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The Housing Authority City of Sanford, Florida
Barbara Green Central Administration Building
94 Castle Brewer Court
Post Office Box 2359
Sanford, FL. 32772-2359
Phone 407-323-3150
Fax 407-324-1806

Public Housing Preliminary Application Form

Who is the Head of the Household? (Legal Name) First Name Last Name Sex Female Male
Social Security Number Date of Birth Age
Race White Black American Indian/Alaskan Native Other
Ethnicity Hispanic Non-Hispanic
Do you require any modifications or accommodations in order to fully utilize the unit or the program and services? Yes No
What is your present address?
Street Address
Mailing Address
Home Tel
Work Tel
Other Tel
What was your street address before you moved to where you live now?
Street Address
If we are unable to reach you, whom can we contact locally?
Name Tel
Address Relationship
Income Information: Provide a complete explanation of "income".
Family member Source of income (e.g. wages, welfare, SSI) Monthly Amount Annualized Income
Household members: List the legal names of all household members below. Start with the head of household, then spouse or co-head, then minors (oldest to youngest), and then any other adults.
# Legal Name Sex Relationship to Head Social Security Number Birth Date Age Occupation or School Name
SHA sorts all application by preference and date/time application was received. Please check the appropriate box by the preference that you wish to claim the preference must still be in affect when you are offered housing assistance, and will be verified at that time.
An Adult Family Member is Employed/Working for at least 24 months (2years) for a minimum of 20 hours per week.
Authorizations, Representations, and Certifications

I understand that any misrepresentation or failure to disclose information requested on this application may disqualify me from consideration for admission or participation, and may be grounds for eviction or termination of assistance.
Signature of Head of Household Date
Signature of SHA Representative Date