Housing – General Release Form


Housing - General Release

GENERAL RELEASE

Consent for Verification

I have applied for or am receiving housing assistance through the Ark-Tex Council of Governments Section 8 Rental Assistance Program. By my signature below, I authorize the Ark-Tex Council of Governments to obtain any information needed to establish my eligibility for assistance; eligibility for continued assistance rental payment, family composition, and eligible deductions. This request for information may be accepted by any financial institution, employer or previous employer, attorney general for child support information, landlord or previous landlord, pharmacy, doctor, hospital, child care provider, creditor, law enforcement agency, utility company, county, state or federal agency, or any assisted housing program. This form shall remain valid as long as I am a participant of or have an application with the Ark-Tex Council of Governments.

This consent form expires 15 months after signed.

Head of Household

Spouse or Other Person Age 18 or Older

Spouse or Other Person Age 18 or Older

Spouse or Other Person Age 18 or Older

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

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