Request To Remove Family Member


Head of Household



Person You Wish To Remove

Please complete the following to remove a family member. You will receive a written response regarding the request to remove the family member.

New Address of Person You Wish to Remove?



Documents Needed

Please provide proof of new address for person(s) being removed from family household. Please attach a copy of two of the following items:

A background check will be conducted on anyone 18 and over to verify that they have no criminal history before request will be considered.
I declare under penalty of perjury, that the above information is true and complete.

WARNING: Title 18, Section 1001 of the United States Code, states that a person who knowingly makes false or fraudulent statements to any department or agency of the United States is guilty of a felony.