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Organization Someone who works for a DC social services agency like a health clinic food pantry immigrant services agency religious organization homeless shelter etc. that serves you may complete Section C of the form if they believe that you live in the District. The called by IMA to verify the information. Why must the person completing this form for me prove that they live in the District By submitting proof that they live in the District the person verifying your residency is taking one more step to prove who they are and where they live making them a verifiable source. Frequently Asked Questions about the Proof of DC Residency Form Do I have to complete the Proof of DC Residency form You can prove that you live in the District by presenting one of the following documents showing your name and DC address A valid DC driver s license or non-driver s ID card A valid lease rental agreement rent receipt deed settlement papers or mortgage statement for a residence in the District - A valid homeowner s or renter s insurance policy for a residence in the District - A DC Property Tax bill for a DC residence issued in the last sixty 60 days - A utility bill water gas electric cable or landline telephone issued in the last sixty 60 days - A pay stub showing a DC address and DC withholding taxes issued in the last thirty 30 days - A DC voter registration card If you do not have any of these you must complete the Proof of DC Residency Form. - The Proof of DC Residency Form asks for another person or organization to verify that I live in the District. Who can fill this form out for me The form has two different sections for someone else to verify that you live in the District one that may be filled out by an individual and one that may be filled out by an organization* Only one verification section needs to be completed* Individual Any DC resident who knows that you live in the District can fill out and sign Section B of the form for you. This could be a roommate neighbor landlord friend etc* This person must also prove that they live in DC by submitting a copy of one of the documents listed above showing their name and address. Organization Someone who works for a DC social services agency like a health clinic food pantry immigrant services agency religious organization homeless shelter etc* that serves you may complete Section C of the form if they believe that you live in the District. The called by IMA to verify the information* Why must the person completing this form for me prove that they live in the District By submitting proof that they live in the District the person verifying your residency is taking one more step to prove who they are and where they live making them a verifiable source. This extra step makes the information more reliable and makes it easier for IMA to quickly decide that you do actually live in the District. Once they determine that you live in the District IMA workers can move on to process your Alliance application for health care benefits..

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