CoH Liberación de Asistencia Financiera - Rent Asst Spanish


Nombre del Acreedor:   

Número de teléfono del acreedor:   

Fecha: 

Autorizo ​​al acreedor mencionado anteriormente a divulgar cualquier información necesaria para que Cradle of Hope confirme y/o verifique mi necesidad de asistencia financiera. Entiendo que esta información se utilizará para determinar si se me otorgará alguna asistencia. Esta autorización caducará al año de la fecha indicada.

Certifico que la información proporcionada en esta solicitud es verdadera y que todos los fondos que reciba se utilizarán para el propósito indicado en esta solicitud. Autorizo ​​a Cradle of Hope y a los representantes de la Agencia a verificar y comunicar cualquier información contenida en esta solicitud o sobre mi situación para ayudarme. Cradle of Hope mantendrá su confidencialidad y no divulgará su información a otras agencias sin su consentimiento.

Escriba el nombre y apellido del cliente Y la dirección de correo electrónico del cliente antes de que el cliente firme este documento:

 

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Signature Certificate
Document name: CoH Liberación de Asistencia Financiera - Rent Asst Spanish
lock iconUnique Document ID: abb627cc9f3a5d00550c8bd8bd22f8a6ed5d7002
Timestamp Audit
January 2, 2024 3:13 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:13 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:27 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:27 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:29 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:29 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:30 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:30 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:31 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:31 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:35 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 3:35 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 2, 2024 8:59 pm CDTCoH Liberación de Asistencia Financiera - Rent Asst Spanish Uploaded by Darlene Kopesky - dkopesky@cradleofhope.org IP 75.247.230.175
January 3, 2024 1:30 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 3, 2024 1:30 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 73.5.168.211
January 19, 2024 12:31 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.134.41
January 19, 2024 12:31 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.134.41
February 19, 2024 12:50 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.230.175
February 19, 2024 12:50 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.230.175
February 19, 2024 1:18 pm CDTDarlene Kopesky - dkopesky@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.230.175
February 19, 2024 1:18 pm CDTBecca Balzer - rbalzer@cradleofhope.org added by Darlene Kopesky - dkopesky@cradleofhope.org as a CC'd Recipient Ip: 75.247.230.175
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