ANNUAL RENTAL COMPLIANCE REPORT PLANNING AND HOUSING DEVELOPMENT DIVISION SFN 01/16 PROJECT, OWNER AND PROPERTY MANAGEMENT INFORMATION Project Name Property Management Contact Owner Name Contact’s Email Address - Contact’s Telephone Number Reporting Period + + + + = INCOME AND / OR RENT RESTRICTED UNITS INFORMATION (Complete & Attach Additional Sheets if Necessary) Total ESW Occupant Income Monthly Occupied ESW Unit’s Number of Income at Income at Income Verification Documents Utility Unit Time Period or Restriction Monthly Unit Bedroom or Unit Initial Annual Used in Allowances Number (m/d/yy) Head of Household this Unit Rent Rent Gross Rent Y N Vacant Count Occupants Occupancy Recertification Most Recent Certification / Last Name Satisfies Rent Subsidy Subsidy (Provide Schedule) Tax Returns & W2s, 30 days *101 3 01/01/15 to 12/31/15 O Y Smith 4 140 $ 42,500 $ 45,000 400 320 0 52 772 paystubs, 2m bank stmts to to to to to to to to to to to to to to Prepared By Title Signature Date
ANNUAL RENTAL COMPLIANCE REPORT PLANNING AND HOUSING DEVELOPMENT DIVISION SFN 01/16 PROJECT, OWNER AND PROPERTY MANAGEMENT INFORMATION Project Name Property Management Contact Owner Name Contact’s Email Address Reporting Period - Contact’s Telephone Number INCOME AND / OR RENT RESTRICTED UNITS INFORMATION (Complete & Attach Additional Sheets if Necessary) + + + + = Unit Number Unit’s Bedroom Count Time Period (m/d/yy) Occupied or Vacant ESW Unit Y / N ESW Occupant or Head of Household Last Name Number of Unit Occupants Income Restriction this Unit Satisfies Income at Initial Occupancy Income at Annual Recertification Income Verification Documents Used in Most Recent Certification Monthly Rent Rent Subsidy Rent Subsidy Total Utility Allowances (Provide Schedule) Monthly Gross Rent *101 3 01/01/15 to 12/31/15 O Y Smith 4 140 $ 42,500 $ 45,000 Tax Returns & W2s, 30 days paystubs, 2m bank stmts 400 320 0 52 772 to to to to to to to to to to to to to to Prepared By Title Signature Date
AnnualRentalComplianceReport.docx