50077CR Civil Rights Certification

U.S. Department of Housing and Urban Development
Office of Public and Indian Housing
Expires 4/30/2011

Civil Rights Certification

Civil Rights Certification
Annual Certification and Board Resolution
Acting on behalf of the Board of Commissioners of the Public Housing Agency (PHA) listed below, as its Chairman or other
authorized PHA official if there is no Board of Commissioner, I approve the submission of the Plan for the PHA of which this
document is a part and make the following certification and agreement with the Department of Housing and Urban Development
(HUD) in connection with the submission of the Plan and implementation thereof:

The PHA certifies that it will carry out the public housing program of the agency in conformity with title VI of
the Civil Rights Act of 1964, the Fair Housing Act, section 504 of the Rehabilitation Act of 1973, and title II of
the Americans with Disabilities Act of 1990, and will affirmatively further fair housing.

________________________________________
PHA Name

__________________________________________
PHA Number/HA Code

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will
prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

Name of Authorized Official

Title

Signature

Date

form HUD-50077-CR (1/2009)
OMB Approval No. 2577-0226