Landlord Rent/Deposit Due Attestation
An eviction notice is not required to be eligible for housing payment assistance. Qualifying need for housing assistance is established by the client producing a late notice from their property owner or providing an attestation that they are behind on rent if no such notice is available. This form may also be used for new rentals if a lease agreement is not yet in place. The Landlord is required to have their Tax ID and W9 on file before making payment.
Name of Tenant
Amount of Rent Due
Do not count any past due rent incurred prior to April 1, 2020. Cares Act COVID-19 assistance may not be incurred prior to March 27, 2020. We will only pay back rent incurred after April 1, 2020.
Security Deposit Due
If this is a new rental
Date Rent/Deposit was or is Due
Enter the first date the rent was past due if multiple months past due
Is the Tennant behind on rent
Business or Lanldord Name as It should appear on the payment
Landlord Tax ID#
If we don't have a W9 on file
We must have Landlord Tax ID or W9 on file, you do not have to upload for each Tennant we only need to have one copy of the W9 on file.
Which type of payment do you prefer?
Mail a check
Landlord Address To Mail Check if you indicated Mail a Check
Street Address Line 2
State / Province
Postal / Zip Code
The Lanldord listed above attests that the Tennant listed on this form owes rent and/or deposit in the amount listed above and the amount requested was incurred after April 1, 2020.
Should be Empty: