Habitat For Humanity
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Phone: (239) 652-0434 |
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Bar Association Build 2012
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Homeownership Interest Form
Homeownership Interest Form
If you can answer yes to the three basic guidelines, please complete the following form. We will contact you with the date and time of the next orientation meeting where applications will be distributed. If you are not sure if you meet the guidelines, please call (239) 652-1681.
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Phone
Ex: (239)555-1212
Email
Ex: email@host.com
Marital Status
*
Single
Married
Divorced
Widowed
Married must apply jointly.
Misrepresenting marital status will automatically disqualify an applicant.
Residency
*
Yes
No
Are you (and co-applicant) a U.S. Citizen or legal permanent resident?
Total Gross Annual Income
*
Please include all sources of income. This includes employment, social security, disability, child support, etc.
# of Residents
*
1
2
3
4
5
6
7
8
9
10+
How many people will be living in your house, including yourself?
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