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* Do NOT include college or university regulated housing.
What was your total rental payment for "reference month" for this unit?
Include any extra charges for garage or parking facilities, but do not include direct payments. [enter value] __________
What was the total rental payment for last two months for this unit?
[enter value] __________
What was your total rental payment for last month for this unit?
Include any extra charges for garage or parking facilities, but do not include direct payments by local, state. or federal agencies. [enter value] __________
Does the rental payment include the cost of -
. . . Electricity?
Does the rental payment include the cost of -
. . . .Gas?
Does the rental payment include the cost of -
. . .Piped in water?
Does the rental payment include the cost of -
. . . .Heating?
Does the rental payment include the cost of -
. . .Trash/garbage collection?
Does the rental payment include the cost of -
. . .Garage and parking facilities?
What is the rental charge to another tenant for a similar unit? [enter value] __________
What period of time does this cover?
* Specify: [enter text] ____________
What is your regular rental payment? [enter value] ___________
Is any portion of this unit used for your own business?
What percent of the rental payment is counted as a business expense? [enter value] _________
* Enter to the nearest whole percent.
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Last Modified Date: October 07, 2005