Checklist for Homeowner (copy of check Stubs for the Last Three (3) Pay Periods for ALL Family Members who are age 18 or older Cicopy of official Birth Certificates for ALL Family Members Cicopy of Social Security Card for ALL Family Members Cicopy of state Issued Driver's License or State ID for ALL Family Members who are age 18 or older ‘Award letters for any funds received Social Security CO pisabitity Cis.N.A.?. (food stamp) statement (If any is received) Dalimony Proof (if any is received) Cicopy of Court Ordered Child Support and 12-month printout of payments received or made copy of w2s and Tax Information with ALL schedules (Federal and State) Please utilize this list to ensure that you have all necessary items for your application.wir Habitat for Humanity” \We are pledged tothe letter and spirit of U.S. poicy for Application Habitat Homeownership Program the nation. We encourage and support an affirmative ‘advertising and marketing program in which there are no Peart) bomers to obtaining housing because of race, colcr, PORTANT’ religion, sex, handicap, familial status or national origin. ear Applicant: Please complete this application for the Habitat or Humanity homeownership program tuthtuly, completely and accurately, Allnformation you include on this application wl be maintained in accordance with our privacy policy Type of credit 11am applying for individual credit {am applying for Joint credit, Total number of borrowers: C1 Each borrower intends to apply for joint credit, Your initials Patclan need Applicant Co-applicant Applicant's name: Co-applicant’s name ‘Alternative and former name: Alternative and former names: Social Secunty number Social Security number Home phone ( Home phone Call phone (_) Cell phone Work phone Work phone Ag Date of bith (mnvayyyy) Age Dale of bith (mmidaivyy) D Married C1 Separated 1 Unmaried (ngs, vert wisved,cttunen, |) Married CI Separated C) Unmarid (sng, ore, wcoves oun tannin egal crest ram ientrtn alate pain wpe poe yr Pat rien Dependents ae ars wh we wh Dependents ard tr who wl wih yu (el sed by evap ome ge le Famale [nome fate Fama oo |, eee ff OF o oa — Qo QO og og ao og oa oa Freer oar et yal 2 code) ClOwn Roni | Preset aos ovata, ate ZP enc) Cl Gwn Ci Ren Number of years Number of years: you have lived at your present address for less than two years, complete the following, forall addresses during the past two years Previous address(es) (street, iy, state, ZIP code): Cl Own CRent [Previous address(es) (sree, oly, stale, ZIP code); Own Rent Number of years: Number of years: oon Rod Date received: Date of selection commitee approval: Date of notice ofincompiete application eter: Date of board approval: a Date of adverse action ltr: Date of partnership agreement.Femi ana Did you (or your deceased spouse) serve, or are you currently serving inthe United States Armed Forces? (Army, Marine Corps, Navy, Ai Force, Space Force, Coast Guard, Reserve or National Guard) CI Yes Cl No It yes, check at that apply [Current serving on active duty with projected expiration date of servicetour_ Currently retired, discharged, or soparated from service Ey. Only period of service was as a non-activated member ofthe Reserve or National Guard surviving spouse Is anyone else in your household serving, or dé they serve, inthe United States Armed Forces? Cl Yes O No It yes, check al that apy [Current serving on active duy with projectes expiration date of servicetour __) 1 current retired, discharged, of separated from service Only perad of service was as a non-activated member of the Reserve or National Guard 1 immssivyyyy) (ommisaiyyyy) To be considered forthe Habitat homeownership program, you and your | AM WILLING TO COMPLETE THE REQUIRED household members must be willing to complete a certain number of‘eweat- | SWEAT-EQUITY HOURS: ‘equi hours, which may include hours spent helping to build your home ars Yes No the homes of others, attending homeownership classes, and/or other Applicant a Qa ‘approved activites, Co-applicant oo 3. PRESENT HOUSING CONDITIONS. Currently, are you CIRenting Renfree Own Number of bedrooms (please cice): 1 2 24 5 (Other rooms inthe place where you are currently wing: CIKitchen (Bathroom CILivingreom LI Diningroom Other (please describe} In the space below, describe the condiion ofthe house or apartment where you ive, Why do you need a Hablat home? you rent your current ri dence, please supply a copy of your lease and a copy of the most recent money order receipt, bank statement or canceled rent check to evidence rent payment. ‘Name, address and phone number of eurent landlord toed [1 140 not own any realestate (move to Section 5). It you own your residence, what's your monthly mortgage payment (mciuding taxes, | Do you own land ater than your residence? CINo Ll Yes insurance, oc.)? Monthly payment (including taxes, insurance, etc) 8 _Imorth Unpaid balance $. 8 | tfyou wish your property to be considered for building your Habitat home, please atlach the deed, ay existing appraisal and infomation about any ton. Note: A separate approval process wil appy with respect fo any such requests, as each parce olan fs unique and may net be sulabiefor ling on {trough the Habitat program.Applicant Co-applicant 1 Does not apply 1 Does not apply. Name end address of CURRENT employer: | Start date (mmisiyyy): | Name and address of CURRENT employer: Start date (mmc) ‘Annual (gross) wages Annual (gross) wages: 8 ‘Type of business: ‘Business phone: Type of business: Business phone {working at current ob lass than one year, complete the following information Name and adéress of PREVIOUS employer: | Yeare on ths job: Name and address of PREVIOUS employer. | Years on this jb ‘Annual (gross) wages ‘Annual (gross) wages: 8 Type of business: Business phone! Type of business: Business phone: PLEASE NOTE: Self-employed ‘applicants wil be required to provide ‘adaiional documents such as tax | returns ane financial statements Giemsa 1 Check i you are the business owner or are self-employed. thave an ownership shere of less than 25%. C1 Ihave an ovmership share of 25% or more Monthy income (or loss). Roser cane Applicant Coapplicant | Others in household Toa ‘Salarylwages (gross) $ s s 3 TANF $ ls $s $ — F s § Is Child support 3 $ [s $ Social Security $s $ 7 s $ [ss 3 3 is q | ast ; 7 is 3 oung ootertea |S $ 5 5 sa {Unemployment benefits VA compensation Military enitements other Total essere Name Income source Monthly income Date of birth 8 8 Retiement (e.g, pension) | 8 8 $ec od enue) | where wil you get the money to make the down payment or pay for closing costs for example, savings orgs rom family member or others: ‘any grants for which you have r intend to app? Hf you borrow the meney, whom il you Borrow it fram, and haw will you pay lt back? Type of asset and name | Address City, state ZIP ‘Account numb Current of bank, savings and loan, balancer credit union, retirement value/vested ‘account, etc. (Do not amount (if Include land here.) applicable) 8 is is 8 5 $ 8 MCLEE RC Kanan ad ‘Account Beemer Monthly payment Cle ‘Unpaid | Months lettto pay Co-applicant Monthly payment ‘Aut tan Instaiment (e.g, bost, personal loan) Lease (0. fume, applances — includes rantto-oun) ‘Alimonyiseparate maintenance ‘Chil suppor Revolving e.., credit cards) ‘Student loan debt (Open 30 days balance paid monthly, 6g, ave card) Medical dete Other otmer Total Account Applicant Co-applicant Total [Rent Unites (electricity, water, gas) Insurance (ental, car, health, ete) hid care Internet service CellphoneLand ine s 3 s Business expenses: $ s s Union dues: s s _ is “Transportation expense (gas, bus pass, vehicle upkeep, ete) s s s Food and essential supplies s s s Eniotainment 3 s s Other s s s Other s is s [Tot s s s ean Please check the box beside the word that best answers the following questions for you and the co-applicant. | Applicant | Co-epplicant | 2. Are there any outstanding judgments because ofa court decison against you? Ces Cio [Elves Ono ©, Have you declared barkrupty within the past seven years? (yes CINo [Yes ONo YES, identity the type(s) of bankruptcy: CChapter7 —_C.Chaptor 11 ©) Chapter 12 CI Chapter 13 ‘Have you had any propery foreclosed upon hn the past seven years? Ces Cio |CiYes No 6: Are you party awsuitn wich you potential have any personal andi aby? Ti¥es Cine [El¥es ONe «@. Have you conveyed tile to any property inl of foreclosure or completed a pre-foeciosure sal or short sale where |ClYes CINo |Lives Cl No the lender agreed to accept less than the oustanding mortgage balance due) within the past seven years? {Are you exrenty delinquent orn defeut on any federal debt or any other loan, mevtgage nancial dbigaton orloan guarantee?” [Cl Yes CINo |O Yes Cl No ‘9. Ae you a co-signer or guarantor on any dbl of lan that isnot dsclosed on this application? Clyes Cio |DYes ONo he you a US. ciizen or permanent resident? - Ciyes ONo |DYes ONe Note: Ifyou answered "yes" to any question a tough 9, or ne" to Question h, please explain on a separate piece of paper a Gees Paine ees | understand that by flog this application, Iam authorizing Habitat for Humanty to evaluate my actual need forthe Habitat homeownership program, my ably to repay an ‘fordable loan and cher expenses of homeownership, and my wlingness tbe a parner through sweat equty and oerwise according to Hail or Humanity pole | understand that he evaluation wilinckde personal vst, a cod check and employment veilation (fapeleable), have anewered all the questions on this ‘application tuthfuly and accurately, and if any of the information provided changes afer ub his aplication, ! wl supplement his aplleaton, as applleabe, | Understand thatf|have not answered the questonstuhfuly, accurately or completely, rf to supplement his application as necessary to mainain is accuracy end ‘completeness, my apalicaton may be denied, an that even have ready been selected to reosive @ Habitat home, Ima be dual rom te program and oti ‘any rghts or aims to @ Habitat home. The orginal ora copy ofthis application wil be relainad by Habit for Humanity even fhe applaton i nat approved. If this application is eceated as (or converied ino) an ‘electronic application” | consent tothe use of ‘electronic records" and “electronic signatures as the terms tare defined in and governed by applicable federal andor state electronic transaction laws | inn to sign andhave atgned this application either using my: (a) flectronic signature or (b) a wien signature and agree that a paper version ofthis application is converted ito an electronic application, te application val be an electronic cord, and the representation of my written signature en this application wil be my binding electronic signature | also understand that Habitat for Humanity screens al applicants on the sex offender registry. By completing this appletio, | arn submiting myself to such an Inquiry. [further understand that by completing this application | am submiting myself toa criminal background check. Applicant signature Date Co-applicant signature Date, x x PLEASE NOTE: If more space s needed to complete any part ofthis application, please use a separate sheet f paper and attach ito tis application. Please mark your additional comments with “A for applcant er C" fr eo-applicant Pianeta hiss to notify you tht if you qual forthe homeownership program and complote the program requirements, we may order an appraisal to determine the value ofa home that you may be eligible to purchase, and we may charge you fortis appraisal. Upon completion of te appraisal, we wil promptly provide @ copy to you, even if the loan does not close Applicant's name Co-applicant’s nameeeom an me nue PLEASE READ THIS STATEMENT BEFORE COMPLETING THE BOX BELOW: ‘The purpose of collecting this Information iso help ensure that applicants are being ealed faiy thatthe housing needs of communities and neighborhoods ar boing fulled, and to otherwise evaluate our programs and repor to our funders. For residential mortgage lending, Federal law requires that \we ask applicants for thelr demographic information (ethnicity, sex and race) In order to monitor our compliance with equal erect opportunity, fer housing and home mortgage disclosure laws. You are not required to provide this information but are encouraged todo 80, You may select one or more designations for "Ethnicity" and one or more designations for‘Race.* The law provides that we may not discriminate on the bass of this information or on whether you choose to provide it, However, f you choose not o provide the information and you have made tis application in person, federal regulations requito us to note your eit, sex and race onthe basis of visual observation or surname. The lw also provides that we may not discriminate on the basis of age or marital status information you provide inthis application, If you do not wish to provide some or alo this information, please check below. ‘Applicant Co-appiicant Ethnicity (check one or more): Ethnicity (chock one or more) Hispanic or Latino Hispanic or Latino CiMexican 1 Puerto Rican Ci Cuban Mexican Puerto Rican C1 Cuban 1B Other Hispanic of Latino — 1D other Hispanic or Latino — Origin: Origin Fr example Argentinean, Cofomblan, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on 1 Not Hispanic or Latino Ido not wish to provide this Intormation For example: Argontinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and s0 on. Not Hispanic or Latino 1 Ido not wish to provide this information American Indian or Alaska Native — Namo of enrolled or principal tnbe Sex: Sex: Female ClMale C21 donot wish to provide this information Beale Male C1 dont wish to provide this information Race (check one or more): Race (check one or more): American Indian or Alaska Native — [Name of enrlled or principal tbe: Avian Asian indian chinese Fipino Dapanese Korean =. Vietnamese 1D Other Asian — race: 1D Black or Atican American Native Hawaiian or Other Paci Islander Native Hawaiian —C} Guamanisn or Chamorro 1D ther Paci Islander — race: For example: Filan, Tongan, and 30 on, Dwnte 160 not wish to provid this information D samoan For example: Hmong, Laotian, Thal, Pakistan, Cambodian, and so on Asian Asian indian chinese Flpino Dapanese Korean) Vietnamese 1D other Asian — race: For example: Hmong Laotian, Thal, Pekstani Cambodian, ad so en Black or African American 1D Native Hawaiian or Other Pact Islander Ci Native Hawaian CI Guamanian or Chamorro 0 Other Pacific slander — race: For example: Filan, Tongan, and 30 07, OWnite Io not wish to provide tis information Ci semoan ‘To be comploted only by the person conducting the Interview Was the ethnicity ofthe Borrower collected onthe basis of visual observation or sumame? Was the sex ofthe Borrower collected on the basis of visual observation or sumame? Was the race ofthe Borrower collected on the basis of visual observation or surname? Yes ONe Dyes Ne Yes Ne This application was taken by 1 Face-toace interview (cluded electronic Interviewers name (pint or type) Interviewers phone number ‘media wivideo component) Oeymai By telophone Interviewers signature DatePatched Foon aeRO REUSE US) Lender instructions for using the Unmarried Addendum: The lender may use the Unmarried Addendum only when a borrower selected “Unmarried” in Section 1 and he information collected is necessary o determine how slate property laws directly a Indirect affecting creditworthiness apply inctuding ensuring clear tle. For example, the lender may use the Unmarried Addendum when the borrower rides in a state that recognizes civil unlons, domestic partnerships or registered reciprocal beneficiary relationships or when the property Is located In such a state “State” means any state, the District of Columbia, the Commonwealth of Puerto Rico, or any terior or possession ofthe United States, it you selected “Unmariod” In Section + 7 Is there a person who isnot your legal spouse but who currently has real property rights similar to those of a legal spouse? CINo Cl Yes IFYES, insiate the typeof relationship andthe state n which te relationship was formed. For example, Indole Ifyou ae in a cv union, domestic partnership, registred reciprocal beneficiary reiatonshi, or other relaionship recognized by the state in which you Curent reside or where the property is located Chit union Ci Domestic partnership 1 Registered reciprocal beneficiary relationship 1 other (expan): Stat