Summit County                                                              Affordable Housing Owner Occupancy Affidavit

Property Information

Address Line 1

Address Line 2

City

State

Please select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code

Owner Information

First name 

Last name

Email

Phone

Mailing Address (if different from property address)

Address Line 1

Address Line 2

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip Code

Occupancy Status

Household Size (how many live in the unit)

Please select... 1 2 3 4 5 6 7 8

Please select one of the following

I / we occupy the residence as my / our primary residence.I / we are renting the unit Other:

Briefly Explain

Rental Information (if property is being rented)

Rental Amount

Please include a copy of the current lease

By hitting submit the owner referenced above acknowledges that the information provided is true and correct.