Rent Increase Request Form
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1
2Oakland Housing Authority
Rent Increase Request Form
Before proceeding, please answer the questions on the Criteria/Information Sheet.
Incomplete requests will be returned without review. Information provided will be verified.
New Total Contract Rent Requested
$
Effective Date
Vendor Information
Requested by: Owner or Agent
Authorized Agent
Legal Owner
Primary Phone #
Home/Work
Email Address
Cell Phone #
Participant / Tenant Information (Attach 60-Day Notice)
Client #
Tenant’s Name
Address
Unit #
Zip
Phone #
Property & Unit Description
Structure Type: Single Family
Townhouse/Condo
Multiple Units, # of Units ____________________
Complete the Rent Roll Form on the back if the structure consists of 2+ units, or attach your spreadsheet.
Unit Size:
# Bedrooms
# Bathrooms
Sq Ft
Yr Built
Amenities ( All That Apply): W/D Hook-Up
Coin-Operated On-Site Laundry
Disposal
Dishwasher
Ceiling Fan
Carport
1 Car Garage
2 Car Garage
Outdoor Lighting
Gated Community
Other Amenities:
Maintenance (Indicate Frequency and Attach Agreement): Lawn/Gardening
Pest Control
Utilities & Appliances Provided By:
List Upgrades & Recent Improvements
O for Owner or T for Tenant
(Since Last Contract Rent Determination)
Electricity
O or T
O or T
Gas
Hot Water
O or T
O or T
Water
Garbage
O or T
Gas or Electric
O or T
Washer
Dryer
Gas or Electric
O or T
O or T
Refrigerator
Stove
Gas or Electric
O or T
O or T
Microwave
Heating Type: Floor Wall Space Central
Heating Source: Gas Electric
A/C Type
Tax Credit Subsidy (Attach Tax Credit Schedule)
Type:
Tax Credit
HOME
Section 202
Section 221(d)(3)BMIR)
Section 236
Signature Required
Print Name
Signature
Date
Return Request by E-mail to:
,
or by Fax to (510) 874-1589 or by Mail to
Oakland Housing Authority Leased Housing Department 1619 Harrison St Oakland CA 94612
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