Dshs Form Landlord PDF Details

The DSHS Landlord form is a crucial document used by the Department of Social and Health Services to ascertain the eligibility of a client for certain benefits and services. This form serves as a primary means of communication between landlords or property managers and the DSHS, facilitating the collection of necessary information regarding the housing and financial situation of the client. It covers several key areas including tenant information, rental details, and utilities, requiring landlords to provide factual information about the rented or leased unit, the amount of rent, the portion of the rent paid by the tenant, and the utilities responsibility. The form is designed to ensure that all relevant information is captured accurately and completely, with specific sections dedicated to the property’s heating source, utilities payment, and the identification of all adults and children residing at the address. By signing it, landlords or authorized managers confirm the veracity of the reported information, playing an integral role in the determination process of a client's eligibility for assistance programs. Introduced to streamline the eligibility verification process, the DSHS Landlord form is structured to minimize gaps and encourage full disclosure, marked by fields where landlords can note specifics including the type of residence, the date when the tenant moved in, and the financial contributions towards the rent by housing agencies if applicable.

QuestionAnswer
Form NameDshs Form Landlord
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdshs 14 224, po tenant zip download, how to dshs 14 224, landlord statement forms sample

Form Preview Example

 

 

 

 

LOCAL OFFICE

 

 

TELEPHONE NUMBER

 

 

STATEMENT FROM

 

 

 

 

 

 

CLIENT IDENTIFICATION NUMBER

 

 

DATE

 

 

LANDLORD/MANAGER

 

 

 

 

 

 

 

 

 

 

 

 

PROPERTY OWNER OR AUTHORIZED MANAGER:

 

 

The Department of Social and Health Services is in the

 

 

 

 

process of determining this client’s eligibility. Please provide

 

 

Complete all sections below with only the information

 

 

 

 

 

 

the information requested below.

 

 

 

 

 

you know to be true. Write “unknown” to questions you

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

can’t answer. (Do not leave any box blank.)

 

 

FINANCIAL SERVICES SPECIALIST’S SIGNATURE

 

 

 

 

 

 

 

 

 

 

A. Rental or leased unit and tenant information:

1.

STREET ADDRESS

APARTMENT (APT) NUMBER

 

 

5. NAMES OF ALL ADULTS AND CHILDREN LIVING AT THIS ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

CITY

STATE

ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

TENANT’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

DATE MOVED IN

4. TYPE OF RESIDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach more pages if needed.

 

 

 

 

 

 

 

 

 

 

 

 

B. Rent information:

 

 

 

 

 

 

 

 

 

 

 

6.

TOTAL RENT AMOUNT

7. HOUSING AGENCY AMOUNT, IF ANY

8. TENANT’S RENT AMOUNT

 

9. DATE THE AMOUNT IN BOX 8 STARTED

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. NAME OF PERSON(S) PAYING THE RENT

 

 

11. NAME OF PERSON(S) PAYING THE RENT

 

 

 

 

 

 

 

 

 

 

12. PLEASE ANSWER THE FOLLOWING QUESTIONS:

 

 

 

 

 

 

 

 

 

Does the tenant pay only a portion of the amount in box 8?

No

Yes, amount: $

 

 

 

Does the tenant work for a portion of the amount in box 8?

No

Yes, amount: $

 

 

 

 

 

 

 

 

 

 

Number of hours worked per month: __________

How does the tenant pay the rent?

Cash

Check/Debit Card

Money Order

 

 

 

 

 

Other (specify):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Utilities information: Mark the box(es) that apply.

13. The main source of heating for this residence is:

Electric Wood

Gas

Propane Other (specify):

YES NO

14. Is there a separate meter for gas and electric?

15. Does the tenant pay for air conditioning?

16. Are all utilities included in the rent?

Yes

If NO, mark the box(es) the tenant pays for:

Electric

Water/sewer

 

Gas

Telephone

 

Propane

Garbage

 

Wood

 

 

Other (specify):

No

17. LANDLORD/MANAGER’S NAME

 

 

 

18. Property Owner’s Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If different from Landlord/Manager)

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS OR PO BOX NUMBER

 

 

 

OWNER’S NAME

 

 

 

 

 

 

 

 

 

 

 

 

CITY

STATE

 

ZIP CODE

 

STREET ADDRESS OR PO BOX NUMBER

 

 

 

 

 

 

 

 

 

 

 

WORK TELEPHONE NUMBER

 

 

HOME TELEPHONE NUMBER

 

CITY

STATE

ZIP CODE

 

 

 

 

 

 

 

 

LANDLORD/MANAGER SIGNATURE

 

DATE

 

WORK TELEPHONE NUMBER

 

HOME TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

DSHS 14-224 (X) (REV. 06/2010)

How to Edit Dshs Form Landlord Online for Free

You can prepare dshs form 14 224 effortlessly with the help of our PDFinity® online tool. To maintain our editor on the cutting edge of practicality, we aim to put into action user-driven features and enhancements on a regular basis. We're at all times thankful for any suggestions - assist us with remolding the way you work with PDF forms. To get the process started, consider these basic steps:

Step 1: Just press the "Get Form Button" at the top of this site to open our pdf editing tool. There you'll find all that is required to work with your file.

Step 2: The tool will allow you to customize almost all PDF forms in a range of ways. Modify it by writing any text, adjust original content, and include a signature - all at your disposal!

It is actually easy to complete the document using out detailed guide! Here's what you need to do:

1. Fill out the dshs form 14 224 with a number of essential blanks. Consider all of the necessary information and be sure there's nothing missed!

Writing part 1 in how to dshs 14 224

2. After filling in the previous part, head on to the next step and fill out the essential particulars in these fields - How does the tenant pay the rent, Cash Other specify, CheckDebit Card, Money Order, C Utilities information Mark the, The main source of heating for, Electric Gas Propane Other specify, Wood, Is there a separate meter for gas, Are all utilities included in the, Yes, YES NO, If NO mark the boxes the tenant, Watersewer Telephone Garbage, and Electric Gas Propane Wood Other.

CheckDebit Card, Wood, and How does the tenant pay the rent in how to dshs 14 224

Concerning CheckDebit Card and Wood, make certain you get them right in this section. These could be the key ones in the form.

Step 3: Check that your information is right and click "Done" to progress further. Go for a free trial plan at FormsPal and get instant access to dshs form 14 224 - download or modify in your personal cabinet. FormsPal offers protected form tools with no personal information recording or sharing. Be assured that your data is safe here!

Dshs Form Landlord isn’t the one you’re looking for?

Related Documents