Cumberland County Habitat For Humanity APPLICATION FOR HOME OWNERSHIP
OFFICE USE ONLY:   File #___________       Date received_________________

PRINT OUT THIS FORM AND THEN FILL IN ALL THE INFORMATION BELOW:

Applicant name: ____________________________________ DOB:____________________
 
Co-Applicant:___________________________ Relationship:____________ DOB:__________
 
Address:___________________________________________ How Long?____________
 
City:___________________________________   State:__TN__   ZIP:__________________
 
Home Phone:_______________ Work Phone:______________ Cell Phone:________________
 
Own/Rent:_______ Monthly Payment:$___________ #Of people living in new home:_______
 
How many children in home?________ Ages/Sex:___________________________________
 
Applicant's Employer:_________________________________ Date Started:_____________
 
Gross income before Deductions:$___________PerHour      Number of Hours per week________
 
Co-Applicant Employer:_________________________________ Date started:______________
 
Gross income before Deductions:$___________PerHour      Number of Hours per week________
 
Other Income: Child Support:$________   SSI:$_________   Other:$____________
 
Have you lived in Cumberland County for 12 months?: Applicant:______ Co-Applicant:_________
 
Citizen or legal resident of the USA? Applicant_________ Co-Applicant__________
 
What is wrong with your present living conditions:__________________________________

___________________________________________________________________________
 
Have either of you declared bankruptcy in the last 2 years:_____________________________
 
Have either of you had property foreclosed -- if so, when?:_____________________________
 
Are either of you presently delinquent on any debts?__________________________________
 

_________________________________________ Applicant Signature	______________________ Date
_________________________________________ Co-Applicant Signature	______________________ Date
After you have printed out this application and filled it in completely, deliver or mail it to: Cumberland County Habitat for Humanity P O BOX 854 329 McLarty Lane Crossville   TN     38555 OR you may fax it to Cumberland County Habitat at 931-484-4599
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, familial status, or national origin. This form revised May 1 2009