Rent Increase Request Template/change In Utilities
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1RENT INCREASE REQUEST
CHANGE IN UTILITIES
In order to process your Rent Increase this form must be filled out in its entirety and sent to the Inspections
Department at least 60 days prior to the anniversary date.
Date:
Apartment or Owner Name:
A
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Number of Baths:
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Client Name:
Client Number:
Current Unit Contract Re
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R
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Requested CHANGE in payment of utilities
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Electric:
Gas:
Water:
Sewer:
Trash:
A rent reasonable survey will be conducted to ensure the rent amount approved is in accordance to HUD
regulations. If the rent is not rent reasonable a denial letter will be sent to the landlord and client.
This serves as written notice that the rent of the unit may increase and that both parties' signatures are
required to process this increase or utility change. If the unit is determined to be rent reasonable this amount
will be implemented on the client's anniversary date and written notice will be sent to both parties.
Note:
The client may relocate at the clients anniversary date if proper notice is given to the landlord
and FWHS. If the new rent amount creates a burden to the client, the client has the right
to give the landlord proper notice to relocate. Effective date of the increase will be either
the anniversary date or 6o days after the 1st of the month following the receipt of the
increase request. The client may contact the counselor if there are any questions.
Client
Landlord
FWHS OFFICE USE ONLY
Approved
Denied
New Rent
Start Date
Inspector:
revised: 4/19/2016
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