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EXHIBIT A: Interview Form - Residential <br />MON 0MWMAL I10SLOCRT #IlN FAxERVURN rn,por, Pad2pa Ltd.. <br />Site W.04n Dale, I d ■ftelea DaW 1 A�_ <br />i <br />Im"OMix Daba:: t f_ C..# -. a larrti.. <br />HeadaF.Dassdadd; <br />Day Tel >•$�Y lwa <br />Add6 . AAlrtg <br />f3H 0 rs�ea Ob <br />Hoaaa TeW OkhW#( l <br />aaaan! <br />5 #: <br />DISPLA.- STATI'S ACS <br />OTHER <br />UTILITIES <br />I TIES. <br />OcoGPaooM SYatac .A LjjOem <br />ErFRa7C1T9'.'. <br />0 WdtelCaucasaaa <br />Afiioan Ama6eiean <br />DTLITESPwa OTTEMANf <br />136- 130e -h5dty OWabr plead+ <br />T' MAO QatW 13010 <br />OFSPLWement Sl*Fearoaaarum I <br />Rsyrlaaed t ReeFxiramreaal:'E =Hat ® <br />mot LaCno <br />ITHLMES INCLIIdEDYWTHREMI: <br />FamWaod -m aamlMeibeb?❑ _1One <br />Asia <br />Mar _ ------- .- ._._..._ <br />OGm DElaft" DYWabe Olaasla <br />Ta�ard'framdkeeavaaoadorF#MCarJ. AaMSSnaMaya,F <br />Cm%W5=aoF..m*-- DExceW&R 130mod C3Fair OPoor <br />PREdRI.L&MAAG1E: <br />AadianxsOwneddwTeaaor- <br />pIw wWrmup tarpon Omiem <br />8E�Wlh p h <br />E33tum IlReMaerator OWO <br />❑PAM ?(dacaim)._.._ .. .. . . . . .. <br />iner.------------- . <br />®Ocher... _...._.. <br />®M aooacalpanTa Jxa6ear ArxxaiMaia11647'Q Y26 Q Na <br />SPECIALIZED NEEDS <br />_ <br />rloxrebraaiareas ?._..__. ®Hit Dyes <br />a :.aMbruiw6alalaMn'o-wma�xza.aaos <br />i55siald <br />Elderdy Noasehadd? <br />Mymbove Mammal araufd'Ioa canem ebrtmatingmor <br />arom aaea? O Yes O Na _..5£ pau...reeu._ <br />O No p Y.. <br />emaaniea,aneaxaranw` axa No ❑Yes <br />saga man. andMLhe <br />INCOME INFORMATION <br />mpFj&mmmdarena P.elheaaorb <br />'. aamblaapbeaTeavraAabNxagT. ®Yes ONm <br />draodrireypeddbaaehaM? <br />®No0Yea <br />TOTAL HOUSEHOW MOWNLY <br />RENTERSZ <br />Total Mcedbly Red: 477= saoead -W iKas— 8) <br />th <br />Landlord. <br />palsaace,.al.ayn�emPoac'of Aaaal•.anmHd, <br />O Moollw4bemanth O Lease 13 YMani'.Ift Coolad <br />1) DayoG etlaoameirom apn'alrorsaT <br />Lease enArdioae dab I I <br />_.._._.._. <br />-a➢ la R"a4u ---- -- ns: <br />ao3`r^arsr }ae�? ONOOYes <br />Security Deposal? <br />.__..._._._... .. ._.... _... ...__._.......... <br />,.1° ®� <br />S'��. i1"TlahxxlS PmiiaRal'rbR'� <br />.____._._._..___.__.- ._ -. -. <br />" jlae @aRj�'GlflAb idAart.lYibdalb <br />RC DUe I f <br />N.&.1floe nearaoaoe <br />eanrera bem ffidheceonen <br />'- <br />Ceoeal <br />Casewoabr. _.___.._.... g � <br />---- <br />medaaad racvTddea? <br />➢aeFecs daariavae,ybaf_s �Ho OYes <br />-My <br />TFFR: ¢.�.2, Exit. <br />rNarcnaaaoar. <br />...._...._. -. ._.._...____ <br />.._... ------------- .. <br />� AnsapY Womax, <br />OWNERSHIP/ FINANCIAL. INFORMATION <br />O M- doaOel -I 13 Cam, Cle. <br />e <br />Ocer Spoaaeed? <br />dAesrraae: <br />IT <br />oramomheamem- Y <br />O._N <br />YaaraaA: AaDeaz sa_a <br />Da goo ran[aruaa T POrmo nr ivarAaaFani°e Q Nu ® Yes <br />.- <br />_e <br />._-_.C_.. <br />_ . <br />YJwafmoC.' ?e [3Yas CINo <br />Cdae PaMisAedaraooe ?O. Mp <br />Lm fff, pa—opal c4pakwDar" <br />Aaimaas. mF, S <br />a5A'ltvA§�AYF�rtnn�d'LFJYMj <br />O Fizad f] AradaNa ab^RR^.._ctwaann.am:' <br />Ofted R% <br />..____...,_..._.__. _._._._._._-..._._..- <br />aM ar <br />Pauoary Traaaspar✓idobM <br />L ry 8rat1Da9e: <br />Chaa7? <br />J} He. aN'aoGnaes mlY"easomebewra <br />'.. Loan &3ai a <br />D-car <br />disaraxed? Dyes ONm <br />v bxiPaF:I <br />O Find O dede atlPR'#. <br />O'PiOF'clrartallan <br />�raamn[khdbiC. <br />Also sefss to Iacaaateat'�oruA'iaedaev. <br />'. L4MIM laaaai <br />D -caner ._ ............... <br />Hivaxxosm:Marearos [na aFFrirffawauaoararidy <br />SFx <br />i4oe <br />9xcoam. <br />aeaaaviaia <br />F re~ea+c °-- <br />xa <br />M F <br />6a <br />M F <br />' <br />as <br />M F <br />i} <br />N F <br />sa <br />M F <br />6a <br />M F <br />?a <br />M F <br />ea <br />M F <br />NOTES- (use ocher side if necessary) <br />❑ma[>uM as n..z..:z. <br />ResPondeors S(Onatumn <br />55[x° - -27 <br />Bate: <br />�ao+u..www <br />