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Other organization or government agency 2026

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The document is a Landlord Affidavit for the Energy Assistance Program (EAP), which requires landlords to provide information about tenants applying for utility cost assistance. It includes sections for applicant details, utility responsibilities, heating sources, and landlord consent for data access.

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How to Fill Out the Energy Assistance Program Landlord Affidavit

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Click ‘Get Form’ to open it in the editor.
Begin by entering the applicant's information. Fill in the Applicant Name, Date, Address, Phone, City, State (IN), and Zip Code accurately.
Next, move to the Utility Information section. As the landlord or authorized designee, indicate whether heating costs are included in the tenant’s monthly rent payment or if they are the tenant's responsibility by checking the appropriate boxes.
Select the primary heating source from the provided options. Ensure you check only one box that best describes the heating method used.
Input how much the tenant pays each month in rent in the designated space.
Confirm if the primary heating source is operable by checking 'Yes' or 'No'.
Finally, provide your name and signature as the landlord or authorized designee along with your address, date, city, phone number, state, zip code, and optional email.

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