Form W-147Q at a glance
What it is: Form W-147Q is the Verification of Secondary Tenant's Residence and Housing Costs.
Who signs: Signature of Primary Tenant.
What to bring and attach to Form W-147Q
Attached is a copy of the lease or other documents proving that you are the primary tenant.
A filled-in Form W-147Q example: a primary tenant verifies a secondary tenant
How to fill out Form W-147Q, box by box
Date, Case Number, Case Name and Center Number
Enter the Date, Case Number, Case Name and Center Number.
Primary Tenant's Name and Secondary Tenant's Name
Enter the Primary Tenant's Name and the Secondary Tenant's Name.
Address of the apartment/house
In box 1, you share with, or rent an apartment/house (or room) to, the secondary tenant named above. In box 2, print the address of the apartment/house of which you are the primary tenant: Street, Apartment Number, Town/State, Zip Code.
Family members of the household
In box 3, print the names of the family members of the secondary tenant's household who live in the apartment/house with the secondary tenant.
Monthly rent: the landlord or me
Enter in box 4 what the secondary tenant pays in monthly rent.
In box 5, check one: the landlord or me, to whom the secondary tenant pays the rent.
Rent is paid to (must include address)
In box 6, enter the Name and the address (Street, Apartment Number, Town/State, Zip Code) of the one the secondary tenant's rent is paid to; the address must be included.
Heating or air conditioning and other utilities
Mark Yes or No: does the secondary tenant pay an amount separate from the rent for heating or air conditioning?
If no, mark Yes or No: does the secondary tenant pay an amount separate from the rent for other utilities that are not heating or air conditioning?
Telephone number
Enter your telephone number.
Affirmation and signature of the primary tenant
You affirm under penalty of perjury that the information you have given on this form is correct and complete to the best of your knowledge.
Signature of Primary Tenant.
Common questions about Form W-147Q
What is form W 147Q used for?
Form W-147Q is the Verification of Secondary Tenant's Residence and Housing Costs. A "primary tenant" is a person listed on a lease or rental agreement who shares with, or rents that apartment/house (or a room) to, another person called a "secondary tenant."
Sources
[1] Form W-147Q (E) 11/02/2018, Human Resources Administration, Family Independence Administration, New York City (the Official source link on this page).
