Landlord Approval of Change of Composition

NOTE: All changes of household composition are subject to MHA approval. Completing this form does not constitute approval.
If you are reporting or requesting a change in household composition, please provide the family member name(s) and information below. Please note that any addition to the household that is not due to marriage, birth, adoption or court awarded custody will not increase your voucher size
Family Composition Change. List all family members requested to be added or removed.
Name Soc. Sec. Number Sex: Live-in Aide?
Family Composition Change. List all family members requested to be added or removed.
Name Soc. Sec. Number Sex: Live-in Aide?
I hereby give written notice that the household member listed below has been approved by the landlord to reside at my unit.
TENANT NAME (PRINT)
TENANT’S SIGNATURE
Date
MM slash DD slash YYYY
LANDLORD NAME (PRINT)
LANDLORD SIGNATURE
Date
MM slash DD slash YYYY

Name	Soc. Sec. Number	Sex:	Live-in Aide?

Name	Soc. Sec. Number	Sex:	Live-in Aide?

NOTE: All changes of household composition are subject to MHA approval. Completing this form does not constitute approval.