Pbv Application Packet - Housing Authority Of Snohomish County Page 5
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38HOUSING AUTHORITY OF SNOHOMISH COUNTY
Avenue West • Everett, Washington 98204
th
12711 - 4
PHONE (425) 290-8499 • FAX (425) 290-5618
TARGETED VOUCHER PROGRAM
COOPERATIVE AGREEMENT
RELEASE OF INFORMATION FORM
I,
do hereby authorize the
Housing Authority of Snohomish County and
to
share information
as it
relates to my Targeted Voucher Program tenancy, including the disclosure to
my landlord that I am participating in a Targeted Voucher Program in
cooperation with the above agency. I further authorize the Housing
Authority of Snohomish County to contact any agencies, officers, groups,
organizations, or individuals to obtain information which is deemed
necessary to determine my eligibility or continued eligibility for
participation in the Housing Authority’s housing assistance program.
Signed:
Tenant
Equal Housing Opportunity
U:\TBA Department\Forms Database\Individual Documents\Cooperative Agreement for Special Programs
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