Town of Islip Housing Authority UNIT AVAILABILITY FORM

Town of Islip Housing Authority UNIT AVAILABILITY FORM
Date form completed:*

MonthDayYear
UNIT INFORMATION
Street Address:*
City-Zip*
Number of Bedrooms*
Number of Bedrooms
Security Amount?*
Dollar amount
Rent Amount?*
Does the unit have any features that provide access to persons with a disability or handicap? Yes No*
If yes please list
Unit Type*
If "other" type of unit please list
Ground Floor unit?*
Utilities:
Optional Amenities
Heat Cost LL or T Responsible*
Heating Fuel Source*
Cooking Fuel Cost LL or Ten Responsibility*
Cooking Fuel Source*
Hot Water Cost Responsibility LL or Tenant*
Hot Water Fuel Source*
Water Cost LL or Tenant*
Electric Cost responsibility LL or Tenant*
Date Unit Available:
Date Unit Available*

MonthDayYear
Date
Owner Name:*
Tel. # Day:*
Tel # evening:*
Email-IF filled in this email will be provided to prospective tenants
example@example.com
Email for owner/HA communications if different ONLY for HA communications
If applicable, Broker Name:
Real Estate Agency:
Contact telephone number:
By my signature below, I hereby certify that the above information is accurate and that I am the owner or an authorized representative thereof. I also understand that the Housing Authority makes no guarantees that a voucher recipient will request to lease the unit and/or that the unit rent is approvable and/or whether the unit will comply with applicable inspection standards. I understand that a valid rental permit issued by the Town of Islip Bldg. Dept. Is required in order for a voucher recipient. I acknowledge that all participation is governed by applicable fair housing and non discrimination laws.
Print Name of Authorized Representative
Signature of Authorized representative

The unit availability listing is made available to Section 8 voucher recipients upon their request.

PLEASE NOTE THAT ALL LISTINGS ARE REMOVED FROM THE HA AVAILABLE UNIT LISTING 30 DAYS AFTER THE UNIT AVAILABILITY DATE UNLESS THE HA RECEIVES A SIGNED UPDATED WRITTEN REQUEST TO MAINTAIN THE LISTING.
Signature*

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Town of Islip Housing Authority UNIT AVAILABILITY FORM

UNIT INFORMATION

Utilities:

Date Unit Available: