Inspection Request Form - Sample
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1
2Section 8 Office
2015 Felton Avenue
PO Box 4928
Macon, GA 31208
Tel. (478) 752-5000
ISSUE__________ REQUEST__________
VOUCHER EXPIRES__________________
Tel: 478-752-5000
INSPECTION REQUEST FORM
Housing Choice Voucher Program
Once you have found a unit, please have the Landlord complete all of the information on this form. Both you and the
Landlord must sign on the back.
You are responsible for promptly returning it to your MHA Admissions or
Recertification Specialist. A letter will be sent to your prospective Landlord with information on how to prepare for and
schedule an inspection. Failure to complete this form accurately or in its entirety may delay the processing of this
request.
Tenant Name: _____________________________________________
Phone #: _______________________________
Current Address: ____________________________________________________________________________________
Mailing Address
:_________________________________________________________
, only if different than present address
Does the Tenant have a child under the age of 6 who will live in the unit?
Yes
No
UNIT INFORMATION – Please provide the following information on the unit that you plan to rent:
Street Address: __________________________________________________________________ Apt. #:____________
Unit Type:
Apartment
Duplex/Triplex/Quad
House
Mobile Home
Year Built: _________ (if unknown, write either “pre-1978” or “1978 or after”)
Number of Bedrooms: __________
Number of Bathrooms: __________
Approx. Square Footage: __________
The contract rent for this unit is $____________ per month and includes the following utilities:
(check each utility that will be paid by the Landlord as part of the lease)
Gas
Water/Sewer
FOR MHA USE ONLY
Electric
Trash Collection
Recert Month:________________
The following appliances and amenities are included in the rent:
□
□
(check each appliance/amenity that will be furnished
Cotton
Tisdol
□
□
and maintained by the Landlord as part of the lease)
Finney
Martin
□
□
Griggs
Fuller
Stove
Central Air
□
□
Hill
______
Refrigerator
Window A/C Unit(s)
Central Heat
Other Heat Source_____________________
Date Rec’d by Case Manager:
Other – please specify: ________________________________
___________________________
Check the type of utility used for the following:
Inspections:
HEAT
Gas
Electric
Heat Pump
___________________________
HOT WATER
Gas
Electric
COOKING
Gas
Electric
Security Deposit to be paid by Tenant: $_________________
Landlord (Individual/Company Name):___________________________________________________________________
Mailing Address: ____________________________________________________________________________________
City:________________________________________________
State: ___________________ Zip: ______________
Telephone #(s):_______________________________________ E-Mail: ______________________________________
MHA Account # (if known):______________________________
PLEASE TURN OVER ─ YOUR SIGNATURE IS REQUIRED --------------------------------------
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