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5 Star CS
Contact Us
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EMERGENCY HOUSING ASSISTANCE REQUEST
Emergency Assistance Request
Name
Phone
Email
Leased Address
Lease Amount Due
Amount of Lease Paid
Lease Payment Current?
Amount Past Due
Type of Assistance Requested
Amount Requested
Plan for repayment
Duration of Anticipated Need (# of months)
Employer
Employer Phone #
Employer Address
Requested Unemployment Benefits
Describe Additional Sources of Assistance Received/Requested
Upload Supporting Documentation
Upload Supporting Documentation
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2018 5 STAR CS
1729 Alexandria Dr. #8181 Lexington, KY 40504
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