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RE: <br />EXHIBIT B -10 200109053 <br />VERIFICATION OF UNEMPLOYMENT BENEFITS <br />CLIENT: <br />ADDRESS: <br />CLAIM NO. <br />The above individual has indicated he /she is receiving benefits from your agency. Information provided <br />will remain confidential and will be used solely for the purpose of determining eligibility for occupancy. <br />BY <br />TITLE <br />I hereby authorize the above named management agent to make inquiries regarding my household income <br />for the purpose of determining my eligibility for occupancy. <br />Signed: Date: <br />Weekly payments to client <br />Beginning date of payments <br />Is this client entitled to an extension of benefits? <br />Remarks: <br />By Date_ <br />Title Phone <br />PLEASE RETURN FORM TO: <br />01- 351904.01 <br />ffim <br />Ending date if known <br />If yes, for how long? <br />