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Item 31 - Emergency Housing Vouchers
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07/20/2021 Regular
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Item 31 - Emergency Housing Vouchers
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City Clerk
Doc Type
Agenda Packet
Agency
Clerk of the Council
Item #
31
Date
7/20/2021
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Part 3: Income Information <br />Did you file a Federal Income Tax Return last year?NoYes <br />TENANT INFORMATION FORM <br />Does anyone living outside your household pay for or provide money for any of your household bills or <br />living expenses?NoYes <br />Member Name <br />Attach Additional Sheets if Necessary <br />Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Income Type <br />1 <br />Income Type <br />1 <br />Income Type <br />1 <br />Income Type <br />Income Type <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Income Type <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Income Type <br />Member Name Monthly Income <br />$ <br />Verification Source Name and Address <br />Documentation Attached <br />NoYes <br />Current Income <br />NoYes <br />Income Type <br />Review and update the following income information for all family members 18 or older, including income received on behalf of <br />household members under the age of 18. Check "Fixed" for income that changes annually based on a COLA or Interest Rate. Add <br />new income sources in the space provided below. An income is any one of the following types without limitation: <br />Alimony Payments <br />Child Support <br />Disability Benefits <br />Financial assistance to attend school <br />Food Stamps <br />Military Pay <br />Periodic Gifts <br />Retirement Payments <br />Self Employment <br />Social Security Benefits <br />SSI <br />Unemployment Benefits <br />Wages/Salaries <br />Welfare Benefits <br />Worker's Compensation <br />DOCUMENTATION REQUIRED:Provide 4 current and consecutive original pay stubs, payroll summary reports, SSA benefit <br />verification letters, child support payment stubs, welfare benefit letters and/or printouts, self employment tax statements, or <br />unemployment benefit notices, and check the Documentation Attached box for each income. <br />Fixed <br />Fixed <br />Fixed <br />Fixed <br />Fixed <br />Fixed <br />Fixed <br />Fixed <br /> Page 3 <br />Page 10 of 29 <br />EXHIBIT 2
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