Waiting List Preapplication Form Lamar Housing Authority
ADVERTISEMENT
1
2
3Waiting List – Preapplication
Lamar Housing Authority
804 S. Main Street – Lamar Colorado 81052
Phone: 719-336-9575 Toll Free: 888-569-2056
TDY-Relay Colorado: 800-659-2656 Fax: 719-336-9529
1.
Head of Household Information
Applicants Name:
Current Address:
Mailing Address:
City
State
Zip Code
Phone # :
Message Phone #:
Social Security Number:
Date of Birth:
2.
Information about Spouse/Companion
Name:
Social Security Number:
Date of Birth:
3.
How many people will live in the unit, including yourself?
Adults: _____ Male_____ Female
Children:____Male
____ Female
4.
Do any persons who will live in the unit have a disability? Yes ____
No
5.
If housing is provided, will the unit serve as your primary residence? Yes_____
No_____
5.
I would like my name placed on the following Housing Authortiy unit waiting lists:
USDA Emerald Homes Units:
3 Bedrooms
4 Bedrooms
Location (USDA only): Lamar
Holly
Granada
Springfield
Sheridan Lake
Strainhurst (1 bedroom units only) Elderly or Disabled:
Section 8 Housing Choice Voucher Program:
6.
List all household income to include monthly amounts:
Wages: $
Social Security: $
SSI: $
TANF/AND: $
Other: $
Family: $
7.
I certify that the above information is accurate and complete.
I understand that submission of false information or misrepresentation for Federal programs may result in
loss of eligibility to participate in housing programs or other penalties as allowable by law.
Date:________
Signature of Head of Household __________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business