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_ HUD <br /> CHILD SUPPORT INCOME VERIFICATION LETTER <br /> EQUAL HOUSING <br /> OPPORTUNITY FROM : Indian River County NSP <br /> Indian River Habitat for Humanity <br /> 4568 N . US Highway 1 <br /> Vero Beach , FL 32967 <br /> ( 772 ) Office <br /> ( 772 ) 562 - 8732 Fax <br /> DATE : <br /> TO : DEPARTMENT OF REVENUE <br /> CHILD SUPPORT ENFORCEMENT <br /> 1436 OLD DIXIE HIGHWAY , SUITE <br /> VERO BEACH , FL 32960 -3798 <br /> The following applicant has applied for public housing assistance . Our <br /> agency is required to conduct a third party verification of all applicants <br /> applying or living in federally assisted housing . <br /> STATEMENT OF AUTHORIZATION . <br /> I , , AUTHORIZE THE DEPARTMENT OF REVENUE TO RELEASE ANY <br /> INFORMATION OR MATERIALS WHICH ARE DEEMED NECESSARY TO COMPLETE MY <br /> DETERMINATION OF ELIGIBILITY FOR PARTICIPATION IN THE NEIGHBORHOOD <br /> STABILIZATION PROGRAM . <br /> X <br /> Name of Applicant ( Printed ) Signature of Applicant Date <br /> Social Security Number of Applicant Housing Agency Representative Date <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - = - - - - - - - - - - - <br /> TO BE COMPLETED BY DEPARTMENT OF REVENUE <br /> DOR VERIFICATION : <br /> ❑ Find attached records on child support paid to the custodial family for the past 12 months . <br /> ❑ The above mentioned person has registered with our agency and has applied for enforcement <br /> action , but is not currently receiving support . <br /> ❑ The above mentioned person has not registered with our agency or has not received child <br /> support payments , <br /> DOR Representative ( signature ) Title Date <br />