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Get Shelter Verification Form

$_________ Owner name: __________________ Other non-heating utilities? Amount: $ _______ Water?  Y  N Amount: $ ___________ __________________ Does anyone from outside of the household pay all or any part of the rent, fuel or utilities?  Y  N If yes, please explain: ________________________________________________ Does anyone perform any services for you for which he/she receives a lower rent?  Y  N Collateral Contact Date: ____________ 4. LANDLORD/OWNER If anyone other than.

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