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VERIFICATION OF SECTION 8 SOUSING ASSISTANCE <br />TQ. <br />Name l9t Addrel of Haraing 1►uthority <br />RE: <br />ApplirsntrTe Gant Name <br />I hereby wthorixe release of my housing assistance information. <br />Signature of Applicant/Tamtt <br />200512606 <br />Unit # (if assigned) <br />Social Security Number <br />Date <br />71te individual named directly abova has indicated that he or $he receiving Scstion 8 assistance from your agency and is an applicant/tenant of a <br />housing program that requires verification of inee ne. The iA foe p w la vilmai n co fidential and will be used solely for the purpose of <br />determining cliguity for occupancy. Your prompt response <br />pmjeot Owner/Management Agent <br />Return Form To: <br />Monthly payment towards rent: Housing Authority S <br />Number of persons in household <br />Applicant $ <br />Housing Authority verifies that the annual income as calculated in a manner consistent with the determination of <br />annual income under section 8 does not exceed S <br />Date <br />Signature <br />Printed Name &Titre <br />Housing Authority Name and Address <br />Phone p <br />Fax # E-mail <br />tiC�TE: Section 1001 of Title i R of the U.S. Cade makes it a .rin l offi:we to make willful faise statements ur misrepteseniations to any ©epartme", or AgOncY of rho <br />(l:p(lated 11 G4) <br />l;nitnd States as to any matter within its jurisdiction. <br />