Lottery Pre App English

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LOTTERY PRE-APPLICATION FOR SECTION 8 VOUCHER PROGRAM

PLEASE PRINT CLEARLY RETURN THE ENTIRE FORM


The Vernon Housing Authority will use Random-Draw Lottery System to determine the order of each Pre-Application on the Section 8 Voucher
Program waiting list. This Form May Be Reproduced on a Copy Machine. The Section 8 Voucher Program is a Federally-funded program to
subsidize decent, safe and sanitary housing for very-low income persons.
PRE-APPLICATIONS MUST BE POSTMARKED
NO EARLIER THAN JULY 29, 2014
NO LATER THAN MIDNIGHT JULY 31, 2014
ENVELOPES POSTMARKED BEFORE 7/29 AND AFTER 7/31 WILL BE REJECTED
Please print clearly and completely fill in all lines that apply to you on this Pre-application form:
1. HEAD OF HOUSEHOLD INFORMATION:
Social Security Number: ________- ______- __________
Name of Head of Household: _____________________________________________________________________________
Street Address:__________________________________________________________ Apt. #:______________________
City: ________________________________________ State: ___________________ Zip Code: _________________________
Date of Birth: __________________________ Age: ________________ Male:____________ Female: _____________
2. TOTAL NUMBER OF MEMBERS IN HOUSEHOLD: Please include yourself:
ADULTS: Male ______ Female _______ CHILDREN: Male _______ Female _______ ELDERLY:________ DISABLED: _________
3. TOTAL HOUSEHOLD GROSS (before taxes) INCOME? _____________________________________
I certify that the above information is accurate and complete. I understand that submission of false information or misrepresentation may
result in loss of eligibility to participate in the housing choice voucher program and is punishable under Federal Law.

____________________________________________________ _____________________________________________
Head of Household Signature Date Signed


Current Income Limits for admission to the Section 8 Voucher Program are as follows:
1 Person $30,000 5 Person $46,300
2 Person $34,300 6 Person $49,750
3 Person $38,600 7 Person $53,150
4 Person $42,850 8 Person $56,600

MAIL ONLY completed Pre-Applications to: (address must appear exactly as below)
Section 8 Wait List
Vernon Housing Authority
P. O. Box 5
Vernon, CT 06066
Pre-applications are available at Vernon Housing Authority, on www.vernonhousing.org, or by utilizing this form.
Only one pre-application per family; any family submitting more than one pre-application will be disqualified.
ONLY ONE PRE-APPLICATION PER ENVELOPE.
The pre-application must be completed with all information and must be written in a legible fashion. Any pre-application that is
not legible will be disqualified.
ONLY PRE-APPLICATIONS POSTMARKED BETWEEN JULY 29, 2014 AND JULY 31, 2014 AND RECEIVED BY AUGUST
6, 2014 WILL BE ACCEPTED.
NO WALK-IN, PHONE, FAX, EMAILED OR VOICE MAIL PRE-APPLICATIONS WILL BE ACCEPTED.
All information will be verified and eligibility determined prior to issuance of voucher.

400 PRE-APPLI CATI ONS WI LL BE DRAWN AT RANDOM. ONLY THOSE SELECTED WILL BE MAILED APPLICATIONS. If you
did not receive an Application by September 30, 2014, your name was not drawn in the Random-Draw Lottery.
THE VERNON HOUSING AUTHORITY DOES NOT DISCRIMINATE IN ADMISSION OR ACCESS TO ITS FEDERALLY-ASSISTED
HOUSING PROGRAMS. WE MAKE EVERY EFFORT TO PROVIDE EQUALLY EFFECTIVE SERVICES TO PERSONS WITH
DISABILITIES. THIS IS AN EQUAL HOUSING OPPORTUNITY/AFFIRMATIVE ACTION PROGRAM.

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