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2. Household Creation/Residency and Veteran Verification

   This form is for our staff to be able to create your household in our system, or establish residency/proof of veteran for future purchases with the City of Broadview Heights.  Once submitted, this form will be reviewed by staff and if approved, you will receive an email confirming the creation of your household, a 2 year residency admission, or a veteran certification for each approved individual. If any documents or information are missing, we will reach out via email or phone call to gather the documents needed to verify residency.  Submission of this form does not guarantee approval of residency.  

   While the aforementioned residency pass is good for two years, we reserve the right to remove the pass from your household within that time frame if we find proof of non residency.

4. Required Documents

   Please attach required documents below. *Please note, information sent via this form must ONLY contain name and addresses for residency verification, and must NOT contain personal identifying information such as Driver's License numbers, ID number or anything of that nature. 

   Please Attach ID for each applying member.

   Examples - Driver's License, State ID, Military ID, Passport or Visa, Student ID

   Youth - Report Card with same address as primary member, Birth Certificate with either adult member, Driver's License with same address as primary member. 

   Veteran - DD214

   Proof of Residency

   Examples (must be current within the last 90 days) - Utility Bill, Bank Statement, Credit Card Statement, Rental Agreement, Pay Stub. 

   Youth Identification can count towards youth proof of residency and does not need to be submitted twice. 

6. Application Type*
   -- Select One --Residency VerificationHousehold Creation

   Please select the type of verification or household you are applying for. 

8. Household Members

   Please note, residency verification is needed for all members. Please see accepted documents below. 

10. Name
11. Date of Birth
12. Phone Number
13. Email
15. Required Document

    Attach required document here

16. Required Document

    Attach required document here

17. Required Document

    Attach required document here

19. Name
20. Date of Birth
21. Phone Number
22. Email
24. Required Document

    Attach required document here

25. Required Document

    Attach required document here

26. Required Document

    Attach required document here

28. Name
29. Date of Birth
30. Phone Number
31. Email
33. Required Document

    Attach required document here

34. Required Document

    Attach required document here

35. Required Document

    Attach required document here

37. Name
38. Date of Birth
39. Phone Number
40. Email
42. Required Document

    Attach required document here

43. Required Document

    Attach required document here

44. Required Document

    Attach required document here

46. Name
47. Date of Birth
48. Phone Number
49. Email
51. Required Document

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52. Required Document

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53. Required Document

    Attach required document here

55. Name
56. Date of Birth
57. Phone Number
58. Email
60. Required Document

    Attach required document here

61. Required Document

    Attach required document here

62. Required Document

    Attach required document here

64. Address*

    Street, City, State, Zip Code

66. Signature (If under 18, parent signature required)*

    By signing this form, I agree that the above information and attachments are correct and accurate.  Additionally, I agree to adhere to all rules and policies found at www.bhrec.org or by request at the front desk. Further, I agree that any documents I attach do not contain sensitive information and I acknowledge that anything attached is not stored on an encrypted server. 

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68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field