1130 Verf. of Rent & Liv#4C.doc-2025

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The document is a verification form for landlords or rental agents to confirm a tenant's rent and living arrangements. It includes sections for detailing the rent charged, utilities included, type of housing, and information about individuals living with the tenant. The form requires signatures from both the landlord and tenant to validate the information provided.

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Click ‘Get Form’ to open the document in our editor.
Begin by entering the Customer Name, Client ID, Case Manager, Telephone, District/County, and Date at the top of the form.
In Section I, landlords or rental agents should fill in the Tenant's name and Date of Occupancy. Provide the full address and specify the rent charged along with its frequency (weekly/monthly/other).
Indicate whether the rent includes utilities such as heat, electric, cooking, water, and air conditioning by checking 'Yes' or 'No'. If applicable, specify any other utilities included.
Complete Section II by listing who lives with the tenant and their relationship. Ensure to answer questions about shared meals.
Finally, both landlord/rental agent and tenant must sign and date at the bottom of the form before submission.

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