Acknowledgement of Receipt of Documents

T-78 Acknowledgment of Receipt of Documents Page 1 of 1 July 2019

Resident Name: _____________________________________________ Unit Number: ____________

Document Names

HUD-9886

EIV and You Brochure

HUD Fact Sheet (How Your Rent is Determined)

Resident Rights & Responsibilities Brochure

Community Rules and Regulations

HUD-5380 Notice of Occupancy Rights Under VAWA

If you are disabled and would like to request an accommodation or if you have difficulty understanding English,

please request our assistance and we will ensure that you are provided with meaningful access based on your

individual needs.

 I would like to update Emergency Contact Information including updating information on HUD Form

92006.

By signing this form, I acknowledge that all persons named on HUD Form 50059 have received all of the forms

and/or documents indicated above. All persons named on HUD Form 50059 have been given the opportunity to

ask questions about the information provided in each of these forms.

________________________________________ __________________________

Head of Household Signature Date

__________________________ does not discriminate on the basis of disability status in the admission or access to, or

treatment or employment in, its federally assisted programs and activities. The person named below has been designated

to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban

Development’s regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988).

Patricia Sherman

Name

401 Harbison Blvd., Suite 3

Address

Columbia SC 29212

City State Zip Code

803-937-3545

Telephone-Voice

1-800-735-8583

Telephone-TTY

Resident's Name

Apt #

Property Name Here