APPLICATION - JMD Einsidler

APPLICATION . Mail only one (1) APPLICATION per family by regular mail (DO NOT SENT BY REGISTERED OR CERTIFIED MAIL). MAIL TO: PAUMANACK VILLAGE I. 650 PAUMANACK VILLAGE DRIVE. GREENLAWN, NY 11740. Each APPLICATION received will be recorded. Since so many families/elderly need housing, this development will not be able to accommodate all who are eligible. As families are reached, they will be called in for an interview. NO PAYMENTS OR FEE SHOULD BE GIVEN TO ANYONE IN CONNECTION WITH THE. PREPARATION, FILING OR PROCESSING OF THIS APPLICATION FOR SUBSIDIZED HOUSING. THIS INFORMATION IS TO BE FILLED OUT BY THE APPLICANT: Name _____ Age _____. Street Address _____ _____. City _____ Town _____State_____Zip_____. Home phone number _____. If you are not at home please list a phone number of family or friend _____. Social Security Number _____. Do you presently own a home? _____ Rent an apartment? _____. Live with Family? _____ Other _____. FUNCTIONAL STATUS. Are you or any member of your family who lives with you disabled?

APPLICATION Mail only one (1) application per family by regular mail (DO NOT SENT BY REGISTERED OR CERTIFIED MAIL) MAIL TO: PAUMANACK VILLAGE I

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