I hereby certify that I am applying to Habitat for Humanity of Greater Dayton for assistance for work on my propertry. I further certify, under penalty of law, that I am the owner and the occupant, and that the income information stated is an accurate prpresentation of my household income.
I will not hold Habitat liable for any legal or financial claim arising from the performance of work. I further understand that the information provided is subject to verification and that if found to be in error may eliminate my participation in this program.
Further, I grant permission to Habitat to verify any and all information provided. All information on this application and related documentation is confidential and is required by the U.S. Department of Housing and Urban Development or The State of Ohio Development Services Agency to determine the applicant's eligibility in a CDBG or ODSA funded program. It may be released to appropriate Federal, State and Local Agencies when relevent to civil, criminal, or regulatory investigators.
This program is run in accordance with the Federal Fair Housing Law (The Fair Housing Amendments Act of 1988). "It is illegal to discriminate against any person because of race, religion, sex, handicap, famillial status, or nation origin."
The information furnished ubn this questionnaire is believed to be true and complete.