Nyc Housing Development Corporation Application For Apartment Page 8

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OFFICE USE ONLY:
Person with Disability:
[ ] Mobility
[ ] Visual
[ ] Hearing
Community Board Resident: [ ] Yes
[ ] No
Municipal Employee:
[ ] Yes
[ ] No
Size of Apartment Assigned: [ ] Studio
[ ] 1BR
[ ] 2 BR
[ ] 3 BR
[ ] 4 BR
Family Composition:
Adult (Males)
Adult (Females)
Children (Males)
Children (Females)
TOTAL VERIFIED HOUSEHOLD INCOME: $
PER YEAR
Plover Apartments Application Page 8 of 8

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