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ANAHEIM HOUSING AUTHORITY CITY HALL WEST 201 SOUTH ANAHEIM BOULEVARD, SECOND FLOOR, ANAHEIM CA 92805 PHONE [PHONE REDACTED] FAX [PHONE REDACTED] WWW.ANAHEIMHOUSINGPROGRAMS.COM DECLARATION OF OWNERSHIP AND AUTHORIZATION FORM RENTAL PROPERTY ADDRESS: NOTE: The following information is required to verify ownership for release of Housing Assistance Payments (HAP). The information provided will be held in strictest confidence. No change to owner or payee address on file. Change(s) to address. (Complete below only if you want to change information.) I HEREBY DECLARE THAT I AM THE LEGAL OWNER OR AGENT AUTHORIZED TO SIGN AND ACT ON BEHALF OF THE RENTAL PROPERTY DESCRIBED IN THE ASSISTED LEASE. 1. Complete for the legal owner(s) of the property: Property Owner/Principal: Attention: Phone No: Residence Address (Not PO Box): Social Security Number OR Tax Identification Number (TIN): 2. Designate a Payee and a mailing address for the Housing Assistance Payment (HAP) checks. This payee needs to match the information completed on Form W-9. HAP will be reported to the IRS on form 1099 at the end of the year with the information listed below. Payee Name Attention: Mailing Address: Social Security Number OR Tax Identification Number (TIN): 3. If there is a Management Company/Manager, please fill out the following: Management Address: Authorized Contract Signer(s): Phone 4. Authorized Signatures: A. Property Owner’s Signature: Date: If a Management signature appears without a Property Owner’s signature, a copy of the management authorization agreement must be attached (management compensation information may be omitted). B. Management Signature: Date: WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its Jurisdictions.