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Cherokee County COVID Rental Assistance Program

Landlord Verification Form

A landlord or tenant may apply with our agency to receive financial assistance through the 2021 Cherokee County Emergency Rental Assistance Program. Please complete the form below as the landlord and a upload copy of your W-9 and a voided check on the next page. This form ensures precise check processing.

Landlord Information

Property Owner Business Name

Legal Business Name as appears on W-9 (not the DBA)

Please select your entity tax classification

IndividualCorporationLLC

Tax ID Number / Federal EIN

Use the XX-XXXXXXX format for an EIN

Social Security Number

Use the XXX-XX-XXXX format for a SSN

Are you or do you use a Property Manager?

YesNo

Landlord/Property Manager Name :

Address

Street

NOTE: The Service Provider must verify any changes to an existing address on file.

City

County

State

2 Character abbreviation only

Zip Code

Payment Address

Payment Street

NOTE: The Service Provider must verify any changes to an existing address on file.

Payment City

Payment County

Payment State

2 Character abbreviation only

Payment Zip Code

Phone Number:

Enter a phone number with dashes only

Email Address :

Tenant Information

Tenant's First Name

IMPORTANT: This MUST match the Head of Household entered on the Tenant's application

Tenant's Last Name

IMPORTANT: This MUST match the Head of Household entered on the Tenant's application

Tenant's Date of Birth (MM/DD/YYYY)

IMPORTANT: This MUST match the Head of Household DOB in the format shown (with forward slashes)

Tenant Address

Address of Rental Unit

IMPORTANT: This MUST match the address entered on the Tenant's application

City

County

State

Zip Code

IMPORTANT: This MUST match the zip/postal code entered on the Tenant's application

Unit Information

Number of Bedrooms in Rental Unit Listed Above

Monthly Rent Amount

Date Next Payment Due

Amount of Last Payment Received

Date of Last Payment

Lease Start Date

Lease End Date

Is the tenant in arrears?

YesNo

Which month is late?	Year?	Past Due Amount?
Late Fees (if any)?

Are you currently receiving any other form of rental assistance for this household?

YesNo

How much have you received?

What type of assistance?

e.g. Section 8

Please upload the following required documents:

IRS W-9 Form. Click here for a blank form.
Voided check
Delinquent Rent/Settlement Statement. Click here for a blank template.

For private landlords, please also upload:

Proof of Identity
Proof of Ownership

For a property management company, documentation must be provided showing authorization to act on behalf of the property owner. This is known as an Authorization Agreement Contract, Memorandum of Understanding (MOU), or Memorandum of Agreement (MOA).

Payments will not be processed without all documentation. Please save your progress and return later if you do not have all documents.

IRS W-9 Form

Delinquent Rent/Settlement Statement

Direct Deposit Information

What is your ABA/routing number?

9 digits only

What is your bank account number?

(Up to) 16 character maximum

Please select the type of bank account

CheckingSavingsLoan

Voided check

Payments will be made directly to the landlord/property owner listed on the previous page via ACH direct deposit. A voided check is required.

For Private Landlords

Proof of Identity

This may include a Driver’s license, Government-issued photo identification, U.S. Military photo ID, Tribal photo ID, or Passport.

Proof of Ownership

This may include a Warranty Deed, Tax Record, or Insurance Binder

For Property Management Companies

Authorization to act on behalf of the property owner

This document may be called an Authorization Agreement Contract, Memorandum of Understanding (MOU), or Memorandum of Agreement (MOA)

The undersigned certifies that to the best of his or her knowledge the apartment referenced contains no health or safety violations that threatens the health or safety of the tenant. The undersigned certifies that they have not received rent payments, from the Cherokee County Rental Assistance provider or any other program, that covers the unpaid rent listed above.

The undersigned agrees that they will not evict the tenant, provide the tenant with a five-day notice, or in any way ask the tenant to leave for the duration of this assistance. The undersigned agrees that if the tenant is facing eviction, the undersigned will only accept payment arrears if the eviction will be avoided. The undersigned confirms that the above information is true and accurate to the best of his or her knowledge and that providing false representations herein constitutes an act of fraud.

Electronic Signature

Enter your name

Title

Date Signed :

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