Landlord Information
Completion of this form is not a guarantee of payment and must only be completed by the Owner, Manager or Caretaker.
If working with a Coach or Navigator please list their name:
MAHUBE-OTWA Staff name if applicable
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)?
*
Yes
No
Number of Adults in this household:
*
Number of Children in this household:
*
Tenant
*
First Name
Last Name
Names of others living 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
Other
Is any portion paid by a rental subsidy?
*
No
Yes
If yes to receiving a rental subsidy, how much monthly?
*
Is the rent past due?
*
No
Yes
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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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Damage deposit amount
*
Total amount due (NO portion of this amount has been paid to me by the 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.
I already receive direct deposit from you.
I would prefer that you mail me a check.
Submit
Should be Empty: