Housing – Asset Verification Form

Housing - Asset Verification

Below is a list of assets for you to list in order to determine your income eligibility for rental assistance.

I, the undersigned applicant, hereby certify that I do not have any assets except as indicated above.

WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentation to any Department or Agency of the United States as to any matter within its jurisdiction.

Equal Opportunity Employer/Program - Auxiliary Aids and Services are available upon request to individuals with disabilities. TIY/TDD (903) 832-5351 4808 ELIZABETH ST.• PO BOX 5307• TEXARKANA, TEXAS 75505-5307• TELEPHONE (903) 832-8636