Landlord Form | Fairfield County Veterans Service Commission

In the print dialog that opens, change the destination/printer to "Save as PDF" and click Save. You'll get a file you can email or keep.

This matter pertains to:

As the owner or landlord, please answer the following questions and return the completed form to this office.

This form will be used only for information purposes regarding rental units. The Veterans Service Commission is in no way obligated for any past or future commitments made by renters.

1. Address of premises occupied by the above-named person:
2. Does the rental have a private entrance?
3. Is the rental property metered separately for utilities and electricity? If not, explain why:
4. Are you related to this person? If yes, how?
5. Number of rooms rented to this person:
6. Number of people occupying those rooms:
7. Name of person making rental agreement regarding those rooms:
8. Exact rent charged tenant: Monthly Weekly
9. Tenant move-in and payment details: Date moved in Rent due Paid to date
10. If delinquent: Date delinquent Amount delinquent

I understand that the above renter is liable and responsible for payment of his/her rent.

I hereby certify that I am the Landlord or Agent and the above statements are true.

Signature of Landlord/Agent

Address

Phone

Date

Note: The making of false or misleading statements may lead to prosecution by this agency.