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11114! 1997 11: 29 5~~-29 i-28~5 HANN~s ~VICELDO~niNFY P~GE 02 <br />~ ~ <br />'ilie Claimaat ie eli~ible to roceive a ront <br />benofit not to atceed: S <br />CLAIM FOR RENTAL ASSLSf ANCE PAYII~NT <br />Claim~ot Name: J 'fer 1am~a <br />Addreas: ,,~//.~Jr ~~;~(~~,.~/~ <br />~~~'C~r.~~~ o~v ~~ ~~.~Q7 <br />A~mcy: Muion Couaty <br />Project: Cowtbouee Squa:e <br />Pa~al A~: Inmra <br />You must te~t aad occupy • decent, safe ~ad s~nituy roplaoommt dwelling within one year of displacameat from your <br />dwollia~. 'Ibe ront bena6t ahall be tho additioorl amaunt neceeeary to ron4 a com~arable dacenc, safe and saaitary dwallin~; <br />or the additioo~l rmouat as determin~d by Mrrion Caunty ag nac~aes~ry, whichever is lees. <br />Data <br />A~ant <br />CLAAtANT PLEASE COMPLE?E THIS SECTION <br />(Chxk appraptiatc boxe8) <br />Date Now Dwelling Numbar of Wifa Husb~nd Boya Girla Otber <br />Occupied: Re~ulu Housohold Adulte <br />Membors: <br />On ~ / ~f `f , I renced and moved co /r~0 ~'~z~rr~ ~~~ .~r~~. D,~ v~~~ <br />r+hich ' my permaaent or customary aad ueual pl~ce of aboda. To the best of my icnowl ge, this dwelling meets t6e <br />required staodards for docent, sefe aad srnitary dwollings. My claim is made oa the basis of tha listad re~ular mambare of <br />my hourehold. <br />I 6avo att~ched ptoof of my ri$ht to occupy tbie dwellin~ (re~tal rocaipt, caaceled check, etc.) <br />I uaderataad that this claim must be filed no Isoer thaa 18 moeths after I hrve moved. <br />I certify that ta the beet of my knowladga aad beliaf all informetion in this claim is true and that I am eatitled to receive a <br />reat supplemeat ia the rmouat of 8_~~~ .~IOQ'' ~R.` h1';rJ_`_wQ u~i iL~@, C~~S~~', <br />N4m~ <br />Dat~ <br />REPLACE11~N7 DWELLING CERTIFICATION <br />7ha dwsllin~ at tha sbove sddress waa ingpected an and meeta the stuidarda for dacent, safe and sanit,~ry housing <br />for the daimaot. The claimant has furniahod proof of tha riQht to occupy. Decent, safe and snnitary inspections are made solely for <br />tbe purpofa of determining benefit eligibilitr and aro noc repreFentations for any other purpoe,~. <br />Drce <br />A~ent <br />-- __ <br />Aental A~~istanee Paymenc Hanna, McEldowncy snd Aseooiaw (S03) 29'1-9588 <br />Appraissl • Ncgotiation • Ralocation • Studiae <br />