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Completion is required to apply for assistance. Please complete this entire form and return it to Detroit Housing Commission Assisted Housing Division Attn Rivertown Waiting List P. Print Form Housing Choice Voucher Project Based Waiting List Application Issued under P. A. 346 of 1996 as amended and Section 8 of the U*S* Housing Act of 1937. O. Box 7549 Detroit MI 48207 APPLICATIONS WILL ONLY ACCEPTED AT THE P. O. BOX LISTED ABOVE Head of Household Name First Address Middle City Annual Gross Household Income Family Member Name Last Zip Code State Telephone Social Security Number Relationship to Head Date Of Birth Sex M/F Race Code No* 1-White 2. Black/African American 3. American Indian or Native Indian 5. Native Hawaiian/Other Pacific Islander 6. Hispanic or Latino 7. Multi-Racial Disabled Yes/No U. S Citizen Race Code 4. Asian Residency Questions Have you been a victim of Domestic Violence within 30days of this application Have you been involuntarily displaced by a natural disaster Are you a Military Veteran Are you elderly handicapped or disabled I need help completing future paperwork with regards to my application* Yes No If Yes I authorize Name of Designed Representative Telephone Number I consent to release criminal conviction records including sexual offense and alcohol abuse pursuant to 24 CFR 982. 307 and allow DHC to receive records from law enforcement agencies and use them in accordance with the U. S Department of Housing and Urban Development regulations and DHC policy. I certify I have not been evicted from any type of Section 8 Program or from Public or Indian Housing within the last three years due to drug-related criminal activity. I certify that no member of my household has been convicted of manufacturing or producing on the premises of assisted housing* I certify that no member within my household has been evicted within the last year from federally-assisted housing* I certify that I do not owe any unpaid debt to DHC or any other Public Housing Agency. I certify that all the information contained in this application is true and complete to the best of my knowledge. I understand that DHC will screen adult applicants for drug-related and violent criminal activity including sexual offense pursuant to 24 CFR 982. 307 and DHC policy. I understand that I must update my mailing address within 10-days of the changes and that if I do not and mail is returned to DHC I can be removed from the waiting list. Signature of Head of Household Equal Housing Opportunity Date Please do not call the office to verify that your application has been received* You will receive a written notice from DHC verifying you have been placed on the Rivertown Project Based Waiting List. O. Box 7549 Detroit MI 48207 APPLICATIONS WILL ONLY ACCEPTED AT THE P. O. BOX LISTED ABOVE Head of Household Name First Address Middle City Annual Gross Household Income Family Member Name Last Zip Code State Telephone Social Security Number Relationship to Head Date Of Birth Sex M/F Race Code No* 1-White 2. Black/African American 3. American Indian or Native Indian 5. Native Hawaiian/Other Pacific Islander 6.