Housing Application - Absentee Shawnee Tribe Of Oklahoma

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AUTHORIZATIONFor Release of InformationCONSENT: I authorize and direct any Federal, State, or local agency, organization, business, orindividual to release to Absentee Shawnee Housing Authority any information or materials needed tocomplete and verify my application for participation, and/or to maintain my continued assistance underthe Section 8, Rental Rehabilitation, Low-Income Public and Indian Housing, and/or other housingassistance programs. I understand and agree that this authorization or the information obtained with itsuse may be given to and used by the Department of Housing and Urban Development (HUD) inadministering and enforcing program rules and policies.INFORMATION COVERED: I understand that, depending on program policies and requirements, previousor current information regarding me or my household may be needed. Verifications and inquiries thatmay be requested include but are not limited to:Identity and Marital Status Employment, Income, and Assets Residences and Rental ActivityMedical or Child Care Allowances Credit and Criminal ActivityI understand that this authorization cannot be used to obtain any information about me that is notpertinent to my eligibility for and continued participation in a housing assistance program.GROUPS OR INDIVIDUALS THAT MAY BE ASKED: The groups or individuals that may be asked torelease the above information (depending on program requirements) include, but are not limited to:Previous Landlords (including Past and Present Employers Veterans AdministrationPublic Housing Agencies) Welfare Agencies Retirement SystemsCourts and Post Offices State Unemployment Agencies Banks and other Financial InstitutionsSchools and Colleges Social Security Administration Credit providers and Credit BureausLaw Enforcement Agencies Medical and Child Care Providers Utility CompaniesSupport and Alimony ProvidersCOMPUTER MATCHING NOTICE AND CONSENT: I understand and agree that HUD or the Public HousingAuthority may conduct computer matching programs to verify the information supplied for my applicationor recertification. If a computer match is done, I understand that I have a right to notification of anyadverse information found and a chance to disprove that information. HUD may in the course of itsduties exchange such automated information with other Federal, State, or local agencies, including butnot limited to: State Employment Security Agencies; Department of Defense; Office of PersonnelManagement; the U.S. Postal Service; the Social Security Agency; and State welfare and food stampagencies.CONDITIONS: I agree that a photocopy of this authorization may be used for the purposes stated above.This authorization will stay in affect for a year and one month from the date signed.SIGNATURESPRINTED/TYPED NAMEHead of Household: ____________________________Date:Spouse: ____________________________ Date:Adult Member: ____________________________ Date:Adult Member: ____________________________ Date:Adult Member: ____________________________ Date:WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statementsor misrepresentations to any Department of Agency of the U.S. as to any matter within its jurisdiction.Page 14 of 18
General AuthorizationI/We hereby authorize Absentee Shawnee Housing Authority and Shawnee Credit Association,Inc. to pull the consumer reports listed below for the purpose of renting, leasing, purchasing orhome improvements. It is understood that a photocopy of this form will also serve asauthorization. I further authorize the release of any past or current employment information tobe released for the purpose of extending credit or for employment purposes. I understand thatif the credit report is for employment purposes, that I will be notified and am able to obtain acopy of the credit report issued.The information obtained is only to be used in connection with this authorization and Iunderstand that this authorization is only valid for 15 days from the date it is signed.______________________________Applicant (full legal name)________________________________Co-Applicant (full legal name)______________________________Applicant Signature________________________________Co-Applicant Signature______________________________Social Security Number (REQUIRED)________________________________Social Security Number (REQUIRED)______________________________Date of Birth (REQUIRED)________________________________Date of Birth (REQUIRED)______________________________Address______________________________________________________________City, State Zip Date______________________________Agent, Manager or OwnerThe credit information that will be furnished is in response to an inquiry for the purpose ofevaluating credit risks. The information obtained is from sources deemed reliable, the accuracyof which Shawnee Credit Association, Inc. does not guarantee. The inquirer has agreed toindemnify the reporting bureau of any damage arising from misuse of this information, and thisreport is furnished in reliance upon that indemnity. It must be held in strict confidence andcomplies with the provision of Public Law 91-508. The Fair Credit Reporting Act.Page 15 of 18
Page 4: approval for an exemption to the Co
Page 7 and 8: HOUSING APPLICATIONABSENTEE SHAWNEE
Page 9 and 10: Employer Name:Hire Date:Employer Ad
Page 11 and 12: Have you or your spouse ever lived
Page 13: AssetsSigning theApplicationRecerti
Page 17 and 18: ATTN: FOR HEAD OF HOUSEHOLD’S SIG

Housing Application - Absentee Shawnee Tribe Of Oklahoma

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