HiddenRRI/COT Please complete this form and submit it on line. The Housing Authority will review your request and determine if an increase/change can be granted. Please allow 60 days for a review to take place. OWNER INFORMATIONName* First Last Mailing Address* Street Address City State Zip Code Phone Number*Email* Tenant Name* First Last Tenant Address* Street Address City State Zip Code No. of Bedrooms* Current Rent*Proposed Rent*Effective Date* MM slash DD slash YYYY If you are requesting a change in rent please answer this question as well: Do you provide any other special services to your tenant? (Landscaping, housekeeping, etc.)* Yes No if yes, please explain: CHANGE IN TERMWhat is the term of the lease?* 1 Year Month to Month CHANGE IN UTILITY RESPONSIBILITY - If you want to modify who is responsible for utilities please complete:Who pays for each of the following utilities?Electricity Tenant Owner Gas Tenant Owner Garbage Tenant Owner Sewer Tenant Owner Water Tenant Owner Hot Water Tenant Owner Who will provide the following appliances?Range Tenant Owner Refrigerator Tenant Owner What is the energy source?Cooking Gas Electric Propane Heating Gas Electric Propane Hot Water Gas Electric Propane Ceritified* I hereby certify that I am the owner or the duly authorized representative of the property for which this rent increase request is being submitted and that entering clicking this checkbox is the equivalent to my handwritten signature. Landlord certifies that he/she has issued 60 (sixty) day notice of this rent increase to the above tenant. EmailThis field is for validation purposes and should be left unchanged.