Chester Housing Authority

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Annual Rent Adjustment Form

Rental Unit Information

 

Utilities/Appliances Included
 
 
Yes
No
Heat
 
 
Hot Water
 
 
Electric
 
 
Water
 
 
Sewer
 
 
Stove
 
 
Refrigerator
 
 
Microwave
 
 
Dishwasher
 
 
Washer
 
 
Dryer
 
 
Will there be any changes in the utilities, appliances, or other amenities provided in the coming year? *
 
Yes
No
 
 
Comparable Unit Information
Comparable unassisted units at or above the proposed rent.
1.  
 
$  
 
2.  
 
$  
 
3.  
 
$  
 
The CHA may request additional documentation from the owner to support proposed rent increase.
Certification
I hereby certify that the foregoing information is correct and no changes to the lease will be made without a 60-day written notice to the Tenant and Chester Housing Authority. I understand that inquiries may be made to certify facts and statements contained herein.