Property Owner Certification of Voluntary Tenant Vacancy
As the property owner of _______________________________________________________
(rental unit address)
I, ____________________________________________ hereby attest under penalty of perjury that the
(printed property owner name)
former tenant ______________________________________________________ who had applied and
(printed tenant / head of household name)
been awarded assistance from the Rent and Mortgage Relief Program (RMRP) for the months of
________________________________________________ at the rate of ________________________
(month(s) and year of RMRP award) (monthly rent amount)
per month, vacated the above referenced rental housing on their own accord on or about
__________________ on their own accord without threat of legal, financial, or any other type of penalty
that may negatively impact their ability to obtain housing in the future. Any assistance provided by
RMRP as a result of false information may result in all or part of that assistance needing to be repaid.
__________________________________________________ __________________________
Property Owner Signature Date
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