Interim (Change) Form - Income - Consent For Release Of Information Page 3
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3CONSENT FOR RELEASE OF INFORMATION
I, ______________________________________________, do hereby authorize the Denton Housing
Print Name of Head of Household
Authority to contact any agencies, offices, groups or organizations to obtain any information or material
that is deemed necessary to complete my application during the next twelve (12) months. I am also
certifying that all information and material provided is true and complete to the best of my knowledge.
___________________________________________________
___________________________
Signature of Head of Household
Date
___________________________________________________
___________________________
Signature of Spouse or Co-head
Date
___________________________________________________
___________________________
Signature of Other Adult 18 years and older
Date
___________________________________________________
___________________________
Signature of Other Adult 18 years and older
Date
___________________________________________________
___________________________
Signature of Other Adult 18 years and older
Date
___________________________________________________
___________________________
Signature of Other Adult 18 years and older
Date
Denton Housing Authority
1225 Wilson St.
Denton, TX 76205
(940) 383-1504
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