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UPDATED: 11/18/14 FOR OFFICE USE ONLY ACCOUNT DATE: STAFF: COMMUNITY DEVELOPMENT DEPARTMENT AFFORDABLE RENTAL HOUSING PROGRAM INFORMATION UPDATE / CORRECTION REQUEST SECTION A: HEAD OF HOUSEHOLD INFORMATION ACCOUNT # LAST NAME FIRST NAME SOCIAL SECURITY # SECTION B: CHECK BOX NEXT TO TYPE OF CHANGE(S) & PROVIDE UPDATED INFORMATION/CORRECTION(S) CHANGE OF ADDRESS or PHONE # STREET ADDRESS PHONE # CITY STATE ZIP CODE CHANGE OF EMPLOYMENT DOES ANY ADULT IN THE HOUSEHOLD WORK IN ANAHEIM: YES NO IF YES, COMPANY NAME AND ADDRESS: CHANGE OF INCOME YES NO (ANNUAL INCOME BEFORE TAXES) SECTION C: ADD OR REMOVE FAMILY MEMBER(S) CHECK ONE: LAST NAME FIRST NAME SOC. SEC. # BIRTH DATE RELATION TO HEAD SEX Add Remove M F Add Remove M F Add Remove M F Add Remove M F Head of Household Signature Date RETURN BY E-MAIL RETURN BY MAIL: RETURN IN PERSON: ANAHEIM HOUSING [EMAIL REDACTED] P.O. BOX 3222 201 S ANAHEIM BLVD.2nd floor ANAHEIM, CA 92805 ANAHEIM, CA