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Exhibit A: Residential Interview Form <br />RESIDENTIAL RELOCATION NfTERVIE4y P Partrl Ltd <br />Srte Wb n Qmr. J 1 brew Da : <br />_ _ _ <br />Ini ORer Dale l 1 Cnaa N_ In[emiewer. <br />Head of Household: <br />Day Tel N {� ezc <br />Address: VnRB <br />0�- Ocel Ow» <br />e-n.ad_ <br />Home TeM �� Olin Ml � <br />S # <br />DISPLACEMENT STATISTICS <br />OT ER <br />MONTHLY UTILITIES <br />0cvwp3 S - El Rem ElOwn <br />FRl1ltLTl Y.- <br />o ,,d eg-=-- =— <br />0 Airira..Vrix.iari <br />IITLRE3 PAD BY TENANT- <br />o� ❑EkUwnty E]W , r ETrr <br />TypeoApt D� oOWL 0 � D "13 <br />Dm'raccr..enr S� Features-RD- m-1 1 <br />Repfacemenf Requke.nent 00. PA O <br />�nicl Latino <br />�%ryrr.. EDWT{Rg[r_ <br />Fun�ahed niNv owm lnrr3imwe9 ❑Yes []Al.p <br />O <br />Other. - <br />0 Gas 0 Electricity 0 water Qlrash <br />TCYaI NfrirW ru b Fii lP: �w. time 6 naweyeJ <br />Conri'dm of v3i¢z[30� OGood ❑Fair ❑Poor <br />PR11fARY LANGfIAGE: <br />APdianrss Owned MTenant: <br />0 Erglish 0 Spa.'eh <br />❑ Law"yFas.p carps[ p K D moo Dam.:. <br />OS[ave ❑Refigera[or OWlD <br />❑Pe6Y[desu )______.. ___._._- -----. <br />D Dlheo <br />OOcher. <br />QwS N oPa.pans more a a me same tunes 0 Yes ❑ No <br />SPECIALIZED NEEDS <br />}tome busirreaa J.. ❑No ❑Yes <br />fadwIXulneeslwJahffe.mwvasmmem- <br />ram' <br />ylfw.sehold? <br />(films+hareb ni <br />YwouFJla�cormderrdoradlout <br />nFd.e area? ❑es ❑ No. ii ya-+'. �? <br />L3 ... <br />LiNo <br />0 Pfo p Yes <br />o•mrcc, waxo9ve s.g 0 No ❑Yes <br />INCOME INFORMATION <br />same rePraP�mtdner�r Dye Orlo <br />Hrmftpp� <br />p No UYes <br />W .re wL Nmy. <br />70EA ousa[aLQ�NaY y <br />........... <br />a 9e laadirtlf <br />RENTERS: <br />To [ Monthly Rerrt SE <br />Landlord: <br />[all zmar�5, antt l� of <br />0 Modh�a.n.iR 0 Lease ONa®.Ilfb Cu.bd <br />}J Da Ya+9�i.mne From open <br />Lease e3q,irann.. dak l ! <br />-spxYllannFeuYne.- <br />ar�Y-�--- ---� orao ores <br />DY. <br />se�.ay Qrnn F' <br />..._......__._....__..........- ................--.. <br />❑ EEC. 8 � Tenan➢'s Portion d I�rrt � <br />2j Ham arty ofede adult :.m.ne <br />____ <br />Aiew.al Review Q..e Daa: ! ! <br />Need m ie nenrsonre <br />s dam x rY..& MY <br />Ci�eW nrkU... ............... .......... ................. <br />.nc�X y <br />n N. <br />Fw tress aFYn one ]rea'/° f1lla D Yes <br />F., k <br />T2$t� Eal <br />NN[P bCdfA.l'.- <br />...................................... <br />3J Are ewvme earners on <br />OWNERSHIP) FINANCrnr INFORMATION <br />❑ YodDaDers} 0 D.F. cwe <br />OB.er-% a mead <br />tee. <br />�� ��kly' ' <br />or ae rase. ? M r U Yes <br />wpn=-3a y <br />oa,w.auro�aoy Poram Wry ,F.Pm•r ONO El Yes <br />C3.en LM DYes O No <br />------------------- ...... --------.......--- <br />0. <br />Loar i r Pd3cipY f OeW� <br />Loan Qala.ee as W r I s <br />a)ffibxYTb: <br />[asrxrDimre.mn[uverl <br />❑Freed p+daiAle APR °/._OwaaGYa Pnt <br />Latler Ilan 8 <br />ProriarYTta'°`p°'.am°^'° <br />Loa. it Pricip.YS OdgvlQ <br />worklsrlvod] <br />a rAve ax anuses wrir,rnn.e seen <br />] <br />Lea, �a� r f s <br />.'_ ` <br />--" - Dues ON. <br />❑Fined ❑lari�le APR"C anacLtr wie <br />p-Pdn>'-ai�utabn <br />Als: ref. m Incene GF3fficatimw fora <br />lcmer lmn s <br />0 -dher <br />Ho�euo Y®u [wa o�rlD] <br />a <br />%a <br />� <br />i� <br />eas.®n <br />'%om <br />y <br />Y F <br />Y F <br />31 <br />Y F <br />ei <br />Y F <br />si <br />Y F <br />Y F <br />Y F <br />9) <br />Y F <br />FIOIEIi (use otlrsr side dneer-cox) <br />❑ mind m <br />Respond: .Sgra. <br />I <br />Date: <br />omr...a�..o <br />55B-37 <br />