Connecticut
Housing Rehab Program Waiting ListProvide the name, address, size of household, and income level of each applicant on the Town’s waiting list for the proposed activity.NameAddressSize of HouseholdHousehold Income Level (<30%, <50%, <80% AMI) The following documents are recommended to be collected for every member of each household at the time of application intake:The most recent tax returns (Form 1040)Six (6) to 8 weeks’ worth of the most recent pay stubsSocial Security benefit statementsPension benefit statementsUnemployment compensation statementsChild support documentationAlimony documentationThree (3) most recent bank statementsOther: ___________________________________________I, the undersigned, hereby acknowledge that the information provided here is true and accurate. The documents checked off above have been collected and are available to the State for review.__________________________________________ ______________Signature of Authorized Official of GranteeDate__________________________________________(TYPE or PRINT) Name and Title ................
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