Cchra.com

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I understand that submitting false or incomplete information to obtain housing assistance is a criminal offense punishable under federal law. I do hereby certify that all statements contained in my online housing application are true and complete, to the best of my knowledge. I understand that deliberate misrepresentation of my circumstances will result in my being rejected for admission to a subsidized housing unit. I hereby authorize the Cumberland County Housing Authority to verify all information contained on this application and to conduct criminal and credit checks on all members of my household.

I understand it is my responsibility to notify the Housing Authority in writing of any changes in my household composition, income, address or phone number. Failure to inform the Housing Authority may result in my name being removed from the waiting list.

______________________________ _______________________________ ____________

Head of Household (print name) Signature Date

______________________________ _______________________________ ____________

Spouse/Co-Head of Household Signature Date

(print name)

________________________________________________________________________________

FOR OFFICE USE ONLY

DATE APPLICATION RECEIVED: ________________________

DATE APPLICATION COMPLETED: ________________________

Income Eligible: Yes No

30% 50% 80%

Anticipated Annual Income: $__________________

Preference: Yes No Shelter Pref: _______

In-County: Yes No

Bedroom Eligibility: ________ Harbour Place: _______

F: Section 8/AppInfo/Online Certification

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CERTIFICATION

ONLINE HOUSING APPLICATION

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AND

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