HOUSEHOLD MEMBER SHELTER UTILITY VERIFICATION - butlercountyohio 2026

1. Click ‘Get Form’ to open the HOUSEHOLD MEMBER SHELTER UTILITY VERIFICATION in our editor.
2. Begin by entering your name, case number, worker's name, and their phone number at the top of the form.
3. In the 'Release of Information' section, provide your landlord’s name, address, and phone number. Ensure you sign and date this section to authorize information sharing.
4. Next, move to the 'Household Member Information' section. Indicate whether the information is being completed by a landlord or a non-relative/non-household member. List all individuals living at the specified address along with their relationship to you and their dates of birth.
5. For 'Tenant/Tent/Utility Information', landlords should fill in tenant names who signed the rental agreement, along with their address details. Specify the monthly rent charged and check applicable utilities that tenants must pay themselves.
6. Complete any additional questions regarding rent subsidies or utility reimbursements as necessary. Finally, ensure that the person completing the form signs it and provides their contact information.

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