Section 8 Pre-Application
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
Elizabethton Housing & Development Agency
| ELIZABETHTON HOUSING & DEVELOPMENT AGENCY SECTION 8 PRELIMINARY APPLICATION SECTION 8 NO LONGER RECOGNIZES FEDERAL PREFERENCES. VACANCIES ARE FILLED BY THE DATE & TIME THE APPLICATIONS ARE SUBMITTED. |
|
USE LEGAL NAME ONLY:
Race Ethnicity: White, Black, Hispanic, Non-Hispanic, American Indian/Alaskan Native,
Asian/Paific Islander.
Asian/Paific Islander.
Present Street Address: ____________________________________How long?______
(street) (city) (state & zip)
Present Mailing Address:
__________________________________________________________________
(P.O.. Number of street) (city) (state & zip)
Day Phone: _____________________Evening Phone: _______________________________
Landlord’s Name: ___________Landlord’s Phone No. ________ Rent $ ____ Utilities $ ____
Emergency Contact: ____________________ Day Phone: ____________
Evening Phone: __________
(street) (city) (state & zip)
Present Mailing Address:
__________________________________________________________________
(P.O.. Number of street) (city) (state & zip)
Day Phone: _____________________Evening Phone: _______________________________
Landlord’s Name: ___________Landlord’s Phone No. ________ Rent $ ____ Utilities $ ____
Emergency Contact: ____________________ Day Phone: ____________
Evening Phone: __________
INCOME: List all money earned or received by everyone in your household. If you receive a monthly check
from a different social security number than your own, please provide us with the appropriate number.
from a different social security number than your own, please provide us with the appropriate number.
|
DO YOU CLAIM ANY OF THE FOLLOWING:
______ 1. Mobility Impairment
______ 2. Hearing Impairment
______ 3. Sight Impairment
Have you or anyone in your household ever been convicted of any crime? ___Yes___No
If yes, please explain__________________________________________________.
Have you or anyone in your household ever been arrested for use and/or possession of drugs
or activities related to abuse of alcohol? _____Yes______No
Explain:____________________________________________________________.
Is anyone in the household currently on probation or parole for any reason?
________Yes_______No-----If yes, reason:________________________________.
County:_____________________ State:__________________________________
Is any member of the household subject to a lifetime registration under a State Sex Offender
Program? _____Yes_______No---If yes, Who?______________ State_____________
Has any member of the household EVER been convicted of the manufacture or distribution of
methamphetamine? ___________Yes ____________No --- If yes, Who?_______________
Are you currently living in government assisted housing? ____Yes_____No
If yes, Where__________________________________________________________.
Has any member of the household ever been evicted/terminated from a government assisted
housing agency? _____Yes______No--If yes, Where?____________________________.
Has any member of the household ever received any type of housing assistance?
______Yes_____No --If yes, Where?____________________________________.
Do you or anyone in your household owe any money to a government assisted housing
agency? _________Yes________No--If yes, Where?________________________.
I/We do hereby swear and/or attest that all of the information above about me/us is true and
correct. I/We also understand that all changes in income, assets and deductions of any
member of the household as well as any changes in the household members must be
reported to the Housing Agency in writing.
________________________________ ____________________________________
Signature of Head of Household Signature of Spouse
___________________________
Date
WARNING! Title 18, Section 1001 of the United States Codes states that a person is guilty of
a felony for knowingly and willing making false or fraudulent statement to any department
or agency of the United States.
______ 1. Mobility Impairment
______ 2. Hearing Impairment
______ 3. Sight Impairment
Have you or anyone in your household ever been convicted of any crime? ___Yes___No
If yes, please explain__________________________________________________.
Have you or anyone in your household ever been arrested for use and/or possession of drugs
or activities related to abuse of alcohol? _____Yes______No
Explain:____________________________________________________________.
Is anyone in the household currently on probation or parole for any reason?
________Yes_______No-----If yes, reason:________________________________.
County:_____________________ State:__________________________________
Is any member of the household subject to a lifetime registration under a State Sex Offender
Program? _____Yes_______No---If yes, Who?______________ State_____________
Has any member of the household EVER been convicted of the manufacture or distribution of
methamphetamine? ___________Yes ____________No --- If yes, Who?_______________
Are you currently living in government assisted housing? ____Yes_____No
If yes, Where__________________________________________________________.
Has any member of the household ever been evicted/terminated from a government assisted
housing agency? _____Yes______No--If yes, Where?____________________________.
Has any member of the household ever received any type of housing assistance?
______Yes_____No --If yes, Where?____________________________________.
Do you or anyone in your household owe any money to a government assisted housing
agency? _________Yes________No--If yes, Where?________________________.
I/We do hereby swear and/or attest that all of the information above about me/us is true and
correct. I/We also understand that all changes in income, assets and deductions of any
member of the household as well as any changes in the household members must be
reported to the Housing Agency in writing.
________________________________ ____________________________________
Signature of Head of Household Signature of Spouse
___________________________
Date
WARNING! Title 18, Section 1001 of the United States Codes states that a person is guilty of
a felony for knowingly and willing making false or fraudulent statement to any department
or agency of the United States.
PLEASE CHECK WHICH WAITING LIST YOU WOULD PREFER TO BE ON: VOUCHER ONLY LIST _________________________________________________________________ A Voucher is where you can find your own unit in Carter County according to your bedroom size. However, you cannot rent from family. VOUCHER & MOD REHAB. APARTMENT LIST _______________________________________ You will be offered either a voucher or an apartment – depending on which one becomes available first. You are in no obligation to take the apartment. MOD REHAB ONLY - YOU WILL BE OFFERED AN APARTMENT ONLY EFFECTIVE 1/1/2011 THE SECTION 8 VOUCHER WAITING LIST IS OPEN. |