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