Transcription of MOBILE HOUSING BOARD
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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: _____ Household Member Date Print Name: _____ Signature: _____ Household Member Date Note: Head of Household may sign this form for any household member under the age of 18.
MOBILE HOUSING BOARD SEC. 1001 FALSE STATEMENTS OR ENTRIES Whoever, in any matter within the jurisdiction of any Department or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick,
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