Cumberland County Habitat For Humanity
OFFICE USE ONLY: File #________________
OFFICE USE ONLY: Date received_________________
APPLICATION FOR HOME OWNERSHIP
PRINT OUT THIS FORM AND THEN FILL IN ALL THE INFORMATION BELOW:
Applicant name: _____________________________________________________
Applicant Date of Birth:__________________ Social Security #____________________
Co-Applicant Name:____________________________________________________
Co-Applicant Date of Birth:________________ Social Security #____________________
Address:_______________________________________ Phone #______________
City:______________________________ State:_______ Zip:_________________
How long have you lived at your current address? ________________________________
Do you own or rent? ______________ Amount of monthly payment:_________________
Number of children in home:_______ Ages/sex:________________________________
Total number of persons in home:___________________________________________
Name of Employer:____________________________________ Date started:_______
Monthly income from work before deductions:___________________________________
Other income: Child support: $________ Food stamps: $________ SSI: $_____________
Other monthly income: __________________________________________________
Total monthly income before deductions: $____________________________
What is wrong with your present housing: _____________________________________
_________________________________________________________________
_________________________________________________________________
How long have you lived in Cumberland County? ______________________
What previous states have you lived in? ______________________________________
_________________________________________________________________
APPLICANT SIGNATURE___________________________________ Date___________
Co-APPLICANT SIGNATURE_______________________________________ Date_____________
After you have printed out this application and filled it in completely, deliver it 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