Displacee Information Project Title: Parcel No.: Name of Displacee(s): Displacee No.: Date of Occupancy: Owner Tenant Cell Phone: Site Address: Mailing Address: Work Phone: Home Phone: Email Address: Residential Information Total Sq Ft: No. Bedrooms: No. Bathrooms: Total No. Rooms: Size: Year Built: Subject DS&S: Garage Stalls: Other major site improvements: Building Type: Single Story 1.5 Story 2 Story Level Basement Other Replacement Preference: Own Transportation Need Transportation Purchase Rent Need Public Transportation Adults: M F Ethnic Identification Utilities: Dwelling Type: Category: Heat Single Family African American NatGas Electric Dwelling Asian/Pacific Islander Oil Propane Apartment American Indian Duplex Alaskan Native Water Mobile Home Children: FT PT M F Caucasian Well Condominium Hispanic American City Water Recreational Other Vehicle Septic Sewer This information is required by Title VI Move Type: Schedule Move Payment Number of Rooms Commercial Move Actual Cost Move Advanced Move Payment Needed: Yes No Disability Issues/Special Needs/Comments:
Displacee Information Project Title: Parcel No.: Name of Displacee(s): Displacee No.: Date of Occupancy: Owner Tenant Cell Phone: Site Address: Mailing Address: Work Phone: Home Phone: Email Address: Residential Information Total Sq Ft: No. Bedrooms: No. Bathrooms: Total No. Rooms: Size: Year Built: Subject DS&S: Garage Stalls: Other major site improvements: Building Type: Single Story 1.5 Story 2 Story Level Basement Other Replacement Preference: Purchase Rent Own Transportation Need Transportation Need Public Transportation Adults: M F Ethnic Identification Category: African American Asian/Pacific Islander American Indian Alaskan Native Caucasian Hispanic American Other This information is required by Title VI Utilities: Heat NatGas Electric Oil Propane Water Well City Water Septic Sewer Dwelling Type: Single Family Dwelling Apartment Duplex Mobile Home Condominium Recreational Vehicle Children: FT PT M F Move Type: Schedule Move Payment Number of Rooms Commercial Move Actual Cost Move Advanced Move Payment Needed: Yes No Disability Issues/Special Needs/Comments: