Declaration of Eligibility
Confirm you are eligible to buy/rent an ADU/IZ unit
Each member of your household who is 18 years or older should complete
this form. The forms should be provided to the agent.
First Name (given): Last Name (family):
Current Residential Address: Unit:
City: State: ZIP:
IZ/ADU Address: Unit(s):
Please confirm that the following statements are true.
I am submitting this Declaration of Eligibility as part of my household’s lease agreement and IZ/ADU
lease rider (for rentals) or contract (for purchases). I understand that the unit is subject to the terms of
the Inclusionary Development or Affordable Housing Covenant recorded against the Unit.
Yes No
Each member of my household has told the leasing agent or community based organization (CBO)
about all of our annual income and household size, supported by reasonable documentation.
Yes No
My household’s annual income is at or below the maximum annual household income for the unit.
Yes No
My household will not spend more than 50% of our annual income on housing costs.
Yes No
My household has been advised that DHCD recommends we not spend more than 38% of our
annual income on housing costs if renting or 41% of our annual income if purchasing.
Yes No
My household size meets the requirements of the unit (at least one person per bedroom).
Yes No
Each member of my household will live in the unit as their principal residence and will not rent or sublet
all or any part of the unit, including temporary rentals such as AirBnB.
Yes No
I currently DO
NOT own
I currently own residential property. (must check all below)
I have completed the Homeownership Disclosure form and submitted it to DHCD;
I will give up my ownership before closing on the purchase of, or signing the
lease for, the unit; and
I will provide reasonable evidence to DHCD to confirm that I no longer own the
I certify that the information I provided on this form is true and complete to the best of my knowledge. I also acknowledge
that making a false statement is punishable by criminal penalties under Title 22 of the District of Columbia Official Code.
Signature: _____________________________________________________________________________________
Department of Housing and Community Development | 1800 Martin Luther King Jr. Ave SE, Washington, DC 20020 | 202.442.7221 | | ver. 5/21/20
FOR ALL SALE UNITS: This document shall be recorded with the deed.
FOR ALL RENTAL UNITS: This document shall be attached to the lease.