APPLICATION



Blair County Housing Authority

Initial Application

Date: ________________________________

Name:____________________________________________________________________________________

Physical Address: ___________________________________________________________________________

MailingAddress:____________________________________________________________________________

Phone No: ________________________________________________ Bedroom Size: _________________

Name SS# Sex Age D.O.B. Place of birth

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Source of Income Amount

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Current Landlord – Name & Address

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Assets (Savings Acct, CD’s, etc. ) Bank Name Amount

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This application is for Section 8 Rental Assistance _______

Bell Court Apartments in Bellwood _______

Cold Springs Apartments near Tyrone _______

Please include the above information for all the persons who will be living with you in your home when you go through one of our programs.

Place of birth is the County and State in which you were born.

If your income is from an employer, please give us the name of the employer in the “Source of Income” block.

Please call our office if you have any questions or need assistance in filling out the application.

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