Resettlement Petition - Part II

Petition Image (38k)

PETITION

We, the householders of ______________, an isolated community comprised of __________householders, hereby agree to move and request assistance under the Household Resettlement Act (April 15, 1965).

PART 2
Name Place of
Resettlement
Proposed
Date of Move
Living
Arrangements
No. in
H. Hold
Children
School Age    others
OCCUPATION
Present    Intended
1.            
2.            
3.            
4.            
5.            
6.            
7.            
8.            
9.            
10.            
11.            
12.            
13.            
14.            
15.            


                                    number    number                                                        (Use additional sheet if the space here is not sufficient)
This is to certify that _____ of _____ householders living at
________________ have signed this Petition and we are enclosing                       SIGNED: ___________________________
completed forms on the communities to which householders intend to move                             Local Committee Chairman


Dated this __________ day of ________month, the year 19__.                                                  ___________________________
                                                                                                                                                                                    Members

                                                                                                                                                                    ___________________________



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