Waiting List Change of Address

HOUSING AND COMMUNITY DEVELOPMENT

WAITING LIST CHANGE OF ADDRESS
Entity ID Number:
HEAD OF HOUSEHOLD INFORMATION ONLY:
Name:

First NameMiddle InitialLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:
Please enter a valid phone number.Format: (000) 000-0000.
E-Mail Address
example@example.com
I understand that I must notify the Housing and Community Development (HCD) in writing of any future address change.

I understand that if mail is returned from the post office due to my failure to provide HCD the correct and complete address, my application will be removed from the waiting list(s).

I declare that the information provided above is true and correct.
Signature of Head of Household

Clear
Date

MonthDayYear
Date
PLEASE FAX OR MAIL THIS FORM TO:

Applicant Leasing Center
701 NW 1 Court, 14th Floor
Miami, FL 33136-3914
Telephone: 786-469-4300 Facsimile: 305-643-8501
TDD: 305-643-3377
Florida Relay Service: 1-800-955-8771

Housing and Community Development does not discriminate on the basis of race, sex, color, religion, marital status, national origin, age, pregnancy, disability, ancestry, sexual orientation, or familial status in the access to, admissions into, or employment in, housing programs or activities.

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 to ada.coodinator@miamidade.gov
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HOUSING AND COMMUNITY DEVELOPMENT