1130 Verf. of Rent & Liv#4C.doc-2026

1. Click ‘Get Form’ to open the 1130 Verf. of Rent & Liv#4C.doc in the editor.
2. Begin by entering the customer name, client ID, case manager, telephone number, district/county, and date at the top of the form.
3. In Section I, landlords or rental agents should fill in tenant details including their name and date of occupancy. Specify the address and rent charged (weekly/monthly/other) along with the amount.
4. Indicate whether the rent includes utilities such as heat, electric, cooking, water, and air conditioning by checking 'Yes' or 'No'.
5. If applicable, list any separate utility costs paid by the tenant in Section I B. Include type of utility, frequency of payment, dollar amount paid each month, and last billed date.
6. Complete Section II by listing all individuals living with the tenant and their relationship to them.
7. In Section III, tenants should answer questions regarding meal preparation and consumption with listed individuals.
8. Finally, ensure both landlord/rental agent and customer signatures are provided along with dates before submitting.

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