Covid-19 Relief Fund
Jennings County Landlord & Rent Survey
Are you..
Landlord
Renter
Are you a Jennings County resident?
Yes
No
Name
First Name
Last Name
Email
example@example.com
Rentals in Jennings County
Rows
Total # of rentals
# current on rent
# 1 month behind
# 2 months behind
# 3 months behind
# 4 months or more behind
Number of Rentals
Total Amount Owed
Landlord / Company name
How far behind are you on your rent / utilities?
Rows
Current
Months Behind
Monthly Amount
Rent
1 Month
2 Months
3 Months
4 or more
Electric
1 Month
2 Months
3 Months
4 or more
Gas
1 Month
2 Months
3 Months
4 or more
Water
1 Month
2 Months
3 Months
4 or more
How far behind are you on your rent / utilities?
Rows
Current
Months Behind
Monthly Amount
Total Amount in Arrears
Rent
1 Month
2 Months
3 Months
4 or more
Utilities- electric, gas, water
1 Month
2 Months
3 Months
4 or more
Submit
Should be Empty: