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I HAVE ATTACHED A COPY OF MY ORDERS AND APPROVED CG-4170A HERETO. CG-4170A N/A FOR SINGLE MEMBERS. DATE SUBMITTED APPLICANT S SIGNATURE PREVIOUS EDITION IS OBSOLETE PAGE 2 OF CG-5267 01-09 SECTION B - HOUSING AUTHORITY ACTION 1. MARITAL STATUS 13. I AM SEPARATED FROM MY DEPENDENTS MARRIED SINGLE CG-4170A not applicable N/A VOLUNTARILY DEPENDENTS RESIDING WITH ME If more space is needed continue on plain paper 14a....
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4170a
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