Habitat For Humanity
Phone: (239) 652-0434 |
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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
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
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New Hampshire
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South Carolina
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Texas
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Washington
West Virginia
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Armed Forces Americas
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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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Mortgage Burning February 2012
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