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Wednesday, September 4, 2024

Before Applying

Critical Home Repair Program

Before applying to Richmond Metropolitan Habitat for Humanity's (RMHFH's) Critical Home Repair Program, review our website.

Click here to review qualification checklist before completing this form. If you are unable to open the link, cut and paste the link to our website into your browser.

https://richmondhabitat.org/critical-home-repairs/

Document Checklist

Please gather the relevant documents prior to completing the application and remove your social security number from all documents. You will upload all required documents at the end of this program application.

You will not be able to save and come back to your application.

* Income documents must be submitted for anyone 18 or older who is receiving income. Those over 18 years old not receiving income must sign a Certificate of Zero Income. Click Certificate of Zero Income to access a copy.

If you have any questions, please email repairs@richmondhabitat.org.

Preliminary Questions

Do you have a reverse mortgage? You may not qualify for some funding if you have a reverse mortgage.

Option 1

Do you own your home?

Option 1

Are you still making loan payments on your home?

Option 1

What is your monthly payment?

Sed ante. Vivamus tortor.

To whom are you making your mortgage payments?

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Are your real estate and property taxes, homeowner's insurance, and mortgage payments up to date?

Option 1

I acknowledge that I pay my utilities in

Opti
on 1

. If my real estate taxes, homeowner's insur

ance, and mortgage payments are not up to da

te, I acknowledge that I may not be eligible

to receive critical home repairs through RM

HFH.

Is someone other than a co-applicant helping you complete this application, the applicant?

Option 1

Complete the following if you are NOT the Homeowner but you are assisting the Homeowner in completing the application.

Printed Name

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Relationship to Homeowner

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Signature

Today's Date

Sunday, April 10, 2011

Email

pharyngton0@dailymotion.com

Phone Number

+23 (11) 576-8083

Section 1: Homeowner Information

Will you apply with a co-applicant?

Option 1

Is the co-applicant a homeowner?

Option 1

Applicant (Homeowner)

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Co-applicant

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Address

2148 Sachs Plaza, 022 Schurz Avenue

North Hollywood, California, 91606

United States

City or County (where you pay real estate and personal property taxes)

Sed ante. Vivamus tortor.

What year was your home built

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Name of Neighborhood

Sed ante. Vivamus tortor.

Number of Years at Address

Sed ante. Vivamus tortor.

Email

pharyngton0@dailymotion.com

Cell Phone Number

+23 (11) 576-8083

Secondary Phone Nu

mber

+23

(11)

576-8083

Work Phone Number

+23 (11) 576-8083

Section 2: Special Needs

Is the homeowner or anyone in the home disabled?

Option 1

Who is disabled?

Sed ante. Vivamus tortor.

Indicate the type of disability below(check all that apply)

Option 1

Section 3: Requested Repairs

The items you list will be considered for repair, but the final decision on what work can be done with the available financial resources will be made by RMHFH staff.

What type of air conditioning system do you have? Select all that apply?

Option 1

What type of heating system is used to heat your home? Select all that apply.

Option 1

Please select whether any of the following electrical and plumbing issues apply. Select all that apply, if any.

Option 1

Please select whether any of the following interior accessibility issues apply. Select all that apply, if any.

Option 1

Please select whether any of the following minor issues apply. Select all that apply, if any.

Option 1

Please select whether any of the following interior structural issues apply. Select all that apply, if any.

Option 1

Please select whether any of the following exterior issues apply. Select all that apply, if any.

Option 1

Please select whether any of the following safety operational issues apply. Select all that apply, if any.

Option 1

Please explain any other repair you would like us to consider.

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Section 4: Personal Statement

Please write a brief explanation of why you feel you should be selected and how it will help you.

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Have you applied for home repair assistance through another organization?

Option 1

Which organization?

Option 1

Asset Checklist

Applicants for Richmond Metropolitan's Habitat for Humanity Critical Home Repair program must provide information regarding their assets. Please declare your family's assets in the following categories and calculate a total value. Include all assets for all household members.

1a. Cash held in savings accounts and checking accounts. For savings accounts use the current balance. For checking accounts use the average 6-month balance.

Amount

9

1b. Cash held in safe deposit boxes, homes, etc.

Amount

9

2. Cash values of revocable trusts available to the applicant(s).

Amount

9

3.Equity in rental property or other capital investments. Equity is the estimated current market value of the asset less the unpaid balance on all loans secured by the asset and all reasonable costs (e.g. broker fees) that would be incurred in selling the asset. Under HOME, equity in the family's primary residence is not considered in the calculation of assets for owner-occupied rehabilitation projects.

Amount

9

4. Cash value of stocks, bonds, Treasury bills, certificates of deposit, and money market accounts.

Amount

9

5. Individual retirmeent and Keogh accounts (even though withdrawal would result in penalty).

Amount

9

6. Retirement and pension funds.

Amount

9

7. Cash value of life insurance policies available to the individual before death (e.g. surrender value of a whole life or universal life policy).

Amount

9

8. Personal property held as an investment such as gems, jewelry, coin collections, antique cars, etc.

Amount

9

9. Lump-sum or one-time receipts, such a inheritances, capital gains, lottery winnings, victim's restitution, insurance settlements and other amounts not intended as periodic payments.

Amount

9

10. Mortgages or deeds of trust held by an applicant.

Amount

9

Total Amount

5420

Exclusions: The following items are not included as assets.

Necessary personal property, except as noted in number 8 of Inclusions, such as clothing, furniture, cars and vehicles specially equipped for persons with disabilities. Interest in Indian trust lands. Assets not effectively owned by the applicant. That is, when assets are held in an individual's name, but the assets and any income they earn accrue to the benefit of someone else who is not a member of the household and that other person is responsible for income taxes incurred on income generated by the asset. Equity in cooperatives in which the family lives. Assets not accessible to and that provide no income for the applicant. Term life insurance policies (i.e. where there is no cash value Assets that are part of an active business. "Business" does not include rental of properties that are held as an investment and not a main occupation.

Applicant Signature

Today's Date

Sunday, April 10, 2011

Co-applicant Signature

Today's Date

Sunday, April 10, 2011

Upload Documents

REMOVE all social security numbers from your documents before you upload them. You can do this manually with whiteout or a marker. You can do this electronically with Adobe Acrobat.

A. Review the list above and UPLOAD ALL APPLICABLE documents. You can drag and drop or browse from wherever you stored your document on your device. You can upload multiple documents.

B. Review the list above and UPLOAD ALL APPLICABLE documents. You can drag and drop or browse from wherever you stored your document on your device. You can upload multiple documents.

* Income documents must be submitted for anyone 18 or older who is receiving income. Those over 18 years old not receiving income must sign a Certificate of Zero Income.

If you have any questions or are ready to make an apppointment to submit your application, please email repairs@richmondhabitat.org

C. Review the list above and UPLOAD ALL APPLICABLE documents. You can drag and drop or browse from wherever you stored your document on your device.

D. Review the list above and UPLOAD ALL APPLICABLE documents. You can drag and drop or browse from wherever you stored your document on your device.

E. Review the list above and UPLOAD ALL APPLICABLE documents. You can drag and drop or browse from wherever you stored your document on your device.

Section 5: Homeowner Certifications

I certify that

: Patty

: Haryngton

: 3547260248996286

: 946

: 3

: 2027

Address: 2148 Sach
s Plaza

Street Address Lin
e 2: 022 Schurz Av
enue

City: North Hollyw
ood

State / Province:
California

Zip Code: 91606

Country: United St
ates

is my primary residence and that I have b

een a resident at this address at least tw

elve (12) months prior to my application f

or assistance through

Richmond Metropolitan Habitat for Humanity's

(RMHFH) Critical Home Repair Program.

I understand there is a priority rankin

g and the decision of my application ma

y be determined based on need. Payment

will not be required for

services. However,

if repairs should exceed $12,500, then a De

ed of Trust for a minimum of 5 years in the

name of the city or county, will be recorded

for the

total amou

nt of repa

irs.

If it is determined my residence may, or w

ill be involved with the regulations conce

rning Lead based Paint, I understand I wil

l be informed of the

process outcome and how it may affect my

ability to receive services under this pr

ogram. I agree to sign all applicable for

ms related to lead testing,

final reports, etc. and allow access to my

home for testing.

I confirm if physically able, I will commi

t to completing the required sweat equity.

In addition, I will attend the required e

ducational class prior to

work being complete on my home. Sex Offender

Registry: I understand RMHFH screens all po

tential staff (whether paid or unpaid), boar

d members

and applicant families on the national sex

offender registry, and that by completing t

his application, I am submitting myself and

all persons, 18 years

and older, listed on the fir

st page of the application t

o such inquiry.

I understand I may not be approved for re

pairs if within the past 10 years I have

received services through any of The City

of Richmond CDBG grant

programs unless authorized by the city's s

taff. RMHFH will consult with the city sta

ff to verify prior to approval. If approve

d, I understand this could

affect my approval for future Ci

ty of Richmond CDBG funded grant

programs.

By signing below, I acknowledge, although

RMHFH follows all CDC guidelines, there is

still a risk of exposure to Covid-19.

My signature below grants permission to th

e designated agent to verify all informati

on contained in this application for housi

ng assistance through

the specific programs. I understand the inf

ormation in this application is strictly co

nfidential. No information contained herein

will be released to any

other local, state, or federal agency for a

ny purpose without my written consent, exce

pt as it may pertain to funding resource ma

de available through

this application. I certify that the inform

ation provided is true, accurate and correc

t to the best of my knowledge.

Everyone 18 years and older, who resides in the house, must complete the information below, acknowledging RMHFH will pull a national criminal background. Please include adult household members first, middle and last name and signature below.

Please include adult household members first, middle, and last name and signature below.

Release of Information Authorization Form

Richmond Metropolitan Habitat for Humanity, Inc.

2281 Dabney Road, Suite A

Richmond, Virginia 23230

PHONE (804) 232-7001 FAX (804) 232-7025

I, {homeownerApplicant}, hereby give permission to Richmond Metropolitan Habitat for Humanity, Inc. to provide and/or obtain information necessary to assist in the repairs on my property to the following:

Funding Sources for Quality Assurance and Monitoring Purposes:

X Virginia Department of Housing and Community Development

X City or County (Economic & Community Development)

X United States Department of Housing and Urban Development

I, {homeownerApplicant}, hereby give permission to Richmond Metropolitan Habitat for Humanity, Inc. to provide and/or obtain information necessary to assist in the repairs on my property to the following:

X Rebuilding together

X Projects: HOMES

X Richmond Regional Energy Alliance

Applicant's Full Name

Flem Glanton

Applicant's Signature

Today's Date

Sunday, April 10, 2011

We, {homeownerApplicant} and Sed ante. V

ivamus tortor., hereby give permission t

o Richmond Metropolitan Habitat for Huma

nity, Inc. to

provide and/or obtain information necessary

to assist in the repairs on my property to

the fo

llowin

g:

Funding Sources for Quality Assurance and Mo

nitoring Purposes:

X

Virginia Department of Housing and Communit

y Development

X

City of Richmond (Economic & Community Deve

lopment)

X

United States Department of Housing and Urb

an Development

We, {homeownerApplicant} and Sed ante. Vivamus tortor., hereby give permission to Richmond Metropolitan Habitat for Humanity, Inc. to provide and/or obtain information necessary to assist in the repairs on my property to the following:

X Rebuilding together

X Projects: HOMES

X Richmond Regional Energy Alliance

X ACES
X Senior Connections

Applicant's Full Name

Flem Glanton

Applicant's Signature