Form Happ 40 C – Fill Out and Use This PDF

SIGNATURES & COPIES OF VALID PICTURE ID ARE REQUIRED FOR ALL REQUESTS

1.For NEW OWNER, please fill out sections 1, 2, 3, 4, 5, 6

2.For OWNERSHIP CHANGE, please fill out sections 1, 6, 10

3.For PAYEE CHANGE, please fill out sections 1, 2, 6

4.For OWNER ADDRESS CHANGE, please fill out sections 1, 6, 8

5.For PAYEE ADDRESS CHANGE, please fill out sections 1, 6, 9

6.For AUTHORIZATION, please fill out section 1, 6, 7 (See reverse side)

SECTION (1). Name of current owner (s), on Title or Business Entity on Title (As they appear on property deed):

A.__________________________________________________________________ Tax I.D______________________

(Must match W-9)

B.________________________________________________________________________________________________

C. Email Address: __________________________________________________________________________________

SECTION (2). Name of Payee on HAP Check: __________________________________________________________

(If different from owner)
Payee Tax I.D _______________________________________________________ Tel No. (	)__________________
MUST BE DIFFERENT FROM OWNER’S TAX I.D

SECTION (3). Permanent Street Address: ______________________________________________________________

(No P.O Box or P.M.B) Street # Street Name/Suite City State Zip

SECTION (4). Mailing Address: _____________________________________________________________________

Street #

Street Name/Suite

City

State

Zip

SECTION (6). Provide complete address of Section 8 Unit: (Attach a separate sheet to this form for additional addresses)

A. ______________________________________________________________________________________________

Street # Street Name/SuiteCityState Zip

B. ______________________________________________________________________________________________

	Street #	Street Name/Suite	City	State	Zip
C. ______________________________________________________________________________________________
	Street #	Street Name/Suite	City	State	Zip
D. ______________________________________________________________________________________________
	Street #	Street Name/Suite	City	State	Zip
E.	______________________________________________________________________________________________
	Street #	Street Name/Suite	City	State	Zip
F.	______________________________________________________________________________________________
	Street #	Street Name/Suite	City	State	Zip

WARNING: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willingly makes or uses a document or

HOUSING AUTHORITY OF THE CITY OF LOS ANGELES

writing containing any false, or fictitious, or fraudulent statement or entry in any matter within the jurisdiction of any department or agency of the United States, shall be fined or imprisoned for not more than five years, or both.

HAPP 40-C (6/2013)

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SECTION (7). AUTHORIZATION. Name of person(s) authorized to negotiate and sign Section 8 HAP Contracts and request changes (owner address, payee address, direct deposit, payee).

(Attach a separate sheet to this form to add more)
A. Name (Print):______________________________________________ Tel No.(	)_________________________
B. Name (Print):______________________________________________ Tel No. (	)_________________________

SECTION (8). OWNER ADDRESS CHANGE

Owner or Vendor Account Number:______________________________ Tel No.( )_________________________

Tenant Name:___________________________________ Tenant Address:______________________________________

Previous Mailing Address:____________________________________________________________________________

New Mailing Address: _______________________________________________________________________________

Residence Address:__________________________________________________________________________________

(If different from mailing address)

SECTION (9). PAYEE ADDRESS CHANGE

Payee Vendor Account Number:_________________________________Tel No.( )_________________________

Previous Mailing Address:____________________________________________________________________________

New Mailing Address: _______________________________________________________________________________

SECTION (10). OWNERSHIP CHANGE

Name:_____________________________________________Tax I.D_________________________________________

Other/ Comments (Please print):________________________________________________________________________

By signing the form, the owner(s) agrees to be bound by and comply with the HAP Contract and HAPP RFTA- 13, OWNER CERTIFICATION OF NO CONFLICT OF INTEREST. A sample HAP contract and HAPP RFTA-13 forms can be viewed and downloaded at http://www.hacla.org/owner-info/. The Section 8 payment will be placed on hold when we receive this completed form. No change in payments can be made until all required documentation has been received and verified by the Housing Authority. Our Section 8 payments are sent to owners on the 1st of each month. The NEW OWNER is responsible for obtaining any payment that may have been posted to the previous owner’s account if we receive this form after the 20th of the month. Outstanding debts and judgments may be reported to the consumer credit reporting agencies. I/We hereby authorize the Housing Authority of the City of Los Angeles, to initiate credit entries and, if necessary, debit entries and adjustments for any past due amount owed to the Housing Authority. Copies of this signed form will be treated as an original for all intended purposes.

________________________________________________		__________________________________________________
Signature	Date	Signature	Date
________________________________________________		__________________________________________________
Print Name/Title	Date	Print Name/Title	Date

HACLA USE ONLY

Print Name/Title of Authorized Official:_________________________________________________________

Signature of Authorized Official:______________________________________ Date:___________________

HAPP 40-C (6/2013)

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