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S.H.I.P.

(State Housing Initiative Partnership) Application Packet Columbia County Return to SREC, Inc.: POB 70, Live Oak FL 32064 Fax 386/362-4078 Email Rev. 1/2018 Program Procedures Manual (Rev. 7/2015) COLUMBIA COUNTY PROGRAM APPLICATION FOR HOUSING ASSISTANCE Type of Assistance: _____ Annual Income: $ Home Ownership Home Repair Income Category (VL, LI, MI): Applicant/Co-Applicant General Information Applicant Co-Applicant Full Name: E-mail: Date of Birth/Age: Street Address: Phone: City: State/Zip: Mailing Address: Phone: City: State/Zip: Other Household Members: Name(s) Date of Birth/Age Relationship to Applicant Applicant Is Applicant, Co-Applicant, or any other household member, age 18 or older, a full-time student?

S.H.I.P. (State Housing Initiative Partnership) Application Packet Columbia County Return to SREC, Inc.: POB 70, Live Oak FL 32064 Fax – 386/362-4078

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