Tenant Information Form

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RETURN TO YOUR LANDLORD
Tenant Information Form (TIF)
HOME Program
Your landlord has applied for a Department of City Development (DCD) loan to improve this property. DCD needs
information about your household and asks that the head of the household fill out this form. Please complete the entire
form.
Tenant’s Name
Phone Number
Landlord’s Name
Property Address
TENANT INFORMATION
Head of Household Only: Are you Hispanic? __ Yes __ No:
NAME
Are you:
__ White
__ Black
__ White & Black/African American
__ Black/African American & American Indian/Alaska Native
__ White & American Indian/Alaska Native
__ Asian
__ American Indian/Alaska Native
__ Native Hawaiian/Other Pacific Islander
__ White & Asian
__ Other Multi Racial
RENTAL INFORMATION
In order for your landlord to continue this application, we
need to confirm that your income is not greater than our
What is your current rent per month? $________________
60% AMI income limits as follows:
(effective 02/05/2014)
Please check any utilities included in the rent:
1 person
$29,600
4 persons
$42,200
___ Heat ___ Electric ___ Hot Water ___ Water/Sewer
2 persons
$33,800
5 persons
$45,600
3 persons
$38,000
6 persons
$49,000
Are you currently receiving rent assistance?
Yes
No
This form is not valid for the NSP
PROPERTY INFORMATION
(foreclosure) program.
Number of bedrooms in your unit:
________________
In addition
INCOME INFORMATION
, attached to this completed form,
please provide documentation for the types of
What is your approximate yearly income? $
income that your household receives. For example,
if your only source of income is wages, you need to
(This information is required by the Rental Rehab Program.)
provide one month of paycheck stubs.
Please list all monthly income and provide copies with this form
)
(see list in right column
For The Following Type
Of Income:
Please provide:
Wages
Social Security
Your household wages
Copy of a wage statement or
Social Security
SSI
and salaries
recent pay stub
Gen. Assistance
Pension
Social Security or other
Copy of a Social Security benefit
Alimony/child support
Other
periodic payments
statement
Unemployment
Copy of an Unemployment
Compensation
Compensation wage statement
I certify that my current family size and income level is accurately
Workman’s
Copy of a Workman’s
reported above. Reportable income includes wages, social security,
pension, child support, rental income and taxable interest income. I
Compensation
Compensation wage statement
certify that this information is true.
W-2 payments
Copy of a W-2 wage statement
Net income from
Copy of recent tax return
I understand that this information is provided as part of a loan
operation of a business
application submitted by my landlord for Rental Rehabilitation Loan
funds and that there is no obligation on the part of THE CITY OF
MILWAUKEE to either make the loan or to certify the tenant’s eligibility
Income information is valid for six months. Thank you for
for Rental Assistance.
providing this information. If you have any questions,
please feel free to contact us at 286-5608.
Please note that you must sign BOTH sides of this form.
06=TIF-NARS.HOME.doc
(Revised 02/21/14)
Tenant’s Signature
Date

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