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  • Everyone Deserves A Decent Place To Live

    An affiliate of Habitat for Humanity, Inc. Americus, GA

    1757 North East Avenue • Sarasota, FL 34234 (941) 487-5522 Fax: (941) 363-7775

    [email protected] www.habitatsrq.org

    Critical Home Repair Program Frequently Asked Questions Updated: April 2020

    1. WHAT IS THE CRITICAL HOME REPAIR PROGRAM?

    The intention of this program is to eliminate health and safety defects from the home; barrier removal to improve housing conditions for accessibility; special needs; and assist seniors to age in place. 2. WHAT REPAIRS ARE ELIGIBLE?

    • Installing new roofs

    • Replacing old and broken heating and cooling systems

    • Replacing water and sewer lines

    • Replacing water heaters

    • Removal of health and safety barriers

    • Eligible repairs cannot exceed the cost of $12,000. Mobile homes are not eligible for assistance. 3. HOW DO I QUALIFY?

    • The applicant must be listed on the deed and live in the home as their primary residence.

    • The mortgage on the home and the property taxes must be current.

    • The home must be located within Habitat Sarasota affiliate boundary area.

    • The current value of the home must be less than $272,000 as determined by the Sarasota Property Appraiser.

    • The total household income must not exceed the income limits shown on the table below. 4. Your household income must be verifiable and include all sources (including Social Security, Child Support, Disability, Alimony, Wages, etc.). You must exhibit job stability, with at least 2 years of consistent employment. Household maximums are determined by family size and are adjusted annually based on HUD income limits (see table below). 5. Your credit and criminal history will be reviewed. Bankruptcies or foreclosures must be at least 4 years old. Collections must be resolved. All medical collections must have an active payment plan in place. Credit is checked during the application process and a fee is collected at the time the credit is requested. 6. HOW CAN I APPLY?

    Applications are available at: www.habitatsrq.org. Applications are available to pick up at our Administrative Office located at:1757 N. East Ave., Sarasota, FL 34234 during normal business hours. 7. WHAT ARE THE PAYMENT TERMS?

    A credit report will be pulled to determine payment/ability to pay. HFHS provides affordable repayment terms based upon the applicant’s ability to pay.

    We are pledged to the letter and spirit of the 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 national origin.

    Family Size Habitat Maximum Income 1 $42,850 2 $49,000 3 $55,100 4 $61,200 5 $66,100 6 $71,000 7 $75,900 8 $80,800

  • Everyone Deserves A Decent Place To Live

    An affiliate of Habitat for Humanity, Inc. Americus, GA

    CRITICAL HOME REPAIR CHECKLIST

    Thank you for your interest in applying for the Habitat for Humanity Sarasota Critical Home

    Repair program. Please complete the attached application and submit with the following

    documents:

    ___ Copy of driver license for all applicants

    ___ Copy of birth certificate for everyone living in the home

    ___ Copy of Social security card for everyone living in the home

    ___ Proof of citizenship if born outside the US

    (US Passport, Cert. of Naturalization, Permanent Resident Card)

    ___ Last 4 paystubs for anyone 16 or older who is working

    ___ 2019 and 2018 tax returns

    ___ 2019 and 2018 W2s

    ___ Bank statements (6 months of checking and 1 month of savings)

    ___ Copy of current mortgage statement

    ___ Copy of current homeowner’s insurance policy

    ___ Copy of the deed

    ___ Copy of title policy

    ___ Award letters for assistance income (If applicable)

    • Child support (Orders, Decrees)

    • SSI or disability

    ___ DD214 (If applicable)

    ___ Borrower’s Authorization Form

    ___ Social Security Verification Form SSA-89

    ___ Income Tax Request Form 4506-T

    ALL FIELDS MUST BE COMPLETE AND ALL DOCUMENTS

    MUST BE ATTACHED.

    4/20

  • 1

    □ □

    □ □

    ApplicationCritical Home Repair Program

    1. APPLICANT INFORMATION

    Applicant Co-applicant

    Applicant’s name Applicant’s email: Co-applicant’s name

    Social Security

    Best Phone # Age

    □ Married □ Separated □ Unmarried (Incl. single, divorced, widowed)

    Social Security

    Best Phone # Age

    □ Married □ Separated □ Unmarried (Incl. single, divorced, widowed)

    Dependents and others who will live with you

    (not listed by co-applicant)

    Name Age Male Female

    Dependents and others who will live with you

    (not listed by co-applicant)

    Name Age Male Female

    Present address (street, city, state, ZIP code) □ Own Present address (street, city, state, ZIP code) □ Own

    Is the above address your primary residence? □ Yes □ No

    Do you rent the property to others □ Yes □ NoIs your mailing address different than above? □ Yes □ NoIf yes, list mailing address (street, city, state, ZIP code)

    Is your mailing address different than above? □ Yes □ NoIf yes, list mailing address (street, city, state, ZIP code)

    2. FOR OFFICE USE ONLY — DO NOT WRITE IN THIS SPACE

    Date received:

    Date of adverse action letter:

    Date of approval:

    Date of commitment letter:

    Dear Applicant: Please complete this application to determine if you qualify for the Habitat for Humanity Sarasota Critical Home Repair program.

    Please fill out the application as completely and accurately as possible. All information you include on this application will be kept confidential in

    accordance with the Gramm-Leach-Bliley Act.

    We are pledged 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 national origin.

  • 2

    3. WILLINGNESS TO PARTNER

    To be considered for Habitat Critical Home Repair Program, you and your family must be willing to make the property available for inspection by Habitat for Humanity Sarasota, Inc or its agents before and after the completed repairs to your home.

    I AM WILLING TO MAKE MY HOME AVAILBLE FOR INSPECTION:

    Yes No

    Applicant

    Co-applicant

    4. TYPE OF CRITICAL HOME REPAIR

    Select the type of Critical Home Repair you are applying for:

    □ Roof □ Hot Water Heater □ Heating and Air Conditioning □ Plumbing□ Other (please describe)

    In the space below, describe the Critical Home Repair issue.

    5. ADDITIONAL PROPERTY INFORMATION

    1. What is your monthly mortgage payment? $ Unpaid balance $

    2. What is your annual property taxes? $ Annual Homeowners Insurance $

    3. Are there any liens on your property? □ No □ Yes If yes, list amount $

    4. Do you own any other real estate? □ No □ Yes If yes, list property address $

    6. OPTIONAL INFORMATION

    1. Did you contact any agency prior to Habitat? □ No □ Yes If yes, list name:

    2. Which agency/person referred you to our program?

    3. What school(s) do your dependents attend?

    4. Is any member of your household disabled? □ No □ Yes

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  • 3

    8. MONTHLY INCOME

    Income source Applicant Co-applicant Others in household Total

    Wages $ $ $ $

    Alimony $ $ $ $

    Child support $ $ $ $

    Social Security $ $ $ $

    SSI $ $ $ $

    Disability $ $ $ $

    Other: $ $ $ $

    Other: $ $ $ $

    Other: $ $ $ $

    Total $ $ $ $

    PLEASE NOTE: HOUSEHOLD MEMBERS WHOSE INCOME IS LISTED ABOVE

    Self-employed

    Name Income source Monthly income Date of birth applicants may be

    required to provide

    additional

    documentation such

    as tax returns and

    financial statements.

    7. EMPLOYMENT INFORMATION

    Applicant Co-applicant

    Name, address, and phone of CURRENT employer

    Years on this job Name, address, email and phone of CURRENT employer

    Years on this job

    Monthly (gross)

    wages

    $

    Monthly (gross)

    wages

    $

    Position Business phone Position Business phone

    If working at current job less than one year, complete the following information

    Name and address of LAST employer Years on this job Name and address of LAST employer Years on this job

    Monthly (gross)

    wages

    $

    Monthly (gross)

    wages

    $

    Position Business phone Position Business phone

  • 4

    9. ASSETS

    Address City, state ZIP Account number

    Current

    balance

    $

    $

    $

    $

    $

    $

    $

    $

    $

    10. DEBT

    TO WHOM DO YOU AND THE CO-APPLICANT(S) OWE MONEY?

    APPLICANT CO-APPLICANT

    Account

    Monthly

    payment

    Unpaid

    balance

    Months

    left to pay

    Monthly

    payment

    Unpaid

    balance

    Months

    left to pay

    Other motor vehicle $ $ $ $

    Boat $ $ $ $

    Furniture, appliance, TVs

    (includes rent-to-own) $ $ $ $

    Alimony $ $ $ $

    Child support $ $ $ $

    Credit card $ $ $ $

    Credit card $ $ $ $

    Credit card $ $ $ $

    Total medical $ $ $ $

    Other $ $ $ $

    Other $ $ $ $

    Total $ $ $ $

    Name of bank, checking,savings, retirement, 401k

  • 5

    MONTHLY EXPENSES

    Account Applicant Co-applicant Total

    Mortgage $ $ $

    Utilities $ $ $

    Insurance $ $ $

    Child care $ $ $

    Internet service $ $ $

    Cell phone $ $ $

    Land line $ $ $

    Business expenses $ $ $

    Other $ $ $

    Other $ $ $

    Other $ $ $

    Total $ $ $

    11. DECLARATIONS

    Please check the box beside the word that best answers the following questions for you and the co-applicant

    Applicant Co-applicant

    a. Do you have any outstanding judgments because of a court decision against you? □ Yes □ No □ Yes □ Nob. Have you been declared bankrupt within the past seven years? □ Yes □ No □ Yes □ Noc. Have you had property foreclosed on or deed in lieu of foreclosure in the past seven years? □ Yes □ No □ Yes □ Nod. Are you currently involved in a lawsuit? □ Yes □ No □ Yes □ No

    e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure,

    transfer of title in lieu of foreclosure, or judgment?

    □ Yes □ No □ Yes □ No

    f. Are you currently delinquent or in default on any federal debt or any other loan, mortgage

    financial obligation or loan guarantee?

    □ Yes □ No □ Yes □ No

    g. Are you paying alimony or child support or separate maintenance? □ Yes □ No □ Yes □ Noh. Are you a co-signer or endorser on any loan? □ Yes □ No □ Yes □ No

    i. Are you a U.S. citizen or permanent resident? □ Yes □ No □ Yes □ Noj. Are you a member of the US Armed Forces? □ Yes □ No □ Yes □ NoIf you answered “yes” to any question a through h, or "no" to question i, please explain on a separate piece of paper.

  • 6

    12. AUTHORIZATION AND RELEASE

    I understand that by filing this application, I am authorizing Habitat for Humanity Sarasota to evaluate my actual need for the Critical

    Home Repair program, my ability to repay an affordable loan, and my willingness to be a partner.

    I understand that the evaluation will include personal visits, a credit check and employment verification. 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. The original or

    a copy of this application will be retained by Habitat for Humanity Sarasota even if the application is not approved.

    I also understand that Habitat for Humanity Sarasota screens all applicants on the sex offender registry. By completing this application, I

    am submitting myself to such an inquiry. I further understand that by completing this application, I am submitting myself to a criminal

    background check.

    Applicant signature Date Co-applicant signature Date

    PLEASE NOTE: If more space is needed to complete any part of this application, please use a separate sheet of paper and attach it to

    this application. Please mark your additional comments with “A” for applicant or “C” for co-applicant.

    13. WARNING

    Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements

    to any department of the United States Government.

    Applicant's name Co-applicant's name

    14. STATEMENT

    The applicant understands that the application is subject to Florida’s public records laws.

  • 7

    15 . INFORMATION FOR GOVERNMENT MONITORING PURPOSES

    PLEASE READ THIS STATEMENT BEFORE COMPLETING THE BOX BELOW: We are requesting the following information to monitor

    our compliance with the federal Equal Credit Opportunity Act, which prohibits unlawful discrimination. You are not required to provide this

    information. We will not take this information (or your decision not to provide this information) into account in connection with

    your application or credit transaction. The law provides that a creditor may not discriminate based on this information, or based on

    whether or not you choose to provide it. If you choose not to provide the information, we may note it by visual observation or surname.

    Applicant Co-applicant

    □ I do not wish to furnish this informationRace (applicant may select more than one racial designation):

    □ American Indian or Alaska Native□ Native Hawaiian or other Pacific Islander□ Black/African-American□ White□ Asian

    Ethnicity:

    □ Hispanic or Latino □ Non-Hispanic or Latino

    Sex:

    □ Female □ Male

    Birthdate:

    / /

    Marital status:

    □ Married □ Separated □ Unmarried (single, divorced, widowed)

    □ I do not wish to furnish this informationRace (applicant may select more than one racial designation):

    □ American Indian or Alaska Native□ Native Hawaiian or other Pacific Islander□ Black/African-American□ White□ Asian

    Ethnicity:

    □ Hispanic or Latino □ Non-Hispanic or Latino

    Sex:

    □ Female □ Male

    Birthdate:

    / /

    Marital status:

    □ Married □ Separated □ Unmarried (single, divorced, widowed)

    To be completed only by the person conducting the interview

    This application was taken by:

    □ Face-to-face interview□ By mail□ By telephone

    Interviewer’s name (print or type)

    Interviewer’s signature Date

    Interviewer’s phone number

  • Borrowers' Certification and Authorization

    CERTIFICATION

    The Undersigned certify the following:

    1. I/We have applied for a mortgage loan through __________________________________. In applying

    for the loan, I/We completed a loan application containing various information on the purpose of the

    loan, the amount and source of the down payment, employment and income information, and the assets

    and liabilities. I/We certify that all of the information is true and complete. I/We made no

    misrepresentations in the loan application or other documents, nor did I/We omit any pertinent

    information.

    2. I/We understand and agree that ___________________________________________reserves the right to

    change the mortgage loan review processes to a full documentation program. This may include verifying

    the information provided on the application with the employer and/or the financial institution.

    3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to

    knowingly make any false statements when applying for this mortgage, as applicable under the

    provisions of Title 18, United States Code, Section 1014.

    AUTHORIZATION TO RELEASE INFORMATION

    To Whom It May Concern:

    1. I/We have applied for a mortgage loan through ________________________________. As part of

    the application process, _____________________________________ and the mortgage guaranty insurer

    (if any), may verify information contained in my/our loan application and in other documents required in

    connection with the loan, either before the loan is closed or as part of its quality control program.

    2. I/We authorize you to provide to ________________________________ and to any investor to

    whom ___________________________________ may sell my mortgage, any and all information and

    documentation that they request. Such information includes, but is not limited to, employment history

    and income; bank, money market and similar account balances; credit history; and copies of income tax

    returns.

    3. ____________________________________ or any investor that purchases the mortgage may address

    this authorization to any party named in the loan application.

    4. A copy of this authorization may be accepted as an original.

    Borrower Date

    Co-Borrower Date

    Calyx Form - borcera.frm (10/2013)

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    Habitat for Humanity Sarasota, Inc.

    (Print Name ____________________ )

  • Everyone Deserves A Decent Place To Live

    An affiliate of Habitat for Humanity, Inc.

    Americus, GA

    I n i t i a l _ _ _ _ / _ _ _ _ P a g e 1 | 2 Updated 10/2019

    E-SIGN ACT DISCLOSURE AND AGREEMENT

    Dear Applicant,

    We are pleased to offer you the opportunity to receive information about your account electronically. If you

    would like to receive correspondence and notices from us electronically, instead of paper copies through the mail,

    please review this notice and provide your consent.

    1. Scope of Communications to Be Provided in Electronic Form. When you use a product or service to which

    this disclosure applies, you agree that we may provide you with any communications in electronic format, and

    that we may discontinue sending paper communications to you, unless and until you withdraw your consent

    as described below. Your consent to receive electronic communications and transactions includes, but is not

    limited to:

    • All legal and regulatory disclosures and communications associated with the product or service available through Habitat for Humanity Sarasota.

    • Notices or disclosures about a change in the terms of your account or associated payment feature and responses to claims.

    • Privacy policies and notices.

    2. Method of Providing Communications to You in Electronic Form. All communications that we provide to

    you in electronic form will be provided either (1) via e-mail, (2) by access to a web site that we will designate

    in an e-mail notice we send to you at the time the information is available, or (3) to the extent permissible by

    law, by access to a web site that we will generally designate in advance for such purpose.

    3. How to Withdraw Consent. You may withdraw your consent to receive communications in electronic form by

    contacting us at [email protected] or 1757 N East Ave Sarasota, FL 34234. At our option, we may treat

    your provision of an invalid email address, or the subsequent malfunction of a previously valid email address,

    as a withdrawal of your consent to receive electronic communications. We will not impose any fee to process

    the withdrawal of your consent to receive electronic communications. Any withdrawal of your consent to

    receive electronic communications will be effective only after we have a reasonable period of time to process

    your withdrawal.

    4. How to Update Your Records. It is your responsibility to provide us with true, accurate and complete e-mail

    address, contact, and other information related to this E-Sign Act disclosure and your account, and to

    maintain and update promptly any changes in this information. You can update information (such as your e-

    mail address) by contacting us at [email protected] or 1757 N East Ave Sarasota, FL 34234.

    5. Hardware and Software Requirements. In order to access, view, and retain electronic communications that

    we make available to you, you must have:

    • an Internet browser that supports 128 bit encryption; • sufficient electronic storage capacity on your computer's hard drive or other data storage unit; • an e-mail account with an Internet service provider and e-mail software in order to participate in

    our electronic communications programs;

    mailto:[email protected]:[email protected]

  • Everyone Deserves A Decent Place To Live

    An affiliate of Habitat for Humanity, Inc.

    Americus, GA

    P a g e 2 | 2

    Updated 10/2019

    • a personal computer (for PC's: Pentium 120 MHz or higher; for Macintosh, Power Mac 9500, Power PC 604 processor 120-MHz Base or higher), operating system and telecommunications

    connections to the Internet capable of receiving, accessing, displaying, and either printing or

    storing communications received from us in electronic form via a plain text-formatted e-mail or

    by access to our web site using one of the browsers specified above;

    • Adobe Reader version 8.0 or higher.

    6. Requesting Paper Copies. We will not send you a paper copy of any communication, unless you request it or

    we otherwise deem it appropriate to do so. You can obtain a paper copy of an electronic communication by

    printing it yourself or by requesting that we mail you a paper copy, provided that such request is made within

    a reasonable time after we first provided the electronic communication to you. To request a paper copy,

    contact us at [email protected] or 1757 N East Ave Sarasota, FL 34234. We may charge you a reasonable

    service charge for the delivery of paper copies of any communication provided to you electronically pursuant

    to this authorization. We reserve the right, but assume no obligation, to provide a paper (instead of electronic)

    copy of any communication that you have authorized us to provide electronically.

    7. Communications in Writing. All communications in either electronic or paper format from us to you will be

    considered "in writing." You should print or download for your records a copy of this disclosure and any

    other communication that is important to you.

    8. Federal Law. You acknowledge and agree that your consent to electronic communications is being provided in

    connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures

    in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent

    possible to validate our ability to conduct business with you by electronic means.

    9. Termination/Changes. We reserve the right, in our sole discretion, to discontinue the provision of your

    electronic communications, or to terminate or change the terms and conditions on which we provide

    electronic communications. We will provide you with notice of any such termination or change as required

    by law.

    10. Consent. By signing below you agree that you have read, understand, and agree to the E-Sign. You hereby

    give your affirmative consent to provide electronic communications to you as described herein. You further

    agree that your computer satisfies the hardware and software requirements specified above and that you have

    provided us with a current e-mail address at which we may send electronic communications to you.

    Acknowledged and Agreed to by:

    Signature: ____________________________

    Print Name: __________________________

    Date: ________________________________

    Signature: ______________________________

    Print Name: ____________________________

    Date: __________________________________

    mailto:[email protected]

  • Everyone Deserves A Decent Place To Live

    An affiliate of Habitat for Humanity, Inc.

    Americus, GA

    EQUAL CREDIT OPPORTUNITY ACT NOTICE

    The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants

    on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the

    capacity to enter into a binding contract); because all or part of the applicant's income derives from any

    public assistance program; or because the applicant has in good faith exercised any right under the

    Consumer Credit Protection Act. The Federal Agency that monitors compliance with this law concerning

    this company is the Federal Trade Commission, with offices at: [FTC Regional Office for the Southeast

    Region, FTC- 225 Peachtree Street, N.E. Suite 1500, Atlanta Ga., 30303 or Federal Trade Commission,

    Equal Credit Opportunity, Washington, DC 20580.

    You need not disclose income from alimony, child support or separate maintenance payment if you

    choose not to do so. However, because we operate a Special Purpose Credit Program, we may

    request and require, in order to determine an applicant's eligibility for the program and the

    affordable mortgage amount, information regarding the applicant's marital status; alimony, child

    support, and separate maintenance income; and the spouse's financial resources.

    Accordingly, if you receive income from these sources and do not provide this information with

    your application, your application will be considered incomplete and we will be unable to invite

    you to participate in the Habitat program.

    Applicant(s):

    Signature: ________________________

    Print Name:

    Date:

    Signature: __________________________

    Print Name: ___________________________

    Date: _______________________________

    1757 N. East Avenue · Sarasota FL 34234 · (941) 365-0700 · www.habitatsrq.org

    http://www.habitatsrq.org/

    CHR ApplicationCHR Program FAQ May2019 newE-Sign_Disclosure_Template rOct2019.pdfSignature: ____________________________Signature: ______________________________