

TV (circle one) cable, satellite______

Car payment______

Insurance______

Child Care______

Medical bills______

Store loan (furniture, appliances, electronics)______

Student loans______

Child support payments______

Average credit card payment______

Average foods costs______

HOUSEHOLD EXPENSE TOTAL______

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I/we will maintain my/our credit report status and score,have not had any foreclosures, repossessions or defaults in the three years prior to applying and will continue to maintain this status.

Yes____ No____

I/ we are citizens of the United States of Americaor legal immigrant and have been residents of PolkCounty for at least one year prior to the date of this application.

Yes____ No____

I/we have read and agree to comply with Habitat for Humanity’s “Sweat Equity Policy”. We are able and willing to invest the required number of hours specified as pre-construction labor on some other candidate’s house and then also participate in the construction of our own house. We agree to keep an accurate record of our hours and to be present when volunteers work on our house unless excused by the Site Foreman.

Yes____ No____

I/we understand that under no circumstances will Habitat for Humanity compensate (pay) for volunteer hours. I/we agree to comply with Habitat for Humanity’s down payment schedule, understanding that a minimum $500 is due prior to the construction start of our house and the balance due before the Closing Date. We also agree to make our mortgage payments on time and regularly and pay a twentydollar late fee for mortgage payments made after the tenth day of the month.

Yes____ No____

I/we understand and agree to attend the required Homeowners’ Class offered by the Keystone Challenge and complete all Dave Ramsey classes offered by HFHEPC prior to the Closing Date on our house and will produce a certificate of attendance when requested.

Yes____ No____

I/we agree to maintain our Habitat house and lot in proper order and reflect positively on our neighborhood as Habitat for Humanity Homeowner-Partners to the benefit of Habitat for Humanity of East Polk County.

Yes____ No____

I/we agree not to solicit donations for our house without the explicit permission of the Executive Director of Habitat for Humanity of East Polk County.

Yes____ No____

We are pledged to the letter and spirit of U.S. policy for the achievement of equal housing opportunity throughout the nation. We encourage and support an affirmative advertising and marketing program in which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial status, or natural origin.

Applicant’s Signature: ______Date: ______

Co-Applicant’s Signature: ______Date: ______

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