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<br />. <br />') ,'-':,' ',...'. > '. ,: ,..' <br /> <br />.,,' , <br /> <br />.;. :' <br /> <br />RELOCATION NEEDS ASSESSMENT FORM <br />PAGE 4 <br /> <br />4. <br /> <br />Have you been served an Eviction Notice to vacate the unit in which you now <br />occupy? [ ] If so, what was the reason the Eviction Notice was served? <br /> <br />5. <br /> <br />Do you have to vacate the unit which you currently occupy for any of the following <br />reasons? (please check the appropriate responses.) <br /> <br />[ <br /> <br />] <br /> <br />Must move due to road construction or other federal or state government <br />action. <br /> <br />[ <br /> <br />] <br /> <br />Must move because of Non Residential Development. Current unit to be <br />demolished. <br /> <br />[ <br /> <br />] <br /> <br />Must move due to any other government action not listed above, i.e., <br />Zoning requirement, unit not a legal dwelling unit. <br /> <br />[ <br /> <br />] <br /> <br />Must move because there are too many people and not enough bedrooms <br />in the present unit. <br /> <br />6. <br /> <br />Current monthly rent: If you are sharing rent with another family, <br />what is your portion of the monthly rent? <br /> <br />Whose name IS on the rental lease or occupancy agreement? <br />(ATTACH COpy OF RENTAL LEASE OR <br />OCCUP ANCY AGREEMENT AND RENT RECEIPTS IF YOU ARE APPLYING <br />FOR A RELOCATION ASSISTANCE PAYMENT.) <br /> <br />What type of utilities do you pay for? <br /> <br />Are <br /> <br />you <br /> <br />receIVIng <br /> <br />assistance <br /> <br />under <br /> <br />any <br /> <br />utility <br /> <br />assistance <br /> <br />program? <br /> <br />25 <br /> <br />---..,..--".,--...., <br />