Read 0814-072-2P-PIN(Ft Belvoir).qxp text version

APPLICATION FOR HOUSING ASSIGNMENT

SECTION I

NAME OF SPONSOR: Last Name ADDRESS (previous or home of record): Street PAY GRADE TELEPHONE #: (HOME) BRANCH OF SERVICE (DUTY) First

Date of Application ____________________Time ____________

APPLICANT INFORMATION

Middle Initial City SOCIAL SECURITY NUMBER (MOBILE) Date of Birth State Date of Rank Zip Code

DATE HOUSING NEEDED E-MAIL ADDRESS

STATUS OF APPLICANT: (X one) ACTIVE DUTY Married Divorced MARITAL STATUS: (X one) Yes No DUAL MILITARY: (X one)

ESTIMATED BAH RATE ____________________________________________ Single

CONTACT SOURCE _______________________________________________

IF YES, SERVICE MEMBER'S NAME ____________________________________________________________PAY GRADE _______BRANCH OF SERVICE _______________________

INSTALLATION / ORGANIZATION TRANSFERRED FROM: _________________________________________________________________________________________________________

INSTALLATION / ORGANIZATION TRANSFERRED TO / MILITARY UNIT: ____________________________________________________________________________________________ DO YOU HAVE A PET? YES NO

How Many? ___________Type ________________________________________________ Weight _____________________

(MAXIMUM OF 2 PETS PER HOUSEHOLD)

SECTION II

TYPE / MAKE TYPE / MAKE MODEL MODEL

VEHICLE INFORMATION

LICENSE PLATE NUMBER / POST DECAL LICENSE PLATE NUMBER / POST DECAL

SECTION III

Last a. NAME First

DEPENDENT DATA (PROOF OF DATE OF BIRTH WILL BE REQUIRED)

b. RELATIONSHIP Middle Initial c. GENDER (M - F) d. DATE OF BIRTH (DDMMYY)

DEPENDENTS RESIDING WITH MILITARY MEMBER: (If more space is needed, continue on plain paper)

e. SOCIAL SECURITY NUMBE

SECTION IV

NAME NAME ADDRESS ADDRESS

EMERGENCY CONTACT INFORMATION

City City State State Zip Zip Phone Phone

EFMP FAMILY MEMBER?

YES

NO

SPECIAL REQUESTS / COMMENTS: (PERTAINING TO HOUSING ASSIGNMENTS OR BAH MATTERS)

_______________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________ SIGNATURE OF APPLICANT

_________________________________________________________________________ SIGNATURE OF APPLICANT

SECTION V

DISPOSITION (TO BE COMPLETED BY HOUSING OFFICE)

DATE APPLICATION RECEIVED _______________________________________ HOUSING QUALIFIED FOR: VILLAGE ___________________________________________ DATE HOUSING ASSIGNED _______________________________________________________

DATE APPLICANT PLACED ON WAITING LIST/POSITION ____________________

SIZE ________________________________________________________________________________________

ADDRESS ASSIGNED ___________________________________________________________________

______________________________________________________________________________________________________ SIGNATURE OF FAMILY HOUSING CONSULTANT

________________________________________ DATE SIGNED

Information

0814-072-2P-PIN(Ft Belvoir).qxp

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