Attachment XVIII

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LANDLORD HOLDER AGREEMENT

This agreement is to confirm the landlord/mortgage holder and tenant/home buyer relationship, the amount of rent/ mortgage due and set the parameters of providing and accepting assistance through the housing assistance program at the case management agency. The items below must be completely filled out and this agreement returned to the case manager.

Tenant(s)/ Home Buyer(s): / Date:
Residence Street Address: / City: / Zipcode:

Monthly

Rent / Mortgage Amount: Weekly

Security Deposit:

Lease Start Date: / Lease End Date: / # of individuals includes on lease:

Landlord/Mortgage Holder

By signing this agreement, the landlord/mortgage holder agrees to the following conditions. The landlord/mortgage holder verifies the above information is accurate. Payments will be made to the landlord/mortgage holder listed below at the address listed below. The landlord/mortgage holder agrees to accept a third party check for the amount authorized by the tenant/ home buyer's housing assistance program case manager. The landlord/mortgage holder understands that thepayment of the rent/mortgage is the responsibility of the tenant/home buyer and that assistance provided under this program is on behalf of the client and in no way obligates the case management agency or program fiscal agency to make past, current or future payments to the landlord/mortgage holder. The landlord/mortgage holder agrees that any unused portion of the payment made by the housing program fiscal agent must be reimbursed to the housing assistance program. Program assistance is based on the tenant/ home buyer's eligibility at the time of the request for assistance. Any questions regarding payment should be directed to the tenant/home buyer to communicate with the case manager.

INITIAL

Ownership of Assisted Unit

I certify that I am the legal owner or the legally designated agent for the above referenced unit, and that the prospective tenant has not ownership interest in this dwelling.

INITIAL

Approved resident of Assisted Unit

I understand that the family members listed on the dwelling lease agreement are the only individuals permitted to reside in the unit. I also understand that I am not permitted to live in the unit while I am receiving housing assistance payments.

INITIAL

Please disclose as necessary:

 I am related to the tenant (s) who is considering leasing this unit

The relationship of the person is as follows:

 Parent Spouse Immediate familyBusiness Associate Other

Rental Assistance Payment

Each month the Tenant Base Rental Assistance Program will make a rental assistance payment to the landlord on behalf of the tenant. This payment shall be credited by the landlord toward the monthly rent payable by the tenant. The balance of the monthly rent shall be paid by the tenant. It is illegal to charge additional amounts for the rent beyond what is on the lease.

INITIAL

Utilities and Appliances

The utilities and appliances listed in Column 1 are provided by the Landlord and included in the rent. The utilities and appliances listed in Column 2 below are not included in the rent and are paid separately by the Tenant.

UTILITY/APPLIANCE / Included in Rent / Tenant Paid
Garbage Collection
Water/Sewer
Lights, electric
Other (specify)

INITIAL

Housing Quality Standards.

The Landlord shall maintain the dwelling unit, common areas, equipment, facilities and appliances in decent, safe, and sanitary condition (as determined by Section 8 Housing Quality Standards).

INITIAL

Payment Information:

Landlord /Mortgage Holder to be paid:

Payment Street Address:

City: / State: / Zipcode:
Payee's Contact Telephone Number:

Payee's Tax ID or Social Security Number:

Payee or Authorized Representative's Signature: ______

Printed Name:______

Any questions regarding payment should be directed to the tenant/home buyer to communicate with the case manager.