Public Records Verification 5-year addresses

HOUSING AND COMMUNITY DEVELOPMENT

PUBLIC RECORD VERIFICATION
Entity #:
Name of Head of Household:
Name of co-head, spouse, or domestic Partner:
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Move-in Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Official Use Only
Property Owner:
If yes, address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Approved:
Disapproved:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Print Name:
Official Use Only - Eligibility Interviewer Completes:
Lanlord Reference:
Debt owed to HCD:
Amount ($):
Double Subsidy (EIV checked):
If yes, list household members/ in Elite Notes
Debt owed to any PHA (EIV checked):
PHA Termination (EIV checked)
Approved:
Disapproved:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Print Name:
This material is available in an accessible format upon request to ada.coordinator@miamidade.gov
Should be Empty:

HOUSING AND COMMUNITY DEVELOPMENT