HCV Voluntary Withdrawal Form

Name *

First

Last

Email

It is my desire to no longer receive rental assistance from Wayne Metropolitan Housing Authority’s Housing Choice Voucher (Section 8) Program:

Please fill in the effective date that you no longer would like assistance. *

Effective Date (Month ending on 30th or 31st and year): Ex. April 30, 2025

In order to avoid any misconceptions or problems in the future, please document specifically your intentions regarding your desire to withdraw from the program in the space provided below.

The reason(s( I wish to withdraw from the Housing Choice Voucher rental assistance program is as follows: *

Signature *

Clear Signature

Date *

longer in withdraw

Wayne Metropolitan Housing Authority

345 N. Market Street
Wooster, Ohio 44691
p: 330-264-2727
f: 330-263-1521

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