LANDLORD INFORMATION
To be completed in FULL by the Owner, Manager or Caretaker ONLY. Completion of this form is NOT A GUARANTEE OF RENT PAYMENT. If assistance is approved, MAHUBE-OTWA is only responsible for the approval amount listed on this form, not for expenses, damages and charges that occur by tenant after entering unit.
If working with a MAHUBE-OTWA Coach or Navigator please list their name:
Tenant
*
First Name
Last Name
Names of others living in this household:
*
Property Owner
*
First Name
Last Name
Is the property owner incorporated?
*
Yes
No
Business name:
*
Federal ID or Social Security Number:
Owner Phone Number
*
Please enter a valid phone number.
Owner Email
*
example@example.com
Is there a property manager?
*
Yes
No
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Property Manager Name
First Name
Last Name
Property Manager Phone:
Please enter a valid phone number.
Property Manager Email:
example@example.com
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Detail on rental
What County is the rental located?
*
Rental location:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
The dwelling is considered a
*
Single-Family House
Duplex
Mobile Home
Apartment
Sleeping Room
What year was it constructed?
*
How many bedrooms?
*
Type of Lease Agreement
*
Monthly
Yearly
Other
Are you RELATED to the Tenant(s)? (will be reviewed situational)
*
Yes
No
Number of Adults in this household:
*
Number of Children in this household:
*
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Rent agreement
Move in date:
*
-
Month
-
Day
Year
What is monthly rent for this unit?
*
Check if included with rent:
*
Heat
Electricity
Water/Sewer
Trash Removal
None
Is any portion paid by a rental subsidy?
*
Yes
No
How much monthly?
*
Damage deposit amount
*
Has this been paid?
Yes
No
First month's rent amount (enter prorated amount applicable to move in date)
*
Has this been paid?
Yes
No
Application fee amount:
*
Has this been paid?
Yes
No
Is the rent past due?
Yes
No
Total balance due (NO portion of this amount has been paid to me by the tenant or by ANY other source).
*
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List a summary of past due amounts here OR if you would prefer to upload a statement instead, type "see attached" in one of the boxes and upload your file below).
*
or upload your ledger here:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Total balance due (this should match the chart above)
*
This amount MUST NOT have been paid for by tenant or by any other source.
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Payment information
Make checks payable to (list the person who will pay taxes on this money and will have or has a w9 on file with us):
*
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How would you like to receive payment?
*
Please sign me up for direct deposit (please request a form for this option).
I already receive direct deposit from you.
I would prefer that you mail me a check.
Submit
Should be Empty: