Annual Gross Income

Adjusted Income

Owner's Requested Rent

Indicate City

Select Below Bay Village Beachwood Bedford Bedford Heights Berea Bratenahl Brecksville Broadview heights Brook Park Brooklyn Brooklyn Heights Chagrin Falls Village Cleveland Cleveland Heights Cuyahoga Heights East Cleveland Euclid Fairview Park Garfield Heights Gates Mills Glenwillow Village Highland Heights Highland Hills Hunting Valley Independence Lakewood Linndale Lyndhurst Maple Heights Mayfield Heights Mayfield Village Middleburg Heights Moreland Hills Newburg Heights North Olmsted North Randall North Royalton Oakwood Village Olmsted Falls Olmsted Township Orange Village Parma Parma Heights Pepper Pike Richmond Heights Rocky River Seven Hills Shaker Heights Solon South Euclid Strongsville University Heights Valley View Walton Hills Warrensville Heights Westlake Woodmere

Indicate Voucher Size - RFTA bottom of Page 1

Select Below 0 1 2 3 4 5 6 7 8

Indicate Unit's Bedroom Size

Select Below 0 1 2 3 4 5 6 7 8

Will the applicant pay for Electricity?

Select Below Yes No

Will the applicant pay for Gas or Electric energy source costs?
(heating, cooking, water heating)

Select Below Yes No

Indicate Unit's Type

Select Below Single-family dwelling Townhouse, Duplex/Triplex, Row House Multi-unit apartment Manufactured home

Indicate Heating Energy Source

Select Below None Natural Gas Electric

Indicate Cooking Energy Source

Select Below None Natural Gas Electric

Indicate Water Heating Energy Source

Select Below None Natural Gas Electric

Will the applicant pay for water/sewer?

Select Below Yes No

Which appliances (if any) will the applicant provide?

RangeRefrigerator