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Application: 123 Main St.

Take a moment to review your information before submitting your application.

You

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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

Alternate Contact

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Name

Michael Smith

Counselor MEDA

Email

michael.smith@gmail.com

Phone

415-876-5432

Mailing Address

456 Mission St
San Francisco, CA 94117

Household Members

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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

Preferences

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Based on the information you have entered, your household has not claimed any housing lottery preferences. you will be in the general lottery.

Income

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Vouchers and Subsidies

No

Household Income

$32,000 per year