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.
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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 □ No
Is your mailing address different than above? □ Yes □ No
If yes, list mailing address (street, city, state, ZIP code)
Is your mailing address different than above? □ Yes □ No
If 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.
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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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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
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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
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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 □ No
b. Have you been declared bankrupt within the past seven years? □ Yes □ No □ Yes □ No
c. Have you had property foreclosed on or deed in lieu of foreclosure in the past seven years? □ Yes □ No □ Yes □ No
d. 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 □ No
h. 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 □ No
j. Are you a member of the US Armed Forces? □ Yes □ No □ Yes □ No
If you answered “yes” to any question a through h, or "no" to question i, please explain on a separate piece of paper.
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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.
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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 information
Race (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 information
Race (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;
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: __________________________________
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
