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EDW IN M. LEE, MAYOR SAN FRANCISCO HOUSING AUTHORITY

REV. AMOS C BROW N, PRESIDENT

AUTHORIZATION TO RELEASE INFORMATION

I, __________________________ authorize the SAN FRANCISCO HOUSING AUTHORITY to permit ____________________________ to examine any and all documents and records maintained by the San Francisco Housing Authority included but not limited to my tenancy, or Conventional Public Housing file, and to allow copying of any such documents. I also authorize the San Francisco Housing Authority to discuss any and all matters concerning my program participation.

Date:______________________

Name (Print): ______________________________ Signature: _________________________________ Address: ___________________________________ ___________________________________

1815 EGBERT AVENUE, 3RD FLOOR, SAN FRANCISCO, CALIFORNIA 94124 TELEPHONE: (415) 715-3280 TTY:415.467.6754 WWW .SFHA.ORG


authorization form