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ATION 1. LAST NAME FIRST NAME MIDDLE INITIAL 2. LAST FOUR DIGITS SOCIAL SECURITY # 3. HOME ADDRESS (NUMBER AND STREET) BOROUGH or CITY APT # STATE ZIP CODE 4. HOME TELEPHONE ( ) 5. TELEPHONE NUMBER WHERE A MESSAGE MAY BE LEFT ( ) NAME OF CONTACT 6. DO YOU LIVE IN A NEW YORK CITY HOUSING AUTHORITY DEVELOPMENT? YES NO YES NO IF YES, NAME OF DEVELOPMENT 7. ARE YOU RELATED TO ANYONE NOW WORKING FOR THE HOUSING AUTHORITY? IF YES, RELATIVE'S NAME 8. IF YOU ARE UNDER 18 O.

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