Unit Availability Form - The Town Of Islip Housing Authority
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1Town of Islip Housing Authority UNIT AVAILABILITY FORM
Date form completed: ___________________Fax completed form to 631 589-6575
UNIT INFORMATION
Street Address:
City-Zip
# of bedrooms
0 1 2 3 4 5 6 Proposed Rent: $___________ Security?$___________
(circle 1):
Does the unit have any features that provide access to persons with a disability or handicap? Yes No
If yes please list_______________________________________________________
Type of Unit
: Apt., Single Family, Approved Multi family,, Condo/co-op, Other:___________
(circle 1)
Utilities:
Responsibility?
Type
Other Amenities?
Optional
Circle one
Circle one
Heat
LL or T
Gas Electric Oil Propane
Cooking
LL or T
Gas Electric Oil Propane
Hot Water
LL or T
Gas Electric Oil Propane
Water
LL or T
Gas Electric Oil Propane
Electric Lights
LL or T
Gas Electric Oil Propane
Date Unit Available: ____________________
OWNER/CONTACT INFORMATION
Owner Name: _______________________________________________________
Tel. # Day: _______________________Tel # evening:_______________________
(If you would like confirmation of this listing, please provide either your fax# or your email
address
)____________________________________________________
If applicable, Broker Name:_____________________________________________
Real Estate Agency: __________________________________________________
Contact telephone number:_____________________________________________
By my signature below, I hereby certify that the above information is accurate and that I am the owner
or an authorized representative thereof. I also understand that the Housing Authority makes no
guarantees that a voucher recipient will request to lease the unit and/or that the unit rent is approvable
and/or whether the unit will comply with applicable inspection standards. I understand that a valid
rental permit issued by the Town of Islip Bldg. Dept. Is required in order for a voucher recipient
to occupy a unit.
Print Name of Authorized Representative____________________________________________
Signature of Authorized representative____________________________________________
The unit availability listing is made available to Section 8 voucher recipients upon their request.
PLEASE NOTE THAT ALL LISTINGS ARE REMOVED FROM THE HA AVAILABLE UNIT LISTING 30 DAYS
AFTER THE UNIT AVAILABILITY DATE UNLESS THE HA RECEIVES A SIGNED UPDATED WRITTEN
REQUEST TO MAINTAIN THE LISTING.
F:Availabilityunitavailabilityform.rtf
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