010110 BA 02262020
2160 41
Avenue, Capitola CA 95010-2040
Ph: (831)454-9455, Fax: (831) 469-3712
Change of Ownership and HAP Contract Transfer
Today’s Date : ______________________ Date Property acquired: ______________________
Address of Property:
(If multiple properties use separate form for each property)
I, certify I am the new ____ owner ____ manager of the above referenced property that is
currently being subsidized through the Housing Authority of the County of Santa Cruz Housing Choice Voucher program.
I agree to accept the terms and conditions of the current lease and the Housing Assistance Payments Contract as
if I had signed them originally. OR
Enclosed is the rental agreement/lease between new owner and tenant that includes the following changes:
Length of lease term changed to: ____________________________________________________________
Payment of utility changed to: ____________________________________________________________
Other changes: ____________________________________________________________
Note: a new lease must include reference to HUD addendum. Suggested wording: “HUD tenancy addendum is
incorporated in this lease”. Changes in lease terms require a re-write of the HAP contract.
Attached are the following required documents. I understand no payments will be made to me until all documents
have been provided.
Proof of Ownership (Grant deed, or HUD-1 final settlement statement)
If the previous owner is deceased the following proof of ownership is required:
Copy of trust/court documents assigning new payee or Executor along with copy of death certificate.
Management Agreement, if applicable and/or Landlord Signature Authorization Form
I already have my owner tax ID on file with the Housing Authority.
ID# _____________________________
I do not have an owner tax ID on file and am attaching the following:
W-9 Certification (can be obtained from www.IRS.gov/pub/irs-pdf/fw9.pdf )
Verification of tax ID number. This must originate from the IRS or SSA and show both the name of
the individual/entity and the tax id number associated with that individual/entity.
Housing Authority Direct Deposit Authorization Form
o Voided Check (Deposit Slips are not acceptable)
Name/Check Payable to:
Owner/Agent: _______________________________________________________________________________
Address: _______________________________________________________________________________
City, State, Zip: _______________________________________________________________________________
Telephone Number: ____________________________ Fax Number: ___________________________
Contact Person: ____________________________ Owner/Agent Signature: ___________________________
** Please complete the New Owner Certifications on the reverse of this form**
010110 BA 02262020
New Owner Certifications
Yes No 1. I am currently the legal owner or the legally designated agent for the unit to be rented.
Yes No
3. I understand that when and if I would like to increase the rent charged for the unit, I must request
any rent changes from the Housing Authority. I further understand that I may not establish any
informal payment arrangements with the tenant to collect additional rent not approved by the
Housing Authority.
Yes No
4. Does any member of the tenant’s household have any ownership interest (listed on the deed,
beneficiary, trustor, trustee, etc.) in this property?
Yes No 5. The ownership of the unit to be rented is held in trust.
Yes No
6. I live on / at the same property as the unit listed on this request, and the property has multiple
Yes No
7. I live in (or plan to live in) a shared housing situation with a Section 8 tenant, as approved by the
Housing Authority.
member or officer of the Housing Authority.
Yes No
9. The owner(s) and / or an immediate family member of the owner(s) is an employee, contractor,
subcontractor, or agent of the Housing Authority.
Yes No
10. The owner(s) and / or an immediate family member of the owner(s) is a public official, member
of a governing body or state or local legislator.
Yes No
11. The owner(s) and / or an immediate family member of the owner(s) is a member of the Congress
of the United States.
Yes No
12. The owner(s) is the parent, child, grandparent, grandchild, sister, brother, aunt, uncle, cousin,
step-parent, step-grandparent, significant other, or related in any way to the tenant or a member of
the tenant’s family? Relation by adoption is included in this definition.
*If the Property Owner is a relative of any member of the HCV (Section 8) family wanting
to rent a unit from you, you cannot agree to rent the unit unless the family has received
prior written authorization from the Housing Authority. Failure to receive prior approval
can result in termination of assistance. Approval may only be granted for persons with
disabilities under certain special circumstances.
Yes No
13. The above referenced property receives on-going subsidy (other than Section 8) from a
government source such as HUD, receives state or local funding, and/or has affordability
restrictions (other than Section 8).
Yes No
14. The above referenced property’s rents and/or rent increases are controlled or restricted by law or
a court order. (If yes, please provide documentation.)
If yes to 12 or 13 above, please identify the source(s) and restriction(s):_______________________________________
I Hereby Certify That All Information Provided Above Is True, Correct, And Complete.
Warning Title 18 section 1001 of the United States Code states that any person would be guilty of a felony for
knowingly and willingly making false or fraudulent statements to any department or agency of the United States.
Print Owner / Agent Name Signature of Owner / Agent Phone Number Date