LOUTH COUNTY COUNCIL
HOUSE PURCHASE SCHEME 1995
APPLICATION FORM
1. (a) Address of dwelling: ______
______
(b) Rental No: ______
2. Name(s) of Tenant(s):
1. ______2. ______
Phone No. ______
3. Age: ______
4. Occupation: ______
5. Employer: ______
6. Weekly Gross Income: ______
7. Have you ever purchased or erected a house in the past – Answer ‘Yes’ or ‘No’ here ______. If ‘Yes’, give full particulars.
______
______
8. Are you prepared to purchase the house in its present state of repair and structural condition.
9. Have you previously been a tenant of another Local Authority house.
Yes/No
10. If the answer to 9 is ‘Yes’ please state:-
(a) address of former tenancy ______
______
(b) period of tenancy: from ______to ______
11. Do you wish to purchase jointly with another person
______
12. If the answer to 11 is ‘Yes’, please state:-
(a) person’s name: ______
(b) present address: ______
(c) relationship to you: ______
Declaration: I/We hereby apply to purchase our house under the terms of the 1995 Tenant Purchase Scheme. I/We make this application having carefully studied the terms and conditions of the Scheme, as adopted by Louth County Council on 19th June, 1995, and I/We fully understand and agree to those terms.
I/We understand and accept that Louth County Council are under no obligation to put our house into good structural condition prior to sale and that the maintenance and repair of our Council house will be our responsibility after sale.
Signed: 1. ______2. ______
Date: ______