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201109462 <br /> VERIFICATION OF SECTION 8 HOUSING ASSISTANCE <br /> ,., , a.. � <br /> N, _ _ <br /> T�TIS SECTLON TE)S�C�NtpLETED BY TENANT AMJ`�XECUT�D'BY MANt1GEMENT "�. <br /> � __ „ <br /> ,_ <br /> _�.::: :�.„ __.. ,� .f:,.� _ --. <br /> TO: <br /> Name&Address of Housing Authority Phone Number <br /> Fax Number <br /> RE: <br /> ApplicanbTenant Name Social Security Number <br /> Unit#(if assigned) <br /> I hereby authorize release of my housing assistance information. <br /> Signature of ApplicandTenant Date <br /> The individual named directly above has indicated that he or she receiving Section 8 assistance from your agency and is an applicanUtenant of a <br /> housing program that requires verification of income.The information provided will remain confidential and will be used solely for the purpose of <br /> determining eligibility for occupancy.Your prompt response is crucial and greatly appreciated. <br /> Signature of Owner's Representative <br /> Return Form To: <br /> _ <br /> = � � � TI-iI�::SECT'It?N�'ft)BE"COMPLET'�I7�BY I��U�INC3 AUTH(7RIT`Y , <br /> , � � <br /> . w < � <br /> � . � °�.�.�� .�� <�u ,�,. ��� � � � <br /> Contract Rent: $ <br /> Housing Authority Portion $ <br /> Family Portion: $ <br /> Effective Date: <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 $ effective on <br /> Signature Printed Name&Tide Date <br /> Housing Authority Name and Address <br /> Phone# Fax# E-mail <br /> �'OTE: Section 1001 of Tide 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 />