Pbv Application Packet - Housing Authority Of Snohomish County Page 11
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38B. FAMILY CIRCUMSTANCES
1. Are any family members temporarily absent from your household?
Yes
No
If yes, please list name and expected date of return.
2. Do you share custody of a dependent with anyone else?
Yes
No
If yes, please list the family member’s name and the percentage of time they live in your household:
3. Do you currently owe money to any Public Housing Authority (PHA) or been required to
Yes No
repay money to a PHA for misrepresenting information?
If yes, please explain:
4. Do you currently or have you ever lived in subsidized housing?
Yes No
If yes, please explain:
5. Have you ever been evicted from any subsidized housing program (i.e. Public Housing,
Yes No
Section 8, Project-based Voucher, Shelter + Care Program, etc.)?
If yes, please explain:
6. Have you or any member of your household ever been convicted of any criminal activity?
Yes
No
If yes, please explain and include dates of conviction:
2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Direct Deposit Authorization Agreement Form - Housing Authority Of The City & County Of Denver
Legal
Ead For J -2 Dependent Application Packet - The University Of South Alabama Office Of International Education
Legal
Form S504-02 - Housing Authority Of The City Of Los Angeles Reasonable Accommodation Questionnaire
Life
Form Aa-5 - Application For And Authorization Of Temporary Involuntary Hospitalization - Massachusetts Department Of Mental Health
Legal
Related Categories
Parent category: Legal