KCKHA Public Housing Hearing Request

[Pages:1]Kansas City, Kansas Housing Authority

1124 North Ninth Street Kansas City, KS 66101-2197 (913) 281-3300 FAX (913) 279-3428 Website:

KCKHA Public Housing Hearing Request

Please Print

I am requesting a Hearing regarding the following matter:

30 Day Eviction

(formal hearing)

Waitlist Denial

(administrative hearing)

Breach of Lease

(administrative hearing)

Maintenance Charge Dispute

(administrative hearing)

Housing Eligibility Denial

(formal hearing)

Other ____________

Be specific as possible about the notice you are referring to, that you are requesting the hearing for:

Name & Full Current Address: ________________________________________________ ________________________________________________ E-mail address: ________________________ Current Phone: _________________________

Request Date: _________________Signature: __________________________

Received By KCKHA Staff: ________________________________Date:_______

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