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P.O. Box 1525/ 115 E. DeKalb ST Suite 5A, Camden, SC 29020
(803) 432-4333 (ph) (803) 432-4325 (fax
Habitat for Humanity of Kershaw County
HHKC Official HomeownershipApplication Package
C2012
Full and complete PRACTICE applications must havebeen RECEIVED in the Habitat Office by the date &
time shown below.
27 January 2012
12:00 NOON
Late applications WILL NOT be Accepted.
DO NOT REMOVE THIS PAGE
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Applicant Information Co-Applicant InformationFirst Name Middle Initial Last Name First Name Middle Initial Last Name
Male Female Male Female
Social Security Number: Social Security Number:
Date of Birth (mm/dd/yyyy):
/ /
Date of Birth (mm/dd/yyyy):
/ /Home and/or Cell Phone Number: Home and/or Cell Phone Number:
Work Phone Number: Work Phone Number:
Email: Email:
Married Single
*Please note if applicant is married but plans to apply to
Habitat as a single person, their divorce must be finalized
before we can consider the application.
Married Single
.
Present Address: Present Address:
Street Address Street Address
City State Zip Code City State Zip Code
Number of years at this address: Number of years at this address:
Household Occupants
List the names and date of birth for all occupants who will be living in the house. Do not include the Applicant and the Co-
Applicant. IMPORTANT: All occupants listed must currently be living with the Applicant. If special circumstances exists, please explain below.
Name (First and Last)Date of Birth
(mm/dd/yyyy)Age Relationship to Applicant(s)
Explanation(s):
If Living at Present Address for Less Than Two (2) Years, Complete the Following:
Dear Applicant: This application must be completed to determine if you qualify for a house
through Habitat for Humanity. Fill it out as completely and accurately as possible. All information
you include on this document will be kept confidential.
1.Applicant Information
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Applicant Co-ApplicantFormer Address: Former Address:
Street Street
City State Zip Code City State Zip Code
Number of years at this address: Number of years at this address:
2.Present Housing ConditionsThis is a REQUIRED part of your application. We WILL NOT review applications without this information filled in.Number of Bedrooms:
Total Number of People in Current Housing: ____________Number of Bathrooms:
Applicant(s) must have a demonstrated need for simple, decent, affordable housing. Use the space below to provide the
Application Review Committee with information about your current housing situation. Indicate all problems, challenges, or
hardships. Your Housing Needwill be further evaluated by a home visit for assesment purposes.
3.Willingness to Partner
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Applicant Co-Applicant
To be considered for a Habitat home, you and your family, must be willing to complete 175 -300 sweat equityhours.
Your help in building your house and the homes of others is called sweat equityand may include clearing the lot,
painting, helping with construction, working in the Habitat ReStore - or office - or other approved activities.
I am willing to complete the required sweat
equity hours.
I am willing to complete the required sweat
equity hours.
4.Employment InformationApplicant Co-Applicant
Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:
Position/ Title: Position/ Title:
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Address of Employer: Address of Employer:
Street Street
City State Zip Code City State Zip Code
Monthly Gross Income (Before Taxes): Monthly Gross Income (Before Taxes):
If you currently have more than one (1) job, please complete the next section
Applicant Co-Applicant
Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:
Position/ Title: Position/ Title:
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Address of Employer: Address of Employer:
Street Street
City State Zip Code City State Zip Code
Monthly Gross Income (Before Taxes): Monthly Gross Income (Before Taxes):
If working at present job for less than one (1) year, complete the following
$ $
$ $
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Applicant Co-Applicant
Check this box if you are self employed. Check this box if you are self employed.
Name of Current Employer: Name of Current Employer:
Position/ Title: Position/ Title:
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Employement Dates:
From: ___________________ To: ___________________
(month/year) (month/year)
Address of Employer: Address of Employer:
Street Street
City State Zip Code City State Zip Code
Monthly Gross Income (Before Taxes): Monthly Gross Income (Before Taxes):
IMPORTANT NOTICE:
If At Any Time During The Application Process
Habitat For Humanity Of Kershaw County
Discovers Undeclared Income By Any Of The
Applicants, Co-Applicants, Or Family Members,That Will Be Grounds For Application Denial.
5a. Financial Information Monthly Household IncomeApplicant Co-Applicant
1. Gross Monthly Wages (Before Taxes): 1. Gross Monthly Wages (Before Taxes):
2. Social Security Income: 2. Social Security Income:
3. Child Support (Monthly amount & how long you expect to receive it): 3. Child Support (Monthly amount & how long you expect to receive it):
4. Alimony 4. Alimony
5. Other (Please specifyAFDC/TANF, Food Stamps etc.): 5. Other (Please specifyAFDC/TANF, Food Stamps etc.):
Total Monthly Income:
(1+2+3+4+5)
Total Monthly Income:
(1+2+3+4+5)
Other Household Member #1 (18 Years or older) Other Household Member #2 (18 Years or older)
$ $
$ A $ B
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Name: Name:
Age: Age:
Relationship: Relationship:
1. Gross Monthly Wages (Before Taxes): 1. Gross Monthly Wages (Before Taxes):
2. Social Security Income: 2. Social Security Income:
3. Child Support (Monthly amount & how long you expect to receive it): 3. Child Support (Monthly amount & how long you expect to receive it):
4. Alimony 4. Alimony
5. Other (Please specifyAFDC/TANF, Food Stamps etc.): 5. Other (Please specifyAFDC/TANF, Food Stamps etc.):
Total Monthly Income:
(1+2+3+4+5)
Total Monthly Income:
(1+2+3+4+5)
Total Household Monthly Income: (A+B+C+D)
You mustprovide official documentation of all sources of income.(Check stubs, Employer Computer Print-out, DSS Print-outs, Social Security Print-outs, Written
Evidence of Income, Etc. )
5b. Financial Information Monthly Household ExpensesExpense Monthly Payment Debt Monthly Payment
Rent: Car Payment
Total Utilities: Credit Card #1:
Child Care: Credit Card #2:
Phone: Credit Card #3:
Cell Phone:Other Credit Cards
Total:
Cable/ Satellite: Furniture:
School Lunch: Appliances:
Auto Insurance: Student Loan(s):
Other: Hospital / Medical:
Other:Other Loans (Please
Specify):
Other: Child Support:
Other: Alimony:
Total Monthly
Expenses:
Total Monthly
Expenses:
IMPORTANT: Section 5c MUST BEcompleted asthoroughly as possible.
5c. Debt Listing
$
$ C $ D
$ $
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List below all payments, of any kind (medical, car furniture, debt consolidation loans, dental, hospital,
etc.) Though you have completed section 5a & 5b, this is where you identifyAlloutstanding debts.Information in this section is important to a complete evaluation of your application.
Businesses or People you
owe money to:Account #:
Amount of Monthly
Payment:Unpaid Balance:
Number of
Payments Left:
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
_____________________ __________ ________________ _______________ ____________
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6. Financial Assests Bank Account(s) and Property Information
Applicant Co-Applicant
Total Number of Checking Accounts: _________________
Total Number of Savings Accounts: _________________
Total Number of Other Type Accounts:_________________
Please Provide specific bank account information forALL
accounts in the space provided below.
Total Number of Checking Accounts: _________________
Total Number of Savings Accounts: _________________
Total Number of Other Type Accounts:_________________
Please Provide specific bank account information forALL
accounts in the space provided below.
Bank Account(s) Information Bank Account(s) Information
Name of Bank: ____________________________Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Co-Applicant
Name of Bank: ____________________________Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Applicant
Name of Bank: ____________________________
Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Co-Applicant
Name of Bank: ____________________________
Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Applicant
Name of Bank: ____________________________
Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Co-Applicant
Name of Bank: ____________________________
Account Number: ____________________________
Type of Account: ____________________________
Avg. Monthly Balance: ____________________________
Check if Joint Account with Applicant
Property Information Property Information
Do you own property?
Yes No
Do you own property?
Yes No
If Yes-
What is your monthly Payment: _____________________
What is your Unpaid Balance: _____________________
Address: ________________________________
________________________________
If Yes-
What is your monthly Payment: _____________________
What is your Unpaid Balance: _____________________
Address: ________________________________
________________________________
Type of Property:
House/Condo
Land
Other: (specify) _______________
Type of Property:
House/Condo
Land
Other: (specify) _______________
7. Down Payment and Closing Cost InformationAll Habitat for Humanity of Kershaw County home buyers must pay a $500.00 down payment. Where will you get this
money from (example; savings, parents, etc.) ? If you are borrowing money to pay this cost, explain how and from whom.
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8. DeclarationsApplicant Co-Applicant
Please Check the box that best answers the following questions.A. Do you have any debt
because of a court decision
against you (i.e. tax lien,
judgement, etc.):
Yes No
A. Do you have any debt
because of a court decision
against you (i.e. tax lien,
judgement, etc.):
Yes No
B. Have you declared
bankruptcy within the past 7
years?
Yes No
B. Have you declared
bankruptcy within the past 7
years?
Yes No
C. Have you had property
foreclosed on within the
past 7 years?
Yes No
C. Have you had property
foreclosed on within the
past 7 years?
Yes No
D. Have you been convicted
of a drug related offense
within the last 5 years?
Yes No
D. Have you been convicted
of a drug related offense
within the last 5 years?
Yes No
Answering Yesto these questions does not automatically disqualify you. If you
answered Yesto any questions A-D, however, explain in the space provided below.
E. Have you ever been convicted of a sexual offense?
Yes No
E. Have you ever been convicted of a sexual offense?
Yes No
Conviction of a sexual offense is grounds for application denial.
F. Are you a legal, permanent resident of the U.S. or U.S.
Citizen?
Yes No
F. Are you a legal, permanent resident of the U.S. or U.S.
Citizen?
Yes No
Additional Information on Items A-D Additional Information on Items A-D
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9. Authorizations
Authorization #1:I / We understand that by filing this application, I am authorizing Habitat for Humanity of Kershaw County to evaluate
my actual need for a Habitat home, my ability to repay the no-interest loan and other expenses of homeownership, and
my willingness to be a partner family. I understand that the evaluation will include personal visits, a credit check,
employment verification, and a criminal record background check. I have answered all the questions on this application
truthfully. I understand that if I have not answered the questions truthfully, my application may be denied, and that
even if I have already been selected to receive a Habitat home, I may be disqualified from the program. The orginal, or a
copy, of this application will be retained by Habitat for Humanity of Kershaw County even if the application is not
approved.
Authorization #2:I / We understand that Habitat for Humanity screens all potential staff (whether paid or unpaid), board members, and
applicant families on the sex offender registry. By completing this application, I am submitting to such an inquiry.
Authorization #3:I / We the undersigned, by the execution of the attached consent form grant Habitat for Humanity of Kershaw County
permission to do a credit check for the Applicant and Co-Applicant as a part of the financial evaluation.
Authorization #4:I / We the undersigned, by the execution of the attached consent form grant Habitat for Humanity of Kershaw County
permission to do a criminal background check upon the tentative selection of the applicant(s) as a Habitat for Humanity
home buyer.
Applicant Co-Applicant
Printed Name Printed Name
Social Security Number: Social Security Number:
Signature Date Signature Date
Occupant 18 Years or Older Occupant 18 Years or Older
Printed Name Printed Name
Social Security Number: Social Security Number:
Signature Date Signature Date
Occupant 18 Years or Older Occupant 18 Years or Older
Printed Name Printed Name
Social Security Number: Social Security Number:
Signature Date Signature Date
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10. Consent to Criminal Background CheckApplicant Co-Applicant
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature Signature
Occupant 18 Years or Older Occupant 18 Years or Older
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct suchcriminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age or
older, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct suchcriminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature Signature
Occupant 18 Years or Older Occupant 18 Years or Older
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age orolder, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
I ______________________________________, an(Printed Name)
Applicant, Co-Applicant, or Occupant 18 years of age orolder, for a Habitat for Humanity of Kershaw County (HHKC)
house, do hereby give my consent to HHKC to conduct such
criminal background check as it deems necessary to qualify
me as a homeowner.
Signed and dated this _______day of _____________, 201__
Signature Signature
11.Credit Report AuthorizationApplicant Co-Applicant
I ______________________________________, hereby(Printed Name)
authorize Habitat for Humanity of Kershaw County to
request credit reports on my behalf from any and all credit
bureaus. This action Is in direct relation to the review of my
application for homeownership.
Signed and dated this _______day of _____________, 201__
I ______________________________________, hereby(Printed Name)
authorize Habitat for Humanity of Kershaw County to
request credit reports on my behalf from any and all credit
bureaus. This action Is in direct relation to the review of my
application for homeownership.
Signed and dated this _______day of _____________, 201__
Signature Signature
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You must submit a $25.00 fee with your application. If Habitat does not receive the fee, your
application will not be reviewed.
YOUR APPLICATION MUST INCLUDE A CASHIERS CHECK OR MONEY ORDER
PAYABLE TO: Habitat for Humanity of Kershaw County**Fee is for background and credit check.**
***No cash or personal checks are accepted.***
Equal Housing Opportunity
We Pledge to the letter and spirit of U.S. policy for the achievement of equal housing
opportunity throughout the nation. We encourage and support an affirmative
advertising and marketing program in which there are no barriers to obtaining
housing because of race, color, religion, sex, handicap, familial status or nation origin.
12. For Office Use Only DO NOT WRITE IN THIS SPACE
Date Received: _______________________
More information requested?
Yes No
Date Application Completed: _______________________
Accepted Denied
Date Letter Sent: _____________________________
Date of Home Visit: _____________________________
Date Letter Sent: _____________________________
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