Homeowner Contact and Information Sheet

Please read over the information and requirements necessary to complete the Homeowner Contact and Information Sheet below.

Household Income Limits

1 Persons2 Persons3 Persons4 Persons5 Persons6 Persons7 Persons8 Persons

Verification Documents

Please attach the following:

  • Provide the following income verification documents for ALL household members:
    • Most recent award letters (Social Security, Supplemental Security Income (SSI))
    • 3 consecutive months of recent paystubs
    • Current documentation for all other forms of income, including but not limited to: unemployment benefits, military income, public assistance (not including food stamps), child support payments (past 12 months), alimony, retirement funds, pensions, real estate property income, etc.
    • Most recent bank statements (Current Savings account and 6 months average for Checking account)
    • EACH household member 18 and over must fill out and sign the attached “Income Certification QuestionnaireandAuthorization for Release of Information Form
  • Copy of Identification (current State ID or Drivers License)
  • Copy of Social Security Cards (for all household members)

Disclosure/Privacy Statement

Services will be provided without discrimination because of age, race, color, religion, sexual orientation, gender identity, handicap, national origin or ancestry. The agency is requesting information necessary to comply with the requirements of the housing program. I understand that the information on this form will be kept confidential but may be shared with other agencies to which I may be referred for services. I understand that I may be requested to verify these statements, and give my consent to this agency to make necessary contacts to verify any statements. I understand that additional information may be required based upon my answers.