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Albany Housing Authority PRE- APPLICATION 716 SOCIETY AVE. ALBANY GA 31701 229 434-4518 Office 229 434-4519 Fax AMP- 1 Name of Head of Household Please indicate the properties for which you would like to be considered O. B. Hines McIntosh Thronateeska Social Security -- Address City State Zip Code Home Work Other 1. Do any household members require a fully accessible unit due to disability YES NO 3. If you answered yes please explain the special features required below. Please provide below the name age sex and relationship to the head of household for all household members. NAME RELATIONSHIP D. O. B. AGE SEX Head of Household Member 1 Check all of the following categories that apply to the head of household or other adult member Stable Work History 20 hours a week over the past 24 weeks. Disabled receiving SSI Elderly 62 or over Displaced due to a natural disaster or governmental action TOTAL ESTIMATED ANNUAL HOUSEHOLD INCOME Minority code Black White American Indian Asian Native Hawaiian Other Ethnicity Code Hispanic Non- Hispanic/ Latino I certify that the statements made on this form are true and complete to the best of my knowledge and belief* I also understand it is my responsibility to update my application and to advise AHA in writing of address changes. The pre- application will not be processed if you fail to complete the entire form sign the form and provide your SSN* Signature of Head of Household Date IF YOU REQUIRE ASSISTANCE COMPLETING THIS FORM DUE TO A DISABILITY PLEASE CONTACT THE PROPERTY MANAGER For Office Use Only Date and Time of Application // Pre-application Form AMP 1 4/2/2008 am or pm Initials. B. Hines McIntosh Thronateeska Social Security -- Address City State Zip Code Home Work Other 1. Do any household members require a fully accessible unit due to disability YES NO 3. If you answered yes please explain the special features required below. Please provide below the name age sex and relationship to the head of household for all household members. If you answered yes please explain the special features required below. Please provide below the name age sex and relationship to the head of household for all household members. NAME RELATIONSHIP D. O. B. AGE SEX Head of Household Member 1 Check all of the following categories that apply to the head of household or other adult member Stable Work History 20 hours a week over the past 24 weeks. NAME RELATIONSHIP D. O. B. AGE SEX Head of Household Member 1 Check all of the following categories that apply to the head of household or other adult member Stable Work History 20 hours a week over the past 24 weeks. Disabled receiving SSI Elderly 62 or over Displaced due to a natural disaster or governmental action TOTAL ESTIMATED ANNUAL HOUSEHOLD INCOME Minority code Black White American Indian Asian Native Hawaiian Other Ethnicity Code Hispanic Non- Hispanic/ Latino I certify that the statements made on this form are true and complete to the best of my knowledge and belief* I also understand it is my responsibility to update my application and to advise AHA in writing of address changes.

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