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Landlord Application
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The Emergency Rental Assistance Program provides assistance to Luzerne County households that are unable to pay rent due to the COVID-19 Pandemic. Please review eligibility requirements and an overview of the application process on our website: www.ceopeoplehelpingpeople.org/COVIDrentrelief
This program is federally funded and we continue to receive ongoing guidance on program requirements. This application and required documentation are subject to change based on federal guidance.
You must have the following information available to you to upload pictures or documents as part of this application. You will not be able to submit an incomplete application, but you can save the application and come back to it later using the link sent to your email.
1. Photo ID for the applicant / landlord and if necessary a copy of the management agreement or proof of LLC ownership. 2. Proof of ownership. Additionally, you or your tenant must provide the following (not required for submission of this application, but is required before processing/reviewing your application): 1. Lease or Property Certification for Verbal Leases 2. Proof of the last rental payment
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Landlord Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
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Tenant Information
Tenant Name
*
First Name
Last Name
Rental Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In what County is the rental property listed above?
*
Luzerne
Wyoming
Other
You indicated the rental property is outside of Luzerne County.
This application is for Luzerne County rental properties only. You find out to apply for assistance in other counties by visiting this website: https://www.compass.state.pa.us/Compass.Web/RAP/Application Please note, CEO does process Wyoming County applications, but they must be submitted through the state application system linked above.
Tenant Phone Number
*
Tenant Email (if available)
example@example.com
Please list the months of rental arrears you are requesting and the amount of rent assistance requested for each month. Do not include any future months.
*
Month & Year
Rent Amount Requested
1
2
3
Have you received subsidized rental assistance for the months noted above?
*
No
Yes
If yes, list the source of assistance under Other below.
Other
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Prior involvement with the COVID Emergency Rental/Utility Assistance Program
Please let us know if you have already submitted the following information for another renter:
*
Photo ID
W-9 form
Proof of Ownership for the Address associated with this application
None of the above
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Required Documentation
State issued photo identification for the applicant / landlord is required.
If the property owner is an LLC or you are the managing representative for the owner, please provide both the management agreement or proof of LLC ownership along with your photo ID as the applicant.
Upload a photo of the front and back of the photo ID and any necessary documentation on your relationship to the owner here. Multiple items can be uploaded.
*
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Ownership must be documented for the rental unit listed above. Acceptable proof of ownership documents include, but are not limited to a copy of the deed, sales contract, most recent property tax receipt, copy of the mortgage, or proof of homeowner's/hazard insurance from the most recent year.
Upload proof of ownership here.
*
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Documentation showing the last payment made by the tenant must be provided. The documentation must include the tenant’s name, date and amount of last payment, and a check number if payment was made by check.
Acceptable documentation can include a cancelled check, payment ledger, dated and signed rent receipt or other documentation acceptable at the discretion of CEO.
Upload last payment documentation here.
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A copy of your full written lease or the form, Landlord & Tenant Property Certification for Verbal Leases. All pages of the Lease must be provided.
Upload your lease or Property Certification for Verbal Leases.
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If you don't have a written lease, download a copy of the Landlord & Tenant Property Certification for Verbal Leases. This needs to be signed by both the tenant and landlord and must be uploaded above. If you cannot preview of the form below, click the button in the top right corner of the box to open it in another tab.
Si no tiene un contrato de arrendamiento por escrito, descargue una copia de la Certificación de propiedad de propietarios e inquilinos para arrendamientos verbales. Esto debe ser completado tanto por el inquilino como por el propietario y debe cargarse arriba. Si no puede obtener una vista previa del formulario a continuación, haga clic en el botón en la esquina superior derecha del cuadro para abrirlo en otra pestaña.
If approved, landlords/property owners will be required to provide a W-9. The landlord/property owner must sign and return a W-9 form prior to the issuance of any payments.
If you do not upload this document now, your application will be considered incomplete. No payments can be issued on behalf of your tenant until the signed W-9 has been submitted.
Please download this W-9 Form, complete and sign it, then upload it below. If you cannot preview of the form below, click the button in the top right corner of the box to open it in another tab.
Descargue este formulario W-9, complételo y fírmelo, luego cárguelo a continuación. Si no puede obtener una vista previa del formulario a continuación, haga clic en el botón en la esquina superior derecha del cuadro para abrirlo en otra pestaña.
Upload the completed, signed W-9 here.
*
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Will you accept electronic payment of funds via Direct Deposit?
*
Yes (ACH form is already on file with CEO)
Yes (I need to complete an ACH Authorization form)
No (any payments issued will be sent via US mail to the address listed on page 1 of this application)
Other
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Authorization Agreement for Direct Deposit / Payments (ACH Credits/Debits)
Company Name: Commission on Economic Opportunity ID Number: 23-1653093
I (we) hereby authorize the Commission on Economic Opportunity, hereinafter called COMPANY, to initiate credit/debit entries to my (our) Checking Account / Savings Account indicated below at the depository financial institution named below, hereafter called DEPOSITORY, and to credit to the same such account. I (we) acknowledge that the originator of the ACH transactions to my (our) account must comply with the provisions of U.S. law.
Bank information
Depository Name (Bank)
*
Branch Name, if one
City
*
State
*
Use 2 letter code
Zip code
*
Account Type
*
Checking Account
Savings Account
Routing Number (must be 9 digits)
*
Account Number
*
This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manners as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.
Account Holder 1
*
First Name
Last Name
Account Holder 1 ID Number
*
Social Security Number or EIN
Signature of account holder 1
*
Account Holder 2 (optional)
First Name
Last Name
Account Holder 2 ID Number (required if named above)
Social Security Number or EIN
Signature of account holder 2 (required if named above)
Today's Date
-
Month
-
Day
Year
Date
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Certifications
Do you attest that the tenant named in this application occupied the applicable residence during all of the months for which assistance is requested, and is delinquent on rent? If yes, please initial below.
*
Do you agree all rental payments made to you on behalf of your tenant will be used to satisfy the tenant's rental obligation?Initials
*
By signing below, you are agreeing to the following statement.
"I acknowledge that all information included is correct and complete and understand that providing a written false statement which I do not believe to be true is a misdemeanor of the third degree and is punishable as perjury under Pennsylvania Title 18, Section 4904, related to unsworn falsification to authorities, and that in addition to any other penalty that may be imposed, a person convicted under this section s hall be sentenced to pay a fine of at least $1,000."
Signature
*
Today's Date
*
-
Month
-
Day
Year
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Submitting Your Application
Please note, completing this form does not guarantee assistance.
Refer to CEO's website: www.ceopeoplehelpingpeople.org/COVIDrentrelief for more information.
If your tenant has not yet applied, please provide them with this link to complete the Renter Application. If you have questions please call: 570-826-0510 and ask for the COVID Emergency Rent and Utility Assistance program or email us at ceorentrelief@gmail.com
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