a. Wages from employment (including commissions, tips, bonuses, fees, etc.);

          b. Income from operations of a business;

          c. Rental income from real or personal property;

          d. Interest or dividents from assests;  

          e. Umemployment or disability payments; 

          f.  Public assitance payments;

          g. Periodic allowances such as alimony, child support, or gifts received from persons not living in my houshould; 

          h. Sales from self-employed resources (Avon, Mary Kay, Amway, etc); 

          i. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; 

          j. Veteran Benefits; 

          k. Supplemental Security Income; 

          l. Any other source of income not listed above. 

Under penalty of perjury, I, {name}, certify that the information presented in this certification is true and accurate to the best of my knowledge. I, {name}, understand that providing false representations herein constitutes as fraud. False, misleading, or incomplete information may result in withdrawal from Richmond Metropolitan Habitat for Humanity's Critical Home Repair Program. 

2281 Dabney Road, Suite A, Richmond, VA 23230

Phone: 804-232-7001 Website: www.richmondhabitat.org

1. Scope of Communications to be Provided in Electronic Form: Your consent to receive electronic communications and transactions includes, but is not limited to:

 

• Notice of incomplete application and/or request for supporting documents. 
• Notice of program application being turned down. 

2. Communications in writing: All communications in either electronic or paper format from us to you will be considered "in writing." 

3. How to Update your Records: It is your responsibility to provide us with an accurate and complete email address and update us promptly of any changes in this information. You can update your email address and other contact information by contacing us at repairs@richmondhabitat.org. Please include your full name, old and new contact information for reference.  

4. Consent: By signing below, you agree that you have read understand, and agree to receive updates about the status of your application via email and that you have provided us with a current email address at which we may send electronic communications to you. You also agree that you are responsible for updating your safe senders list to include repairs@richmondhabitat.org to prevent delays in receiving communications.