The Department of Social and Health Services is in the process of determining this client's eligibility.
Unknown answers: write “unknown” to questions you can't answer; do not leave any box blank.
Section A: rental or leased unit and tenant information.
Section B: rent information.
Section C: utilities information; mark the box(es) that apply.
| Question | Answer |
|---|---|
| Form Name | DSHS 14-224 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 67 |
| Avg. time to fill out | 12 min |
| Edition | Rev 06/2022 |
| Other names | DSHS 14-224, 14-224, DSHS 14224, DSHS landlord form, Statement from Landlord/Manager |
| Official source | DSHS 14-224 (Rev 06/2022) Statement from Landlord / Manager |
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