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The document is an affidavit for landlords to complete on behalf of tenants applying for the Energy Assistance Program (EAP) in Indiana. It collects information about the applicant, utility costs, and the landlord's permission for data access regarding utility accounts. The form emphasizes confidentiality and mandates that it be submitted with the EAP application to ensure eligibility for energy benefits.

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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', and 'Zip Code' fields accurately.
Next, move to the utility information section. Indicate whether heating and electric costs are the responsibility of the landlord or renter by checking the appropriate boxes.
If applicable, provide a utility statement copy for any checked responsibilities. Specify the primary heat source and number of household members, including adults and children.
Complete the dwelling type section by selecting one of the options provided (e.g., mobile home, single site).
Finally, ensure that you print your name as the landlord, sign where indicated, and fill in your address, date, city, phone number, state, zip code, and optional email.

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Form online 2025

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How to use or fill out the Energy Assistance Program Landlord Affidavit online

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Form online 2025

Here's how it works

How to use or fill out the Energy Assistance Program Landlord Affidavit online

Got questions?

How can I generate an electronic signature on my form online from Google Chrome?

How do you edit form online on iOS?

How do I create a fillable form?

What is the best way to create an electronic form?

Where can I create an online form?

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People also ask

How do I create an online form to fill out?

How do I create an easy online form?

Where can I create forms for free?

How do I create a fillable form online?

How do I create an easy online form?

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