Eureka Housing Authority

Part 2 - HUD Form 52675 (other adult)

002 HUD Form 52675 Debts Owed to Public Housing Agencies and Terminations

HUD Form 52675 declares that the Housing Authority verifies employment and income information provided by the applicant. We also check to ensure that the applicant does not owe debt to any other Public Housing Agency.


Please read, print out, sign and date Form 52675 as indicated.

After you have completed HUD Form 52675, please print the form and return to this page to continue to

Part 3 - Previous Rental History