"Tenant Lease Verification Form" - New Jersey

Tenant Lease Verification Form is a legal document that was released by the New Jersey Department of Community Affairs - a government authority operating within New Jersey.

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Download "Tenant Lease Verification Form" - New Jersey

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NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS
LOW INCOME HOME ENERGY ASSISTANCE &
UNIVERSAL SERVICE FUND PROGRAMS
Tenant Lease Verification Form
(This form is to be filled out only by the landlord and/or superintendent)
This is to verify that (
tenant’s name
) __________________________________________ is residing at:
Street Address: ______________________________________________Apt. Number: ________
City, State, Zip Code _____________________________________________________________
The number of occupants in this residence is: ____________
Names of ALL members of the family living in the unit:
______________________________________________________________________________
Rent payment amount: _____________________
Please verify heating arrangement:
(
) Heat is included in rent, which is subsidized.
(
) Heat is included in rent, which is not subsidized.
(
) Tenant pays separate charge for heat.
(
) Tenant is responsible for paying his/her own heating expenses.
(
) Tenant pays separate charge for air conditioning.
Landlord’s information:
First Name: _________________________________ Last Name: __________________________
Address: __________________________________________________________________________
City, State, Zip code: ________________________________________________________________
Phone Number: _______________________________
__________________________________
_____________________
Landlord/Representative Signature
Date
NEW JERSEY DEPARTMENT OF COMMUNITY AFFAIRS
LOW INCOME HOME ENERGY ASSISTANCE &
UNIVERSAL SERVICE FUND PROGRAMS
Tenant Lease Verification Form
(This form is to be filled out only by the landlord and/or superintendent)
This is to verify that (
tenant’s name
) __________________________________________ is residing at:
Street Address: ______________________________________________Apt. Number: ________
City, State, Zip Code _____________________________________________________________
The number of occupants in this residence is: ____________
Names of ALL members of the family living in the unit:
______________________________________________________________________________
Rent payment amount: _____________________
Please verify heating arrangement:
(
) Heat is included in rent, which is subsidized.
(
) Heat is included in rent, which is not subsidized.
(
) Tenant pays separate charge for heat.
(
) Tenant is responsible for paying his/her own heating expenses.
(
) Tenant pays separate charge for air conditioning.
Landlord’s information:
First Name: _________________________________ Last Name: __________________________
Address: __________________________________________________________________________
City, State, Zip code: ________________________________________________________________
Phone Number: _______________________________
__________________________________
_____________________
Landlord/Representative Signature
Date