TEAGUE HOUSING AUTHORITY
205 SOUTH 5TH
TEAGUE, TEXAS 75860
UPDATE FORM
Date: ______________ Phone #:
Name of Head of Household: Social Security #:
Date of Birth: _____________________________ E-mail: ____________________________________
Mark 'Type of Change' and fill out information completely:
NEW/ CURRENT __________________________________________________________
Street or P.O. Box
Mailing Address: __________________________________________________________
City, State Zip
Adding New Family Member: List the family members who you are adding to your household.
Attach another sheet of paper if needed. (This section is not used to add an adult person(s) to your low rent dwelling lease agreement.)
Elderly/
First Name Last Name Birth Date SS# Sex Relation Disabled?
1)
2)
3)
Deleting a Family Member: List the family members who you are removing from your household.
Attach another sheet of paper if needed.
1)
2)
3)
Change of income: List all current income sources and recipients. Check one or more of the options that apply.
I am no longer employed I have a new job I am now receiving TANF
I am no longer receiving TANF I am receiving Child Support My Child Support increased
My SS/SSI check has decreased I now receive SS/SSI payments My income is cash payment only
I no longer receive a SS/SSI check I am no longer receiving Child Support My SS/SSI check has increased
Other: ____________________________________________________________________________________ (please explain)
Income Source How often
First Name Last Name (From where/who) Amount (Weekly/monthly)
1)
2)
3)
Certification: I certify that the above information is true and correct
to the best of my knowledge and understand that any false statements
are punishable under Federal law.
Signature of Head of Household Date
