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<br />Consent For Release of Criminal Conviction Records <br /> <br />(The criminal conviction records are to be used to screen applicants for admission to the program.) Under 24 <br />CFR 5.903, each adult household member is subject to this screening process. <br />CONSENT: I consent to allow the Office of Housing and Community Development to request and obtain <br />information of any criminal convictions from a law enforcement agency for the purpose of screening for <br />admission to the Housing Choice Voucher (Section 8) and Tenant Based Rental Assistance Programs. <br />All adult household members must complete and sign the consent form. <br />Please print your first name, middle initial, last name, Social Security Number, birth date and sign. <br />Head of Household (First, MI, Last Name / Social Security / Birth Date) Signature <br />Spouse / Co-Head (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br /> <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />Other Family Member (First, MI, Last Name / Social Security / Birth Date) Signature <br />ЍЎЎЍƭķŭĭ <br />