060101 11272017 BA RA
2160 41st Avenue, Capitola, CA 95010-2040
Tenant Name: ______________________________________________ Tenant SS#: _____________________________________
Owner Name: ______________________________________________ Owner SS#/Tax ID#: ______________________________
Owner’s Home Address: _____________________________________ Owner Phone:____________________________________
According to HUD regulations, a Section 8 tenant may not be related by blood or marriage to the owner of the unit they rent under the
Section 8 program. Exceptions may only be granted in rare cases as a reasonable accommodation for a person with disabilities who
requires a specially-modified unit and such a unit is only available from a relative.
In no case is a Section 8 tenant permitted to rent a unit from a relative if the relative also lives in the unit. Therefore, the owner must
provide verification that they do not live in the unit to be assisted through the Section 8 program.
To request permission to rent from a relative, please provide the following documents:
1. Completed Request for Reasonable Accommodation form, with explanation as to the special features that your unit must
have to accommodate your disability. We will verify this with your health care provider or social worker after you return the
2. A List of Properties Contacted (enclosed) verifying that you have searched for a unit with the necessary modifications and
been unable to locate one.
3. Verification that the owner does not live in the unit you propose to rent. This verification can include utility bills, rental
agreements, and/or mortgage documents showing the owner’s residence.
4. The owner and tenant must sign this request and return it to us.
5. If your request is approved, you will be notified in writing. You are encouraged to continue to look for units to rent while
your request is being processed.
I, (OWNER) certify that I am the owner of the unit at: (address of rental unit for which tenant is requesting authorization to rent)
______________________________________________________________________________ and that I am the
(relationship-father, cousin, daughter, etc.) _____________________ of the tenant.
You will be informed of the Housing Authority’s granting, denial, or status of this request within thirty (30) days of the receipt of this
I certify, under penalty of perjury, that I do not live at the unit that I propose to rent to the tenant, nor do I intend to live in the unit
during the period of Section 8 assistance. I certify that the property is not covered by any local ordinance that requires the owner to
live in the unit, and that by renting to this specific Section 8 tenant, I am in full compliance with the requirements of any state and
local laws.
Owner Signature Date Tenant Signature Date
If you have any questions regarding this, please contact the Housing Authority at (831) 454-5955 Monday through Thursday, between
8:00 a.m. 4:45 p.m. and Friday from 8:00 a.m. and 12:00 p.m.