REQUEST TO ADD A FAMILY MEMBER
HEAD OF HOUSEHOLD___________________________________________________
SS #_______________________________ PHONE #_____________________________
Please complete the following to add a family
member. Completion of this form does not guarantee that the request will be granted. You will receive a written response regarding the approval or denial of this request.
Name of the person you wish to add ________________________________________________
Relationship to you ______________________________Date of birth_____________________
What income does this person have?________________________________________________
Current address of person you wish to add? __________________________________________
Why do you want to add this person to your household?
Certificate ______ Social Security Card ______ Picture ID (18 and over)______
Information Release Form (HUD-9886)______ Applicant/Tenant Certification ______
Declaration 214 Form ______ ***legal proof of guardianship or custody (a notarized letter is not considered legal
Members 18 and over must sign the Release form,
Applicant/Tenant Certification and Declaration 214.
** A background check will be conducted on
anyone 18 and over to verify that they have no criminal history before request will be considered.**
Warning Title 18, Section 1001 of the United States Code, state that a person who knowingly and willingly makes false or fraudulent statements
to any department or agency of the United States is guilty of a felony.