Fillable REQUEST FOR PORTABILITY (City of Garland)

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REQUEST FOR PORTABILITY (City of Garland)

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The REQUEST FOR PORTABILITY (City of Garland) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of Garland

BROWSE CITY OF GARLAND (TX) FORMS

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REQUEST FOR PORTABILITY
Date: ______________________
Name: _____________________ SSN: _________________
_____________________
_____________________
Complete the following information for the area you want to move under the
portability option.
Name of Agency: _____________________________________________
Address: ___________________________________________________
City, State, Zip: ______________________________________________
Contact Person: _____________________________________________
I will be moving out of my current address effective: __________________
Client’s Signature: ____________________________________________
GHA Use Only
Approved: ______________ Denied: __________________
Date Portability paperwork mailed to receiving HA: ___________________
Reason: ____________________________________________________
__________________________________________________________
Case Manager Signature: _______________________________________
210 Carver St. Suite 201B, Garland, TX 75040 Tel: 972-205-3393 Fax: 972-205-3388
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REQUEST FOR PORTABILITY (City of Garland)

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Completed 3 August 2020

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