Tenant Information Form

By submitting this form, I agree to the rehabilitation work to be done through this program in the rental unit I inhabit.
I (we) certify that the statements made in this form are true, complete and correct to the best of my knowledge, and are made in good faith to obtain rehabilitation assistance. I (we) further understand that any willful misstatement of material fact will be grounds for disqualification.
Signature*
Name*
Date*
MM slash DD slash YYYY

Multifamily Rehabilitation Grant Program