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MILITARY PAY VERIFICATION 201109462 <br /> - ,� .,� _ � � . �� � .�� <br /> � ,. . <br /> THIS SEG'LION TO BE COMPLETED''B'Y TENANT AND�XCU'T�°I7'BY MANAGEME2V'T `` � <br /> TO: <br /> Name&Address of Employer Phone Number <br /> Fax Number <br /> RE: <br /> ApplicanUTenant Name Social Security Number <br /> Unit#(if assigned) <br /> I hereby authorize release of my military employment information. <br /> Signature of Applicant/Tenant Date <br /> The individual named directly above is an applicant/tenant of a housing program that requires verification of income.The information provided will remain <br /> confidential and will be used solely for the purpose of determining eligibility for occupancy.Your prompt response is crucial and greatly appreciated. <br /> Signature of Owner's Representative <br /> Return Form To: <br /> �::. <br /> , • ;;; T'kTTS SECTIQN TD HE'Ct�MPLE�D BY APPROPRIA7'E MII:,TTAR1' F'k'IC,IAL; ; °. <br /> _ , ,N�..� <br /> ,�w , , _ ��� �.� <br /> Gross Earnings anticipated over next 12 months: <br /> Monthly Base Pay <br /> B,e,Q Grade Level <br /> FED-RATE Probability of Continued Enlistment <br /> Clothing Allowance Commuted Rations <br /> Hazardous Duty Pay Other Special Pay <br /> Total Monthly Entitlement Year-to-date Earnings <br /> Additional remarks: <br /> Authorized Official Signature Authorized Officia]Printed Name&Title Date <br /> Military Agency Address <br /> Phone# Fax# E-mail <br /> NOTE: Section 1001 of Title 18 of the U.S.Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the <br /> United States as to any matter within its jurisdiction. (Updated 12/10) <br />