Lihtc Demographic Data Release Consent Form printable pdf download

LIHTC DEMOGRAPHIC DATA RELEASE CONSENT FORM

We, the adult members of the household living in the property at the address below, do hereby give consent to the

owner and the manager of that property to share with offices of the state and federal governments, and their

designated subcontractors and agents, demographic and other information about my household, myself, and members

of my household.

The information is intended for use in compliance with the reporting requirements regarding the characteristics of

households living in each Low Income Housing Tax Credit property, including race, income, age, ethnicity, family

composition, use of Section 8 and other rental assistance, and monthly rental payments, pursuant to the Housing and

Economic Recovery Act of 2008. All information obtained through this Consent Form shall be protected and shall remain

confidential to the extent required by federal and state privacy laws and regulations.

A copy of this Consent Form has the same authority as the original. Consent forms signed separately by different adult

members of the household will have the same effect as one consent form signed by all adult members of the household.

Property Name: _____________________________________________

Address: _____________________________________________

Date: ____________

Signature: ______________________________________

Adult Household Member Name [please print]: ______________________________________

Address: ______________________________________________________________________

Date: ____________

Signature: ______________________________________

Additional Adult Household Member [please print]: ___________________________________

Address: ______________________________________________________________________

Date: ____________

Signature: ______________________________________

Additional Adult Household Member [please print]: ___________________________________

Address: ______________________________________________________________________

I, having custody of the minor children listed below who are members of the household living in the property at the

address above, do hereby give consent to the owner and the manager of that property to share with offices of the state

and federal governments, and their designated subcontractors and agents, demographic and other information

(described above) about those minor children.

Child’s Name: ______________________________________

Date: ____________

Signature: ______________________________________

Adult Household Member Name [please print]: ______________________________________

Address: ______________________________________________________________________

Lihtc Demographic Data Release Consent Form