Voluntary Portability

Voluntary Portability
I,*
Head of Household Full Name
Authority transfer my Housing Choice Voucher to:
Housing Authority
If you do not know the name of the Housing Authority, please leave blank and fill in the City, State, and Zip address line below.
Address

Address

Street Address Line 2

City/State/ZipState / Province

Postal / Zip Code
PHA’s Telephone
PHA’s Fax
PHA’s Portability Email
example@example.com
I understand that my initial Public Housing Authority (PHA), the Spokane Housing Authority, will

limit my ability to move from the new PHA’s jurisdiction for the next twelve (12) month period.

I understand that by signing this statement I will adhere to its’ contents.
Signature*

Clear
Date*

MonthDayYear
Date
Contact Phone*
Contact Email*
example@example.com
Should be Empty: