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<br />200809274 <br /> <br />20NQlRs <br /> <br />VERIFICATION OF SECTION 8 HOUSING ASSISTANCE <br /> <br /> <br />TO: <br /> <br />Name & Address of Housing Authority <br /> <br />Phone Number <br /> <br />Fax Number <br /> <br />RE: <br /> <br />Applicant/Tenant Name <br /> <br />Social Security Number <br /> <br />Unit # (if assigned) <br /> <br />I hereby authorize release of my housing assistance information. <br /> <br />Signature of ApplicantlTenant <br /> <br />Date <br /> <br />The individual named directly above has indicated that he or she receiving Section 8 assistance from your agency and is an applicant/tenant of a <br />housing program that requires verification of income. The information provided will remain contidential and will be used solely for the purpose of <br />determining eligibility tor occupancy. Your prompt response is crucial and b'Teatly appreciated. <br /> <br />Signature of Owner's Representative <br /> <br />Return Form To: <br /> <br /> <br />Contract Rent: $ <br /> <br />Housing Authority Portion $ <br />Family Portion: $ <br />Effective Date: <br /> <br />Number of persons in household <br />Housing Authority verifies that the annual income as calculated in a manner consistent with the determination of annual income <br />under Section 8 is $ <br /> <br />Signature <br /> <br />Printed Name & Title <br /> <br />Date <br /> <br />Housing Authority Name and Address <br /> <br />Phone # <br /> <br />Fax # <br /> <br />F:'mai I <br /> <br />NOTE: Section 1001 of Title 18 of the u.S. Code makcs it a criminal otfense to make willful false statements or misrepresentations to any Deparrment or Agency of the <br />United States as to any matter within its jurisdiction_ (Updated 11/07) <br />