TX Waco Housing Assistance Application free printable template

WACO HOUSING AUTHORITY AFFILIATES Housing Assistance Application Do Not Write In This Area - WHA USE ONLY This form must be completed in your own handwriting. PLEASE PRINT AND USE BLUE OR BLACK INK. NAME HEAD OF HOUSEHOLD MAILING ADDRESS CITY STATE ZIP HOME PHONE NUMBER Bedroom Size Application No. WORK or OTHER PHONE NUMBER APPLYING FOR X Public Housing Kate Ross South Terrace Estella Maxey RACE check all that apply to you White Black/African PRINCIPAL LANGUAGE Hispanic American Indian or...Alaskan English Hawaiian or Other Pacific Spanish Asian Other HOUSEHOLD MEMBERS No List all persons who will be living in your household beginning with head of household at 1. Checking savings credit union shares annuities stocks bonds CD s etc. Name of Financial Institution Type of Account Current Balance CREDIT HISTORY CREDITOR CREDIT TYPE loan credit card car payment etc. INPUT CLERK DATE PROGRAM INTEGRITY INFORMATION HAVE YOU YOUR SPOUSE OR ANY HOUSEHOLD MEMBER LISTED ON YOUR...APPLICATION Been evicted or asked to move out of any rental property If yes Who Where When Been arrested for criminal activity Been convicted of a crime Been sued for damage to rental property Been sued for nonpayment of rent Broken a rental agreement or lease contract Been arrested and/or convicted for the use sale manufacture or distribution of any controlled substance Lived in Subsidized Housing Public Housing Section 8 etc. Been evicted from Public or Assisted housing for violent criminal or...drug related activity Used a name other than the one you are using now If yes what name Used a social security number other than the one listed above If yes what is it DO YOU YOUR SPOUSE OR ANY HOUSEHOLD MEMBERS LISTED ON YOUR APPLICATION Currently use a controlled substance or illegal drug If yes explain Owe money to a Public or Assisted Housing Agency What Agency Have any relatives by blood or marriage who are now an employee of Waco Housing Authority Are you or anyone listed on your...application a registered sex offender Does anyone listed on page 1 as a Household Member claim mobility visual or hearing impairment or other special need which would require a special type of unit or other accommodation If yes please describe Do you expect anyone to move in or out of your household within the next 12 months Do you have any pets If yes what kind AUTHORIZATIONS REPRESENTATIONS AND CERTIFICATIONS I/We do hereby authorize the Waco Housing Authority to release information regarding...any of the following information for purposes of verifying information on my/our apartment rental application. I understand that previous or current information regarding me/us may be needed. Verifications made may include any of the groups or individuals as defined below. PLEASE PRINT AND USE BLUE OR BLACK INK. NAME HEAD OF HOUSEHOLD MAILING ADDRESS CITY STATE ZIP HOME PHONE NUMBER Bedroom Size Application No. WORK or OTHER PHONE NUMBER APPLYING FOR X Public Housing Kate Ross South Terrace...Estella Maxey RACE check all that apply to you White Black/African PRINCIPAL LANGUAGE Hispanic American Indian or Alaskan English Hawaiian or Other Pacific Spanish Asian Other HOUSEHOLD MEMBERS No List all persons who will be living in your household beginning with head of household at 1. Relationship LEGAL NAME Social Security Occupation or City State of to Head of Date of Birth Must use correct legal name Number School Name Birth Household Age Sex HOH INCOME List all income of household...members listed ABOVE including benefits for children Salary Tips Social Security SSI TANF Food Stamps Pensions Child Support etc. ONE SOURCE OF INCOME PER LINE FAMILY MEMBER Job SS SSI TANF Individual child support AMOUNT HOW OFTEN weekly monthly bi-monthly etc. INCOME INFORMATION YES These questions apply to all household members NO Has anyone in your household applied for any benefits or money which is in the process of being approved Does anyone outside of your household pay for any of your...bills or expenses Are you entitled to Child Support Alimony Maintenance Do you receive Child Support Alimony Maintenance Does anyone in your household receive an educational scholarship or grant MONTHLY EXPENSES Rent Electric Gas Telephone Auto Payment Auto Insurance Water From preceding month Medical Cable Child Care Credit Card Loan Rentals CHILDCARE EXPENSES Do you pay childcare expenses Yes If yes list each child s name below Amount Per Month Weekly etc. HANDICAPPED ASSISTANCE EXPENSES...Per Reason Month Weekly etc. MEDICAL AND UNUSUAL EXPENSES ELDERLY FAMILIES ONLY Medicare Other health insurance Regular payments on medical bills Anticipated healthcare related expenses in the next 12 months Have you or anyone in your household ever owned a home or property ASSETS List all assets of all Household Members listed on page 1. real estate boats mobile homes etc. CASH VALUE VEHICLES Owner Make How many vehicles does the family own Model Year Color License State HOUSING AUTHORITY OF...THE CITY OF WACO TEXAS LOCAL PREFERENCE CLAIM FORM For Public Housing and Section 8 Applicants READ CAREFULLY AND CHECK ONLY THE PREFERENCES THAT APPLY TO YOU.