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.
2. The proposed rent is more than the rent charged for comparable units in the same building.
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
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.
6. I live on / at the same property as the unit listed on this request, and the property has multiple
7. I live in (or plan to live in) a shared housing situation with a Section 8 tenant, as approved by the
8. The owner(s) and / or an immediate family member of the owner(s) is a present or former
member or officer of the Housing Authority.
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.
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.
11. The owner(s) and / or an immediate family member of the owner(s) is a member of the Congress
of the United States.
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.
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).
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