Application: 123 Main St.

Name

Laura Smith

Date of Birth

12/02/1980

Phone

415-123-1234

Cell

Additional Phone

415-123-1234

Home

Email

lara.smith@gmail.com

Address

649 Avalon St
San Francisco, CA 94117

Mailing Address

456 Mission St
San Francisco, CA 94117

Name

Michael Smith

Counselor MEDA

Email

michael.smith@gmail.com

Phone

415-876-5432

Mailing Address

456 Mission St
San Francisco, CA 94117

Name

Michael Smith

Child

Date of Birth

12/2/1980

Name

Michael Johnson

Family Member

Date of Birth

12/2/1970

Address

700 Avalon St
San Francisco, CA 94117

Rent at 2106 Park Blvd

$1200 per month

for Michael Smith

Rent at 4106 Terrace St

$1200 per month

for Jane Smith and Denise Jones

Seniors in Household

Yes

Veterans in Household

Yes

People with Developmental Disabilities

Yes

ADA Accessible Units

Mobility Impairments
Visual Impairments

Vouchers and Subsidies

Yes

Household Income

$32,000 per year

You Have Claimed

Certificate of Preference

for Michael Smith

You Have Claimed

Neighborhood Resident Housing Preference

for Michael Smith Telephone Bill attached

You Have Claimed

Rent Burden Preference

for 2106 Park Blvd Copy of Lease and Cancelled Check attached for 4106 Terrace St Copy of Lease and Money order attached