Allowances for Tenant U.S. Department of Housing …

1 Date 3/01/2017 AHACODE0 BR1 BR2 BR3 BR4 BR5 BR001 GHeatinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane001 EElectric$ $ $ $ $ $ Pumpd. Oil / Other002 GCookinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane002Ec. Electric$ $ $ $ $ $ $ $ $ $ $ $ Heatinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane005Ec. Electric$ $ $ $ $ $ Oil / Other006W$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ for Tenant Furnished Utilities and other ServicesOMB Approval No. 2577-0169 (exp. 04/30/2018)Locality: Area Housing Authority of the County of Ventura, CAUnit Type: Apartment/ Department of Housing and Urban Development Office of Public and Indian HousingOther Electric (Lights, Appliances & Monthly Credit)Air ConditioningSewer Monthly Dollar AllowancesUtility or month costOther--specify:Monthly Gas Fee $ Family AllowancesUtility or ServiceTrash CollectionRange / Microwave Tenant -purchasing/leasingRefrigerator Tenant -purchasing/leasingWater HeatingCooking$$$To be used by the family to compute allowance .

2 Complete below for the actual unit ElectricTrash Collection$$$$$Air ConditioningWater HeatingWaterSewerTotalRange / Microwave$Refrigerator$Number of Bedrooms$Other$Other$Name of FamilyAddress of Unitform HUD-52667 (04/15)ref. Handbook 3/01/2017 AHACODE0 BR1 BR2 BR3 BR4 BR5 BR001 GHeatinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane001 EElectric$ $ $ $ $ $ Pumpd. Oil / Other002 GCookinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane002Ec. Electric$ $ $ $ $ $ $ $ $ $ $ $ Heatinga. Natural Gas $ $ $ $ $ $ Bottle Gas/Propane005Ec. Electric$ $ $ $ $ $ Oil / Other006W$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ for Tenant Furnished Utilities and other ServicesMonthly Dollar AllowancesOMB Approval No. 2577-0169 (exp. 04/30/2018)Locality: Area Housing Authority of the County of Ventura, CAUnit Type: Detached House & Mobile Department of Housing and Urban Development Office of Public and Indian HousingUtility or ServiceTrash CollectionRange / Microwave Tenant -purchasing/leasingTo be used by the family to compute allowance .

3 Complete below for the actual unit Family AllowancesRefrigerator Tenant -purchasing/leasingOther--specify: Monthly Gas Fee $ Other Electric (Lights, Appliances & Monthly Credit)Air ConditioningSewer per month cost$$CookingUtility or ServiceHeatingWater HeatingWater$$$$Other ElectricAir ConditioningRange / MicrowaveSewerTrash Collection$$$Refrigerator$Total$Other$Ot her$Number of BedroomsName of FamilyAddress of Unitform HUD-52667 (04/15)ref. Handbook