Request to Add-remove household members to Application

HOUSING AND COMMUNITY DEVELOPMENT

REQUEST TO ADD/REMOVE HOUSEHOLD MEMBERS TO APPLICATION
Head of Household Last 4 of Social Security #: XXX-XX-
Date:

MonthDayYear
Date
Head of Household Name:

First NameLast Name
Entity #:
Present Bedroom Size:
True
Individuals:
True
Individuals:
Explain the circumstances why this action is necessary:
Signature of Head of Household:

Clear
Date:

MonthDayYear
Date
Note: Pre-approval of HCD is required prior to adding/removing a household member to the application or dwelling lease; once you have signed the dwelling lease only those household members listed may reside in the unit unless written authorization is granted by HCD.

Warning: Title 18, US Code Section 1001, states that a person who knowingly and willingly makes false or fraudulent statements to any Department or Agency of the United States is guilty of a felony. State law may also provide penalties for false or fraudulent statements.

This material is available in an accessible format upon request at ada.coodinator@miamidade.gov
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HOUSING AND COMMUNITY DEVELOPMENT