important message from the housing authority

IMPORTANT MESSAGE FROM THE HOUSING AUTHORITY As a reminder, the Southern Nevada Regional Housing Authority is not associated with nor manages the GoSection8 website or any other website with available properties for rent. With security on the news lately, much has been said about protecting your information. To guard against possible scams, always be cautious about sharing personal information and never share information with anyone over the phone, even if they claim to be someone you do business with. Please know that Housing Authority staff would not contact you and request personal financial information such as credit or debit card numbers and/or their PIN’s. Also, we do not charge a fee for your participation in any of our programs nor will we ever request for you to wire us any money. Lastly, final signs of a scam could be if you are advised to wire money (Zelle, cashapp, Bitcoin or any other electronic method), they want a security deposit or first month’s rent before you’ve met or signed a lease, or they say they’re out of the country. Please remain vigilant and only give money to trusted sources and keep the receipts. If you are a victim of a rental scam, you can report it to your local law enforcement and to the Federal Trade Commission at https://reportfraud.ftc.gov/#/.

https://reportfraud.ftc.gov/#/

RFTA Packet, SNRHA – H0077 Revised 8-2017

SOUTHERN NEVADA REGIONAL HOUSING AUTHORITY

Housing Choice Voucher Department P.O. Box 1897, Las Vegas, NV 89125-1897

Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

HOUSING CHOICE VOUCHER PROGRAM

REQUEST FOR TENANCY APPROVAL (RFTA) PACKET FOR OWNERS/LANDLORDS/MANAGERS

NOTE: The original RFTA must be returned. Please call your caseworker to make an appointment. Owners, if you are returning these documents, please ask your prospective tenant for their caseworker’s name so that you can schedule an appointment to turn in these documents. The only documents that can be faxed in are the owner’s W9, W8 and ACH form with voided check. When you fax these, please ensure you put the client’s name on the cover and fax to the attention of the caseworker so we can ensure they get to the correct person. If you fax these documents mentioned above, they must be received “prior” to the client bringing the original RFTA packet.

This form to be used for SNRHA purposes only. Please be advised while we are here to serve you, Housing Choice Voucher (HCV) Regulations authorize a public housing authority to terminate benefits when a family engages in or threatens abusive or violent behavior toward the authority’s personnel [24 CFR § 982.552(c)(1)(ix.)]

WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any department or Agency of the United States as to any matter within its jurisdiction.

Our agency provides reasonable accommodations to elderly or disabled applicants and participants to ensure programs and services are accessible. If you need a reasonable accommodation, please submit your request in writing to: SNRHA, P.O. Box 1897, Las Vegas, NV 89125, Attention: 504 Officer.

Southern Nevada Regional Housing Authority will not discriminate because of race, color, religion, age, national origin, disability, familial status or sexual orientation. If you feel you have a Fair Housing Complaint, please contact HUD at 1-800-669-9777 or TTY 1-800-927-9275. The Equal Access to Housing in HUD Program Regardless of actual or perceived Sexual Orientation, Gender Identity, or Marital Status in compliance with Final Rule, published in the Federal Register August 2014. SNRHA will comply with 24 CFR Parts 5, 91, 880, et al. Violence Against Women Act Conforming Amendments.

Si usted no puede leer este documento por favor pida la asistencia de nuestro personal bilingüe. La Vivienda Regional del Sur de Nevada, proporciona servicios de traducción para participantes y clientes que califican. Si usted necesita esta forma en Español, por favor contacte a su asistente social.


PART I: HUD NEW FORECLOSURE RULES 1. In compliance with HUD’s PIH notice 2009-52, which provides guidance on Section 702 of the

Protecting Tenants at Foreclosure Act (PTFA) of 2009, and the American Recovery and Reinvestment Act of 2009, the SNRHA shall enforce HUD’s new regulations relating to landlords providing notices to Housing Choice Voucher (HCV) participants.

2. The new regulations require that during the term of the lease, the owner shall not terminate except

for serious and repeated violations of the terms and conditions of the lease or other good cause, and in the case of an owner who is an immediate successor in interest pursuant to foreclosure during the term of the lease vacating the property prior to the sale shall not constitute other good cause, except that the owner may terminate the tenancy effective the date of transfer of the unit to the owner, if the owner:

• will occupy the unit as a primary residence; and • has provided the tenant a notice to vacate at least 90 days before the effective date of such

notice. 3. This change provides our HCV participants with more protection! Nevada leads the nation in

foreclosures and that is impacting a lot of HCV participants. Please ensure you notify the assigned caseworker if your unit goes into foreclosure immediately!

PART II: LEASING OVERVIEW 1. Lease Agreement

a. The Southern Nevada Regional Housing Authority (SNRHA) does not furnish a lease agreement between the owner and the tenant. The owner and the tenant must enter into a lease agreement furnished by the owner and submit a signed lease with “NO” effective date with your complete RFTA packet. The effective date shall be the later of the date the unit passes Housing Quality Standards (HQS) or when the tenant takes possession of the unit.

• The Lease Agreement: • Must be a standard form used in the locality. • Must contain terms consistence with state and local laws. • Must generally be applied to unassisted tenants in the same property. • All provisions of the HUD Lease Addendum shall be added to the Owner’s standard

lease as an addendum to the lease.

b. The terms of the HUD required Tenancy Addendum should prevail over any other provisions of the lease agreement.


2. Leasing Procedures. SNRHA must determine that the unit is eligible before a HCV contract is signed. To determine eligibility, the tenant must submit a request for the unit to be inspected via the Request for Tenancy Approval packet.

a. The unit will be determined eligible if: • All required leasing forms are return completed and signed. • If the rent is reasonable and/or meets the client’s 40% threshold. • If the unit meets HQS.

b. After the unit is determined eligible: • SNRHA will sign and then furnish the owner with copies of the HCV contract and lease

with the effective date entered. The effective date shall be the latest of the date unit passed its HQS inspection or the date the client takes possession of the unit.

3. Scheduling an Inspection for a Unit to be leased by a New Family. SNRHA will conduct the unit inspection within seven (7) to ten (10) business days of receiving the “completed” RFTA packet, if the unit is ready, the utilities are on, and the asking rent is determined to be reasonable by SNRHA. Staff shall contact the owner/management to verify the unit is ready. If you have questions regarding an inspection, please call (702) 477-3100.

4. For the Inspection a. The owner or client must have all of the utilities connected for the inspection. b. The appliances (stove/refrigerator) must be in place.

PART III: DOCUMENTS TO BE RETURNED TO SNRHA 1. Please note that the RFTA must be an original and you or your prospective tenant can return

these documents. Please call ahead to the caseworker for an appointment so that you can receive prompt service. Please ensure all documents are completed and the following items are attached: • Completed RFTA – must return original – cannot be faxed _____ • Lease – signed by both parties with no effective date _____ • Proof of ownership (copy of actual record warranty deed) _____ • Statement of Property Ownership/Authorization _____ • Lead Base Form _____ • ACH form and voided check _____ • Two (2) IRS – W9 Forms (One for Owner and one

for Management Company) _____ • IRS – W8 Form (If you do not have a SSN or EIN #,

you must complete a W8 Form) _____ • Copy of Management Agreement, if applicable _____ • Acknowledgement Form (screening responsibility/

Fair Housing Laws _____ • Smoke Detector Form _____ • Special Amenities Form _____

Note: All payments shall be made only via Direct Deposit.


Please double check your RFTA and the accompanying documents for completeness and required signatures. Missing information will delay the housing assistance payment.

• Utilities must be on a least one day before the inspection.

• The tenant is responsible for paying the security deposit and the security deposit cannot exceed one month’s contract rent.

• All forms must be completed and all required documents attached.

2. The contract shall be brought to the inspection for you to sign if the unit passes the HQS

inspection. Staff will receive the contract and mail you a copy that has also been signed by SNRHA management executing the contract no later than five (5) business days after the inspection. Staff shall also attach a copy of the lease and lease addendum. If you or your assigned management cannot attend the inspection, the contract will be mailed. Please note payment will not begin until the contract is returned and SNRHA cannot execute a contract that is more than 60 days old.

3. Moving In Before the Lease is Approved. The SNRHA will not pay any money on a unit until it

passes inspection. Any arrangement for occupancy before the unit passes inspection is strictly between the owner and the participant. The participant would therefore be responsible for 100% of rent.

4. References and Screening. SNRHA does not screen participants for tenancy; we certify their

eligibility to receive assistance under the program. 5. Side-Payment. You cannot make arrangements for side payments with your tenant. The tenant

can only pay the amount approved by SNRHA. If they pay additional, they will be terminated and you will be barred from participating in the HCV Program.

6. Change of Ownership/Management. Please notify our office immediately of change of

ownership and/or management. You must also notify us of your new address. If you have questions, please call the Housing Choice Voucher Department at (702) 922-6900. Ask the client submitting this packet to you for their caseworker’s name and phone number, as that is the person you will need to speak with to assist you with this lease-up process.

SOUTHERN NEVADA REGIONAL HOUSING AUTHORITY Housing Choice Voucher Department, P.O. Box 1897, Las Vegas, NV 89125-1897

Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

Statement of Ownership /Letter of Authorization Rev.11-2018

STATEMENT OF PROPERTY OWNERSHIP/LETTER OF AUTHORIZATION Prospective Tenant Name: _______________________________________________________ Rental Property Address: ________________________________________________________

Ownership: PLEASE ATTACH COPY OF RECORDED DEED - I/we declare the recorded property owner(s) are as follows:

Name: ______________________________________________________________________

Address: _____________________________________________________________________

City/State/Zip: _____________________________ E-mail: ____________________________

Phone: ( )___________________________ Fax: ______________________________

Authorization: The following individual(s)/agency is designated as my/our representative and is authorized to act on my/our behalf, which includes the power and authority to sign and enter into a Housing Assistance Payment (HAP) contract with the Southern Nevada Regional Housing Authority. PLEASE ATTACH A COPY OF THE MANAGEMENT AGREEMENT OR POWER OF ATTORNEY. Business/Management Name: ____________________________________________________

Authorized Agent(s): ___________________________________________________________

Address /City/State/Zip:______________________ E-mail: ____________________________

Phone: ( )___________________________ Fax: ______________________________

1099 Payment Instructions: The Housing Assistance Payment (HAP) shall be paid to the following (select one): Owner: __________________________________ Tax ID__________________________

Address: _____________________________________________________________________

Agent: __________________________________ Tax ID___________________________

Address: _____________________________________________________________________

BY SIGNING THIS FORM, I ACKNOWLEDGE I HAVE NO INTEREST WITH SNRHA DIRECTLY OR INDIRECTLY IN ACORDANCE WITH 24 CFR 982.161l.

Owner signature: ____________________________________ Date: __________________ Agent signature: ____________________________________ Date: __________________

This form to be used for SNRHA purposes only. Please be advised while we are here to serve you, Housing Choice Voucher (HCV) Regulations authorize a public housing authority to terminate benefits when a family engages in or threatens abusive or violent behavior toward the authority’s personnel [24 CFR § 982.552(c)(1)(ix.)] WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any department or Agency of the United States as to any matter within its jurisdiction. Our agency provides reasonable accommodations to elderly or disabled applicants and participants to ensure programs and services are accessible. If you need a reasonable accommodation, please submit your request in writing to: SNRHA, P.O. Box 1897, Las Vegas, NV 89125, Attn: 504 Officer. Southern Nevada Regional Housing Authority will not discriminate because of race, color, religion, age, national origin, disability, familial status or sexual orientation. If you feel you have a Fair Housing Complaint, please contact HUD at 1-800-669-9777 or TTY 1-800-927-9275. The Equal Access to Housing in HUD Program Regardless of actual or perceived Sexual Orientation, Gender Identity, or Marital Status in compliance with Final Rule, published in the Federal Register August 2014. SNRHA will comply with 24 CFR Parts 5, 91, 880, et al. Violence Against Women Act Conforming Amendments. Si usted no puede leer este documento por favor pida la asistencia de nuestro personal bilingüe. La Vivienda Regional del Sur de Nevada, proporciona servicios de traducción para participantes y clientes que califican. Si usted necesita esta forma en Español, por favor contacte a su asistente social.


Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

ACH Form – Direct Deposit, SNRHA – H0079 Rev. 8-2018

AUTHORIZATION AGREEMENT FOR AUTOMATED DEPOSITS (ACH CREDITS) Property Owner/Agent Information & Authorization

K P L E A S E I N C L U D E A V O I D E D C H E C K A N D W - 9CCCCCC

___________________________________________ __________________________________________ Owner Name (please print) Management Agent Name (please print) ___________________________________________ __________________________________________ Owner Federal Identification Number (SSN, EIN, or ITIN) Agent Federal Identification No. (SSN, EIN or ITIN) ___________________________________________ __________________________________________ Owner Phone Number Agent Phone Number ___________________________________________ __________________________________________ Owner E-mail Address Agent E-mail Address **Account Information: ___ Checking ___Savings **Property Rental Information: ___________________________________________ __________________________________________ Name of Financial Institution Tenant Name ___________________________________________ __________________________________________ Address Rental Address ___________________________________________ __________________________________________ City, State, Zip Code City, State, Zip Code ________________________________________ Bank Routing Number ________________________________________ Bank Account Number

I authorize and request the Southern Nevada Regional Housing Authority (SNRHA) to deposit my Housing Assistance Payments automatically to my account identified above each month. This authorization will remain in effect until I have cancelled it in writing.

NOTE: If the 1st is on a weekend, holiday, or other business closure day, the deposit will post the first business day of the month. Please contact SNRHA at (702) 477-3128 or fax (702) 922-6620 for additional forms or email [email protected] or [email protected] for questions. __________________________________________________ ______________________________ Payee Signature Date Signed

Purpose of Authorization (Select one)

� New Authorization � Changes to Authorization � Change in Ownership / Management

Office Use Only: Tenant ID: __________________ Owner ID: __________________ Payee ID: _________________

Notes: ________________________________________________________________________________________

mailto:[email protected]

mailto:[email protected]

Form W-9(Rev. October 2018)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the

requester. Do not

send to the IRS.

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3.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions)

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)

(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

–

Part II Certification

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of

U.S. person Date

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

Form W-9 (Rev. 10-2018) Page 2

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are

considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign

Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.3. The article number (or location) in the tax treaty that contains the

saving clause and its exceptions.4. The type and amount of income that qualifies for the exemption

from tax.5. Sufficient facts to justify the exemption from tax under the terms of

the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup WithholdingWhat is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the instructions for Part II for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships, earlier.

What is FATCA Reporting?The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your InformationYou must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.

PenaltiesFailure to furnish TIN. If you fail to furnish your correct TIN to a

requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.


Criminal penalty for falsifying information. Willfully falsifying

certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions

Line 1

You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.

a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.

b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.

c. Partnership, LLC that is not a single-member LLC, C

corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.

d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.

e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Line 2

If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.

Line 3

Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.

IF the entity/person on line 1 is

a(n) . . .

THEN check the box for . . .

• Corporation Corporation

• Individual • Sole proprietorship, or • Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes.

Individual/sole proprietor or single-member LLC

• LLC treated as a partnership for U.S. federal tax purposes, • LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes.

Limited liability company and enter the appropriate tax classification. (P= Partnership; C= C corporation; or S= S corporation)

• Partnership Partnership

• Trust/estate Trust/estate

Line 4, Exemptions

If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.

Exempt payee code.

• Generally, individuals (including sole proprietors) are not exempt from backup withholding.

• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.

• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.

The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.

1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2—The United States or any of its agencies or instrumentalities

3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

4—A foreign government or any of its political subdivisions, agencies, or instrumentalities

5—A corporation

6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession

7—A futures commission merchant registered with the Commodity Futures Trading Commission

8—A real estate investment trust

9—An entity registered at all times during the tax year under the Investment Company Act of 1940

10—A common trust fund operated by a bank under section 584(a)

11—A financial institution

12—A middleman known in the investment community as a nominee or custodian

13—A trust exempt from tax under section 664 or described in section 4947


The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt

for . . .

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be reported and direct sales over $5,0001

Generally, exempt payees 1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, and its instructions.2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup

withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B—The United States or any of its agencies or instrumentalities

C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)

E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)

F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G—A real estate investment trust

H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I—A common trust fund as defined in section 584(a)

J—A bank as defined in section 581

K—A broker

L—A trust exempt from tax under section 664 or described in section 4947(a)(1)

M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.

Line 5

Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records.

Line 6

Enter your city, state, and ZIP code.

Part I. Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.

If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification

Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

Part II. CertificationTo establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.


1. Interest, dividend, and barter exchange accounts opened

before 1984 and broker accounts considered active during 1983.

You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts

opened after 1983 and broker accounts considered inactive during

1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of

secured property, cancellation of debt, qualified tuition program

payments (under section 529), ABLE accounts (under section 529A),

IRA, Coverdell ESA, Archer MSA or HSA contributions or

distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.

What Name and Number To Give the RequesterFor this type of account: Give name and SSN of:

1. Individual The individual

2. Two or more individuals (joint account) other than an account maintained by an FFI

The actual owner of the account or, if combined funds, the first individual on

the account1

3. Two or more U.S. persons (joint account maintained by an FFI)

Each holder of the account

4. Custodial account of a minor (Uniform Gift to Minors Act)

The minor2

5. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law

The grantor-trustee1

The actual owner1

6. Sole proprietorship or disregarded entity owned by an individual

The owner3

7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i)(A))

The grantor*

For this type of account: Give name and EIN of:

8. Disregarded entity not owned by an individual

The owner

9. A valid trust, estate, or pension trust Legal entity4

10. Corporation or LLC electing corporate status on Form 8832 or Form 2553

The corporation

11. Association, club, religious, charitable, educational, or other tax-exempt organization

The organization

12. Partnership or multi-member LLC The partnership

13. A broker or registered nominee The broker or nominee

For this type of account: Give name and EIN of:

14. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments

The public entity

15. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B))

The trust

1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.2 Circle the minor’s name and furnish the minor’s SSN.3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier.

*Note: The grantor also must provide a Form W-9 to trustee of trust.

Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records From Identity TheftIdentity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:

• Protect your SSN,

• Ensure your employer is protecting your SSN, and

• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Pub. 5027, Identity Theft Information for Taxpayers.

Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes.

Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.


The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at [email protected] or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.

Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.

Privacy Act NoticeSection 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.


AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)

PROPERTY OWNER/AGENT INFORMATION/AUTHORIZATION Please include a voided check or copy of a voided check

__________________________________ _______________________________ Owner’s Name (Please Print) Federal Employer Identification Number (FEIN) Social Security Number of owner _____________________________________________ _________________________________________ Management Company/Agent’s Name (Please Print) Federal Employer Identification Number (FEIN) Social Security Number (Management Company or Agent) I authorize and request the Southern Nevada Regional Housing Authority to deposit my Housing Assistance Payments automatically to my account identified below each month. This authority will remain in effect until I have cancelled it in writing.

Purpose of Authorization (Check One)

______ New Authorization ______ Changes to Authorization ______ Cancellation

Checking Account Information OR Savings Account Information Name of Financial Institution Name of Financial Institution Address Address City, State, Zip City, State, Zip Bank Routing Number Bank Routing Number Account Number Account Number

Landlord Signature Date Signed Landlord Phone Number Owner/Vendor Number Tenant Name Rental Unit Address Rental Unit – City, State Rental Unit – Zip Code NOTE: If the 1st is on a weekend or holiday, the deposit will post the first business day of the month. Please contact the Southern Nevada Regional Housing Authority at (702) 922-6608 or Fax (702) 922-6620 for additional forms or questions.


SOUTHERN NEVADA REGIONAL HOUSING AUTHORITY Housing Choice Voucher Program, P.O. Box 1897, Las Vegas, NV 89125-1897

Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

SMOKE DETECTOR CERTIFICATION

Address: ______________________________________ Zip Code: ____________ I do hereby certify that in accordance with U.S. Department of Housing and Urban Development regulations regarding smoke detectors, effective October 30. 1992, that:

1. The dwelling unit identified above is protected by at least one battery operated or hard-wired smoke detector, in properly working condition, on each level of the unit;

and

2. Each bedroom occupied by a person known to me to be hear-impaired has a visual alarm system connected to the smoke detector installed in the hallway; and

3. A properly functioning smoke detector is located in the hallway near all

bedrooms. This certification must be signed, dated and returned to our Housing Choice Voucher Department. ____________________________________ ________________ Signature of Owner or Agent Date



Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

SPECIAL AMENITIES

Address: ____________________________________________________ Zip Code: ___________ This form is designed to collect additional information about other positive features of the unit that may be present. Although the features listed below are not included in the Housing Quality Standards, the tenant, landlord and Housing Agency (HA) may wish to take them into consideration in decisions about renting the unit and the reasonableness of the rent. _____ NO AMENITIES TO BE CONSIDERED (If none, check here and form is complete.) 1. Living Room 5. Laundry Room ___ High quality floors or wall coverings ___ Washer ___ Working fireplace or stove ___ Dryer ___ Balcony, patio, deck, porch ___ Special windows or doors 6. Overall Characteristics ___ Exceptional size relative to needs of family ___ Storm windows and doors ___ Other forms of weatherization 2. Kitchen (insulation, weather-stripping) ___ Screen doors or windows ___ Dishwasher ___ Good upkeep of grounds (i.e., site ___ Separate freezer cleanliness, landscaping, condition ___ Garbage disposal of lawn) ___ Eating counter/breakfast nook ___ Ceiling fans ___ Pantry or abundant shelving or cabinets ___ Driveway ___ Double oven/self cleaning oven, ___ Large yard microwave ___ Gated community ___ Stove ___ Gate code ___ Refrigerator ___ Good maintenance of building exterior ___ Double sink ___ Pool ___ High quality cabinets ___ Condominium ___ Abundant counter-top space ___ Modern appliances Air Conditioning ___ Exceptional size relative to needs of family ___ Windows A/C ___ Other: (Specify)_____________________ ___ Central A/C ___ Evap cooler 3. Other Rooms Used for Living Heat ___ High quality floors or wall coverings ___ Working fireplace or stove ___ Window ___ Balcony, patio, deck, porch ___ Central ___ Special windows or doors ___ Furnace ___ Exceptional size relative to needs of family Parking ___ Other: (Specify)_____________________ ___ Driveway 4. Bath ___ Open ___ 1 Car Port ___ Special feature shower head ___ 2 Car Port ___ Built-in heat lamp ___ 1 Car Garage ___ Large mirrors ___ 2 Car Garage ___ Glass door on shower/tub ___ 3 Car Garage ___ Separate dressing room ___ Double sink or special lavatory 7. Disabled Accessibility ___ Exceptional size relative to needs of family ___ Other: (Specify) _____________________ ___ Unit is accessible to a particular disability-

_________________________________


TOTAL POINTS: ________________


Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

HOUSING CHOICE VOUCHER PROGRAM ACKNOWLEDGMENT OF LANDLORD/TENANT

SCREENING RESPONSIBILITY FORM

All Southern Nevada Regional Housing Authority (SNRHA) Housing Choice Voucher owner/managers are responsible for screening families based on their tenancy histories, including such factors as:

1. Payment of rent and utility bills

2. Caring for a unit and premises

3. Respecting the rights of other residents to the peaceful enjoyment of their housing

4. Drug-related criminal activity that is a threat to the health, safety or property of others and compliance with other essential conditions of tenancy

FAIR HOUSING LAWS

SNRHA will actively enforce all Fair Housing Laws. Owners determined by a court or other administrative agency to be in violation of federal equal opportunity requirements will be barred from participating in the Housing Choice Voucher Program.

LEASING TO RELATIVES

The unit to be rented to the Housing Choice Voucher participant will not be a unit owned by a parent, child, grandparent, grandchild, sister or brother of the Housing Choice Voucher participant, in accordance with HUD’s final rule effective 6/17/98. I hereby acknowledge my receipt of this form. ___________________________________________ _______________________ Landlord Date

Previous editions are obsolete 1 HUD-52517 (7/2019)

Request for Tenancy Approval Housing Choice Voucher Program

The public reporting burden for this information collection is estimated to be 30 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The Department of Housing and Urban Development (HUD) is authorized to collect the information on this form by Section 8 of the U.S. Housing Act (42 U.S.C. 1437f). Form is only valid if it includes an OMB Control Number.

HUD is committed to protecting the privacy of individuals’ information stored electronically or in paper form, in accordance with federal privacy laws, guidance, and best practices. HUD expects its third-party business partners, including Public Housing Authorities, who collect, use maintain, or disseminate HUD information to protect the privacy of that information in Accordance with applicable law.

When the participant selects a unit, the owner of the unit completes this form to provide the PHA with information about the unit. The information is used to determine if the unit is eligible for rental assistance. HUD will not disclose this information except when required by law for civil, criminal, or regulatory investigations and prosecutions. 1. Name of Public Housing Agency (PHA) 2. Address of Unit (street address, unit #, city, state, zip code)

3. Requested Lease Start

Date

4. Number of Bedrooms 5. Year Constructed 6. Proposed Rent 7. Security Deposit

Amt

8. Date Unit Available

for Inspection

9. Structure Type 10. If this unit is subsidized, indicate type of subsidy:

□ Single Family Detached (one family under one roof)

□ Semi-Detached (duplex, attached on one side)

□ Rowhouse/Townhouse (attached on two sides)

□ Low-rise apartment building (4 stories or fewer)

□ High-rise apartment building (5+ stories)

□ Manufactured Home (mobile home)

□ Section 202 □ Section 221(d)(3)(BMIR)

□ Tax Credit □ HOME

□ Section 236 (insured or uninsured)

□ Section 515 Rural Development

□ Other (Describe Other Subsidy, including any state

or local subsidy) ___________________________

11. Utilities and Appliances

The owner shall provide or pay for the utilities/appliances indicated below by an “O”. The tenant shall provide or pay for the

utilities/appliances indicated below by a “T”. Unless otherwise specified below, the owner shall pay for all utilities and provide the

refrigerator and range/microwave.

Item Specify fuel type Paid by

Heating □ Natural gas □ Bottled gas □ Electric □ Heat Pump □ Oil □ Other

Cooking □ Natural gas □ Bottled gas □ Electric □ Other

Water Heating □ Natural gas □ Bottled gas □ Electric □ Oil □ Other

Other Electric

Water

Sewer

Trash Collection

Air Conditioning

Other (specify)

Provided by

Refrigerator

Range/Microwave

U.S Department of Housing and Urban Development Office of Public and Indian Housing

OMB Approval No. 2577-0169 exp. 7/31/2022

Previous editions are obsolete 2 HUD-52517 (7/2019)

12. Owner’s Certifications a. The program regulation requires the PHA to certify that

the rent charged to the housing choice voucher tenant is not more than the rent charged for other unassisted comparable units. Owners of projects with more than 4 units must complete the following section for most recently leased comparable unassisted units within the premises.

c. Check one of the following:

□ Lead-based paint disclosure requirements do not apply because this property was built on or after January 1, 1978.

□ The unit, common areas servicing the unit, and exterior painted surfaces associated with such unit or common areas have been found to be lead-based paint free by a lead-based paint inspector certified under the Federal certification program or under a federally accredited State certification program.

□ A completed statement is attached containing disclosure of known information on lead-based paint and/or lead-based paint hazards in the unit, common areas or exterior painted surfaces, including a statement that the owner has provided the lead hazard information pamphlet to the family.

13. The PHA has not screened the family’s behavior or suitability for tenancy. Such screening is the owner’s responsibility. 14. The owner’s lease must include word-for-word all provisions of the HUD tenancy addendum. 15. The PHA will arrange for inspection of the unit and will notify the owner and family if the unit is not approved.

Address and unit number Date Rented Rental Amount

1.

2.

3.

b. The owner (including a principal or other interested party) is not the parent, child, grandparent, grandchild, sister or brother of any member of the family, unless the PHA has determined (and has notified the owner and the family of such determination) that approving leasing of the unit, notwithstanding such relationship, would provide reasonable accommodation for a family member who is a person with disabilities.

Print or Type Name of Owner/Owner Representative Print or Type Name of Household Head

Owner/Owner Representative Signature Head of Household Signature

Business Address Present Address

Telephone Number Date (mm/dd/yyyy) Telephone Number Date (mm/dd/yyyy)

SOUTHERN NEVADA REGIONAL HOUSING AUTHORITY

P.O. Box 1897 • Las Vegas, Nevada 89125

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

WATCH OUT FOR LEAD-BASED PAINT POISONING NOTIFICATION

PLEASE READ THE FOLLOWING INFORMATION CONCERNING LEAD-BASED PAINT POISONING

TO: TENANTS OF HOUSING CONSTRUCTED BEFORE 1978

This building was constructed before 1978. There is a possibility that it may containlead-based paint.

The interiors of older apartments often have layers of lead-based paint on the walls, ceilings, window sills and door frames. Lead-based paint and primers may also have been used on outside porches, railings, garages, fire escapes and lamp posts. When the paint chips, flakes or peels off, there may be a real danger for babies and young children.

Children may eat paint chips or chew on painted railings, window sills or other items when parents are not around. Children can also ingest lead even if they do not specifically eat paint chips. For example, when children play in an area where there are loose paint or dust particles containing lead, they may get these particles on their hands, put their hands into their mouths, and ingest a dangerous amount of lead.

Has your child been especially cranky or irritable? Is he or she eating normally? Does your child have stomach aches and vomiting? Does he or she complain about headaches? Is your child unwilling to play? Those may be signs of lead poisoning, although many times there are no symptoms at all. Lead poisoning can eventually cause mental retardation, blindness and even death.

If you suspect that your child has eaten chips of paint or someone told you this, you should take your child to the doctor or clinic for testing. If the test shows that your child has an elevated blood lead level, treatment is available. Contact your doctor or local health department for help or more information. Evelated Blood Lead Level (EBLL) screening and treatment are available through Medicaid Program for those who are eligible.

Inform other family members and baby-sitters of the dangers of lead poisoning. You can safeguard your child from lead poisoning by preventing him or her from eating paint that may contain lead.

Look at your walls, ceilings, door frames and window sills. Are there places where the paint is peeling, flaking or chipping? If so, there are some things you can do immediately to protect your child:

Over Rev 04/2010

1) Cover all furniture and appliances;

2) Get a broom or stiff brush and remove all loose pieces of paint from walls, woodwork and ceilings.

3) Sweep up all pieces of paint and plaster and put them in a paper bag or wrap them in newspaper. Put these packages in the trash can. DO NOT BURN THEM.

4) Do not leave paint chips on the floor. Damp mop floors in and around the work area to remove all dust and paint particles. Keeping the floor clean of paint chips, dust and dirt is easy and very important.

5) Do not allow loose paint to remain within your children’s reach since children may pick loose paint off the lower part of the walls.

IF YOUR CHILD HAS AN ELEVATED BLOOD LEAD LEVEL:

If your child is tested and the test confirms a concentration of lead in whole blood equivalent to 25 ug/dl or greater, you should present test evidence to your management office or the landlord immediately.

IF YOU FIND FLAKING, CHIPPING OR PEELING PAINT:

If the unit in which you live has flaking, chipping or peeling paint, water leaks from faulty plumbing, or defective roofs, you should notify the management office or the landlord immediately.

You should cooperate with the management office’s or landlord’s efforts to repair any deficiencies and keep your unit in good shape. When lead-based paint is removed by scraping, a hazardous dust is created which can enter the body either by breathing or swallowing the dust. The use of heat or paint removers could create a vapor or fume which may cause poisoning if inhaled over a long period of time. Whenever possible, the removal of lead-based paint should take place when there are no children and pregnant women on the premises.

Remember that you, as a parent, play a major role in the prevention of lead poisoning. Your actions and awareness about lead problem can make a big difference.

Signatures:

1. Date signed

2. Date signed

By:

Head(s) of Household

(Property)

Agent


Phone (702) 477-3100 FAX (702) 922-6929 TDD (702) 387-1898

Lease Addendum for Drug-Free Housing Rev. 11-2016

LEASE ADDENDUM FOR DRUG-FREE HOUSING

In consideration of the execution or renewal of a Lease of the dwelling unit identified in the Lease, Owner and Tenant agree as follows:

1. Tenant, any members of the tenant’s household, or a guest or other person under the tenant’s control shall not engage in criminal activity, including drug-related criminal activity, on or near leased premises. “Drug-related criminal activity” means the illegal manufacture, sale, distribution, use, or possession with intent to manufacture, sell, distribute, or use of a controlled substance (as defined in Section 102 of the Controlled Substance Act [21 U.S.C. 802].)

2. Tenant, any member of the tenant’s household, or a guest or other person under the tenant’s control shall not engage in any act intended to facilitate criminal activity, including drug-related criminal activity, on or near leased premises.

3. Tenant or members of the household, will not permit the dwelling unit to be used for, or to facilitate criminal activity, including drug-related criminal activity, regardless of whether the individual engaging in such activity is a member of the household or a guest.

4. Tenant or members of the household will not engage in the manufacture, sale, or distribution of illegal drugs at any location, whether on or near the leased premises or otherwise.

5. Tenant or any member of the tenant’s household or a guest or other person under the tenant’s control shall not engage in acts of violence or threats of violence, including, but not limited to, the unlawful discharge of firearms, on or near the premises.

6. VIOLATION OF THE ABOVE PROVISIONS SHALL BE A MATERIAL VIOLATION OF THE LEASE AND GOOD CAUSE FOR TERMINATION OF TENANCY. A single violation of any of the provisions of this addendum shall be deemed a serious violation and a material non-compliance with the Lease. Unless otherwise provided by law, proof of violation shall not require criminal conviction, but shall be based upon a preponderance of the evidence.

7. In case of a conflict between the provisions of this addendum and any other provisions of the Lease, the provisions of the Addendum shall govern.

8. This Lease Addendum is incorporated into the Lease executed or renewed this day between the Owner and Tenant.

Date: ______________________________ Date: __________________________________ ______________________________ __________________________________ OWNER TENANT

This form to be used for SNRHA purposes only. Please be advised while we are here to serve you, Housing Choice Voucher (HCV) Regulations authorize a public housing authority to terminate benefits when a family engages in or threatens abusive or violent behavior toward the authority’s personnel [24 CFR § 982.552(c)(1)(ix.)] WARNING: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any department or Agency of the United States as to any matter within its jurisdiction. Our agency provides reasonable accommodations to elderly or disabled applicants and participants to ensure programs and services are accessible. If you need a reasonable accommodation, please submit your request in writing to: SNRHA, P.O. Box 1897, Las Vegas, NV 89125, Attention: 504 Officer. Southern Nevada Regional Housing Authority will not discriminate because of race, color, religion, age, national origin, disability, familial status or sexual orientation. If you feel you have a Fair Housing Complaint, please contact HUD at 1-800-669-9777 or TTY 1-800-927-9275. The Equal Access to Housing in HUD Program Regardless of actual or perceived Sexual Orientation, Gender Identity, or Marital Status in compliance with Final Rule, published in the Federal Register August 2014. SNRHA will comply with 24 CFR Parts 5, 91, 880, et al. Violence Against Women Act Conforming Amendments. Si usted no puede leer este documento por favor pida la asistencia de nuestro personal bilingüe. La Vivienda Regional del Sur de Nevada, proporciona servicios de traducción para participantes y clientes que califican. Si usted necesita esta forma en Español, por favor contacte a su asistente social.

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