Declaration of Amount Paid for Care of Children or Dependent Person(s)

Please NOTE - before completing this form. This form requires notarization by a Notary of Public.

Complete the form online & print.  DO NOT submit this form online.  Take the form to a Notary to be notarized.

After Notarization, drop off or mail the form to our office: 
Housing Authority City of Odessa, Texas
124 E 2nd Street
Odessa, TX 79761