RENTAL INCOME - Absentee Shawnee Tribe Of Oklahoma

#2 – SpouseName: _____________________________ Birthday: _______________ Social Security #: ____________Relationship: ____________________________ Age: ____________________ Sex: __________________Tribal Affiliations:__________________________________________________________________________Income or Assets (check all that apply): Verification of income must be attached.[ ] Student 18 years of older (please state if high school or college/vo­tech):__________________________[ ] Employed (list employer name, address & phone #): __________________________________________[ ] Unemployed (& receiving no assistance or benefits)[ ] Unemployed benefits or workman’s comp. (circle one)[ ] Social Security and/or S.S.I.[ ] TANF (formerly AFDC) or Aid to the Disabled (circle one)[ ] Child Support (please list agency to individual): _______________________________________________[ ] Retirement or pension (please list agency received from):_______________________________________[ ] Other: ________________________________________________________________________________#3 – OtherName: ______________________________ Birthday: _______________ Social Security #: ____________Relationship:_____________________________ Age: ____________________ Sex: __________________Tribal Affiliations: _________________________________________________________________________Income or Assets (check all that apply): Verification of income must be attached.[ ] Student 18 years of older (please state if high school or college/vo­tech):__________________________[ ] Employed (list employer name, address & phone #): __________________________________________[ ] Unemployed (& receiving no assistance or benefits)[ ] Unemployed benefits or workman’s comp. (circle one)[ ] Social Security and/or S.S.I.[ ] TANF (formerly AFDC) or Aid to the Disabled (circle one)[ ] Child Support (please list agency to individual): _______________________________________________[ ] Retirement or pension (please list agency received from): ______________________________________[ ] Other: ________________________________________________________________________________If you or your spouse are over 62, disabled, or handicapped, and have medical expenses, pleasesubmit verification for an income adjustment. If you have child care expenses for children 12 andunder, contact our office for proper verification forms.Have you ever filed an application with the Absentee Shawnee Housing Authority before?________When?__________________________________________________________________________Have you ever filed an application with any other Housing Authority? ______If so, which one? ___________________________________ When? ______Have you ever lived in Low Rent Housing before? _______If so, which one? __________________________________ When? ________________________Are you or your spouse currently in a home that is subsidized by the Department of Housing andUrban Development in an ownership capacity? ________________Have you or your spouse ever lived in a Mutual Help Home?: ________If so, which one? __________________________________ When?: _______Have you or any member of your family ever been evicted?If yes, explain the circumstances: