Landlord Verification Form
For Payment on Behalf of Tenant through ARPAHRG
Tenant Name
*
First Name
Last Name
Confirmation Number that Tenant or Processor Provided
*
Any documentation submitted without a valid confirmation number will be deleted.
Name of Processor Requesting Documents
Name of Property Holding if Owned by a Business
Landlord Name
First Name
Middle Name
Last Name
Landlord Email
example@example.com
Landlord Phone Number
Please enter a valid phone number.
County of Property Owned
Please Select
Montgomery
Greene
Preble
Darke
If property owned by a business, please provide Property Management Agreement, Business Operator Agreement, or other documentation of who is authorized to receive payment.
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Upload Completed W-9 for Proof of Property Ownership. The address on this form is where payment will be mailed.
*
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Upload Completed Landlord Statement for Payment Agreement.
*
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*
By signing and submitting requested forms, I accept the terms of payment under the Landlord Statement and certify that I am the property owner where the names tenant resides.
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