Rent Adjustment/utility Change Request - Arlington Housing Authority Page 2
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2Building Type (cont.)
Amenities included in Contract Rent:
2 Window Units
Large yard
Playground
Central A/C
Laundry facilities
Pool/Hot tub
Cable TV
Laundry hook-ups
Private Patio
Ceiling Fan(s)
Owner provide washer/dryer
Range vent-a-hood
Dishwasher
Microwave/double oven
Recreation equipment
Drapes/Mini blinds
Refrigerator
Screens - door(s)
Exercise Room
Range
Screens - windows
Extensive rehab
On-site Management
Security
Fence
On-site parking
Security system
Fireplace
Ongoing exterior maintenance
Storage
Garage/Covered Parking
Ongoing interior maintenance
Storm door(s)
Garbage disposal
Party/Recreation room
Storm windows
Statement of understanding
This is to certify that the Property Owner has informed the Tenant of the amount of the proposed rent adjustment or
utility responsibility. Property Owner and Tenant agree to the requested contract rent amount. I/We agree to the
requested contract rent amount. I/We have read and understand the policy as it is written above. I/We understand
that this is only a request and is subject to AHA approval. I/We understand that the increased contract rent amount
may increase the tenant's portion of contract rent and not the AHA's housing assistance payment (subsidy) to the
owner/landlord.
___________________________________
___________________________________
Owner/Landlord Signature
Tenant Signature
________________
_______________
Date
Date
Submit completed form to the Arlington Housing Authority via the following options:
or email landlordrequest@arlingtonhousing.us
Arlington Housing Authority Office Use Only
_________________________________
_________________________________
Approved Contract Rent Amount
Staff Signature
_________________________________
_________________________________
Tenant ID
Date
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