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There are at least two working outlets or one working outlet and one working light ﬁxture.
There are no known electrical hazards.
Windows and doors that are accessible from the outside are lockable.
There is at least one window and ALL the windows are free of signs of severe deterioration and have no missing
or broken panes in each room of the apartment.
The ceiling is sound and free from hazardous defects.
The walls are sound and free from hazardous defects.
The ﬂoor is sound and free from hazardous defects.
All interior surfaces are free of cracking, scaling, peeling, chipping, and loose paint. In addition, all were treated
and covered to prevent the exposure of lead based paint hazards.
Weather stripping is present and in good condition on all windows and exterior doors.
There is a working toilet in the unit for exclusive private use.
There is a working, permanently installed wash basin with hot and cold running water.
There is a working tub or shower with hot and cold running water.
The bathroom has operable windows or a working vent system.
By signing below, I hereby attest that the lessee will be released from any remaining obligation for any past due or future
rent for which CARES RRP funding is received. I acknowledge that the Agency makes no representation or warranty
regarding the condition of any property or rental unit for which CARES RRP assistance is received and that issuance of
CARES RRP funding on behalf of any tenant to any landlord or property owner should not be construed as the Agency’s
acceptance of any property condition(s) or approval of the terms of any lease that has been provided as a part of this
I understand that providing a written false statement which I do not believe to be true to PHFA is a misdemeanor of the
third degree and is punishable as perjury under Pennsylvania Title 18, Section 4904, relating to unsworn falsiﬁcation to
authorities, and that in addition to any other penalty that may be imposed, a person convicted under this section shall be
sentenced to pay a ﬁne of at least $1,000.
Landlord Name: ___________________________________________ Date: ___________________
Landlord Signature: _______________________________________ Date: ___________________
*** Please ensure you have a signed copy of the Lease Agreement for each tenant or household for which you
are seeking assistance. These documents must be submitted as part of your application. Insucient or missing
documentation may cause a delay in processing or, in some cases, a denial of the application. Additional
documentation may be requested during the review of your application.
CARES RENT RELIEF PROGRAM
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