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PORTABILITY TRANSFER REQUEST

PORTABILITY TRANSFER REQUEST

Head of Household:
SSN:
Current Address:
Phone #:
Note: A minimum of ten (10) days is necessary to process your file and mail it to the receiving Housing Authority.
Tenant’s Signature
Date
MM slash DD slash YYYY
MHA Only:
- Approved
- Disapproved
Date Faxed:
MM slash DD slash YYYY
Date Mailed:
MM slash DD slash YYYY
MHA Signature:
Date
MM slash DD slash YYYY