Please complete all of the information about the housing unit listed below.

Submission Type

Unit Information

Visit to locate your parcel #

**If all units at this location do not have the same number of bedrooms, please complete a separate form for each unit.

Management and Owner Information

Management Info

Owner Info

Unit Size, Cost, and Utilities Provided

Size of Unit

Lease Information


Indicate whether the owner or tenant is responsible for the following utilities

The unit is heated with

The stove uses

The hot water is heated with

Unit Type, Quality, and Age

Describe the overall quality and condition of the unit in comparison with other apartments you have seen.

Estimated year of construction or last major renovation

Check all boxes that apply if the unit has specific features to assist people with the following types of disabilities

Amenities, Services, and Maintenance

Check all boxes that apply