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MOBILE HOUSING BOARD

MOBILE HOUSING BOARD PUBLIC HOUSING , HOUSING CHOICE VOUCHER & MODERATE REHABILITATION PROGRAMS DECLARATION OF UNITED STATES CITIZENSHIP I hereby declare, under penalty of perjury, that I am a citizen of the United States of America. Print Name: _____ Signature: _____ Head of Household Date Print Name: _____ Signature: _____ Spouse Date Print Name: _____ Signature: _____ Household Member Date Print Name: _____ Signature: _____ Household Member Date Print Name: _____ Signature: _____ Household Member Date Print Name: _____ Signature: _____ Household Member Date Print Name: _____ Signature.

AUTHORIZATION I authorize the MOBILE HOUSING BOARD and HUD to obtain information about me or my family that is pertinent to eligibility for or participation in assisted housing programs.

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  Mobile, Board, Housing, Mobile housing board

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