U. S. Department of Housing and Urban Development

Public and Indian Housing

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Special Attention of: NOTICE PIH 97-56 (HA)

Issued: November 5, 1997

Public Housing Agencies; Expires: November 30, 1998

Public Housing Directors;

State/Area Coordinators;

Secretary\'s Representatives

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Subject: Sample Public Housing Lease

The purpose of this Notice is to distribute to public

housing agencies (PHAs) and HUD field personnel a copy of a

sample public housing lease. This lease complies with the

Housing Opportunity Program Extension Act of 1996, and One Strike

and You\'re Out Policy.

A Public Housing Authority\'s (PHA) dwelling lease must be

structured to, and in conformance with, its Admissions and

Continued Occupancy Policy, the Lease and Grievance Procedures

outlined in 24 CFR, Section 966.4, and state laws. Since this

lease includes both required and optional elements, it is

recommended that a PHA review each optional element carefully

before adopting it.

/s/

Kevin Emanuel Marchman

Acting Assistant Secretary

Office of Public and Indian Housing

Attachment

SAMPLE LEASE

HOUSING AUTHORITY of \_\_\_\_\_\_\_\_\_\_\_

RESIDENTIAL LEASE AGREEMENT

THIS LEASE IS IN TWO PARTS:

Part I establishes the Terms and Conditions of the lease.

These apply to all residents;

Part II is a sample lease contract. This is executed by the

resident and the Authority, includes Part I Terms and

Conditions (by reference) and the following information

specific to each family\'s circumstances:

\_ Identification of all members of Tenant household by

relationship to the Head of the Household, their

social security numbers, ages (at the time of lease

execution) and dates of birth (DOB);

\_ Unit address, occupancy date, and unit number;

\_ Pro-rated and full monthly rent amount, security

deposit required, pro-rated and full monthly utility

allowance provided (if any), pro-rated and full

monthly utility reimbursement (if any) and the amount

of any other charges due under the lease;

\_ Utilities and appliances provided by the Authority

with the unit;

\_ All pamphlets or informational materials provided to

Tenant;

\_ Signature line for the parties to the lease (all

adult members of Tenant household must sign the

lease);

\_ Emergency telephone number for Tenant to use if

maintenance problems arise with the unit outside of

normal Authority working hours.

PART I of the RESIDENTIAL LEASE AGREEMENT: TERMS AND CONDITIONS

Housing Authority of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

THIS LEASE AGREEMENT (called the \"Lease\") is between the

Housing Authority of \_\_\_\_\_\_\_\_\_\_\_\_, and Tenant named in Part

II of this lease (called \"Tenant\"). \[966.4 (a)\]

I. Description of the Parties and Premises: \[966.4 (a)\]

\(a\) The Authority, using verified data about income,

family composition, and needs, leases to Tenant, the

property (called \"premises\" or \"dwelling unit\")

described in Part II of this Lease Agreement, subject

to the terms and conditions contained in this lease.

\[966.4 (a)\]

\(b\) Premises must be used only as a private residence,

solely for Tenant and the household members named on

Part II of the Lease. The Authority may, by prior

written approval, consent to Tenant\'s use of the unit

for legal profit-making activities incidental to the

residential use subject to the Authority\'s policy on

such activities. \[966.4 (d)(1 & 2)\]

\(c\) Any additions to the household members named on the

lease, including Live-in Aides and foster children, but

excluding natural births, require the advance written

approval of the Authority. Such approval will be

granted only if the new family members pass the

Authority\'s screening criteria and a unit of the

appropriate size is available. Permission to add Live-in

Aides and foster children shall not be unreasonably

refused. \[966.4 (a)(2) & (d)(3)(i)\]

Tenant agrees to wait for the Authority\'s approval

before allowing additional persons to move into the

Premises. Failure on the part of Tenant to comply with

this provision is a serious violation of the material

terms of the lease, for which the Authority may

terminate the lease in accordance with Section XVI .

\[966.4 (f)(3)\]

\(d\) Deletions (for any reason) from the household

members named on the lease shall be reported by the

Tenant to the Authority in writing, within 10 days of

the occurrence. \[966.4 (c)(1) & (2) & (f)(3)\]

II\. Lease and Amount of Rent

\(a\) Unless otherwise modified or terminated in

accordance with Section XVI, this Lease shall

automatically be renewed for successive terms of one

calendar month. \[966.4 (a)(1)\]

The rent amount is stated in Part II of this Lease.

Rent shall remain in effect unless adjusted by the

Authority in accordance with Section VII herein.

\[966.4 (c)\]

The amount of the Total Tenant Payment and Tenant Rent

shall be determined by the Authority in compliance with

HUD regulations and requirements and in accordance with

the Authority\'s Admissions and Occupancy Policy. \[966.4

(c)\]

\(b\) Rent is DUE and PAYABLE in advance on the first day

of each month and shall be considered delinquent after

the fifth calendar day of the month. Rent may include

utilities as described in Section VII below, and

includes all maintenance services due to normal wear

and tear. \[966.4 (b)(1), (e)(1) & (3)\]

When the Authority makes any change in the amount of

Total Tenant Payment or Tenant Rent, the Authority

shall give written notice to Tenant. The notice shall

state the new amount, and the date from which the new

amount is applicable. Rent redeterminations are subject

to the Administrative Grievance Procedure. The notice

shall also state that Tenant may ask for an explanation

of how the amount is computed by the Authority. If

Tenant asks for an explanation, the Authority shall

respond in a reasonable time. \[966.4 (c)(4)\]

III\. Other Charges

In addition to rent, Tenant is responsible for the payment of

certain other charges specified in this lease. The type(s)

and amounts of other charges are specified in Part II of this

Lease Agreement. Other charges can include: \[966.4 (b)(2)\]

\(a\) Maintenance costs \-- The cost for services or

repairs due to intentional or negligent damage to the

dwelling unit, common areas or grounds beyond normal

wear and tear, caused by Tenant, household members or

by guests. When the Authority determines that needed

maintenance is not caused by normal wear and tear,

Tenant shall be charged for the cost of such service,

either in accordance with the Schedule of Maintenance

Charges posted by the Authority or (for work not listed

on the Schedule of Maintenance Charges) based on the

actual cost to the Authority for the labor and

materials needed to complete the work. If overtime work

is required, overtime rates shall be charged. \[966.4

(b)(2)\]

\(b\) Excess Utility Charges \--At developments where

utilities are provided by the Authority, a charge shall

be assessed for excess utility consumption due to the

operation of major tenant-supplied appliances. This

charge does not apply to Tenants who pay their

utilities directly to a utility supplier. \[966.4

(b)(2)\]

\(c\) Installation charges for tenant-supplied air

conditioners.

\(d\) Late Charges \-- A charge of \$1.00 per day late for

rent or other charges paid after the fifth calendar day

of the month. \[966.4 (b)(3)\] The Authority shall

provide written notice of the amount of any charge in

addition to Tenant Rent, and when the charge is due.

Charges in addition to rent are due no sooner than two

weeks after Tenant receives the Authority\'s written

notice of the charge. \[966.4 (b)(4)\]

IV\. Payment Location

Rent and other charges can be paid at the Main Office located

at \_\_\_\_\_\_\_\_\_\_\_or at other locations specified in Part II of

this Residential Lease. However, if needed as a reasonable

accommodation, the Authority shall make other arrangements for

payment of rent. The Authority will not accept cash. \[8.24

(a)(1)(2) and (b)\]

V. Security Deposit

\(a\) Tenant Responsibilities: Tenant agrees to pay an

amount equal to \$\_\_\_\_\_ or one month\'s Total Tenant

Payment, whichever is greater. The dollar amount of

the security deposit is noted on Part II of this

Residential Lease. \[966.4 (b)(5)\]

\(b\) Authority\'s Responsibilities: The Authority will use

the Security Deposit at the termination of this Lease:

1\. To pay the cost of any rent or any other charges

owed by Tenant at the termination of this lease.

2\. To reimburse the cost of repairing any intentional

or negligent damages to the dwelling unit caused by

Tenant, household members or guests.

\(c\) The Authority shall not charge a higher security

deposit for tenants with disabilities who use

wheelchairs and/or have service or companion

animals necessary as a reasonable accommodation.

The Security Deposit may not be used to pay rent or other

charges while Tenant occupies the dwelling unit. No refund of

the Security Deposit will be made until Tenant has vacated,

and the dwelling unit has been inspected by the Authority.

The return of a security deposit shall occur within 30 days

after Tenant moves out. The Authority agrees to return the

Security Deposit plus accured interest (subject to applicable

laws), if any, to Tenant when he/she vacates, less any

deductions for any costs indicated above, so long as Tenant

furnishes the Authority with a forwarding address. If any

deductions are made, the Authority will furnish Tenant with a

written statement of any such costs for damages and/or other

charges deducted from the Security Deposit.

VI\. Utilities and Appliances \[966.4 (b)(1)\]

\(a\) Authority-Supplied Utilities: If indicated by an

\(X\) on Part II of the Lease Agreement, the Authority

will supply the indicated utility: electricity, natural

gas, heating fuel, water, sewer service. The Authority

will not be liable for the failure to supply utility

service for any cause whatsoever beyond its control.

If indicated by an (X) on Part II of the Lease

Agreement, the Authority will provide a cooking range

and refrigerator. Other major electrical appliances,

air conditioners, freezers, extra refrigerators,

washers, dryers, etc., may be installed and operated

only with the written approval of the Authority. A

monthly service charge will be payable by Tenant for

the electricity used in the operation of such

appliances, as shown on the Schedule posted in the

Project Office. \[966.4 (b)(2)\]

\(b\) Tenant-paid Utilities: If Tenant resides in a

development where the Authority does not supply

electricity, natural gas, or heating fuel, an Allowance

for Utilities shall be established, appropriate for the

size and type of dwelling unit for utilities Tenant

pays directly to the utility supplier. The Total Tenant

Payment less the Allowance for Utilities equals Tenant

Rent. If the Allowance for Utilities exceeds the Total

Tenant Payment, the Authority will pay a Utility

Reimbursement to the utility supplier or Tenant each

month. \[5.603\]

The Authority may change the Allowance at any time

during the term of the lease, and shall give Tenant 60

days written notice of the revised Allowance along with

any resultant changes in Tenant Rent or Utility

Reimbursement. \[965.502 (c)\]

If Tenant\'s actual utility bill exceeds the Allowance

for Utilities, Tenant shall be responsible for paying

the actual bill to the supplier. If Tenant\'s actual

utility bill is LESS than the Allowance for Utilities,

Tenant shall receive the benefit of such saving.

\(c\) Tenant Responsibilities: Tenant agrees not to waste

the utilities provided by the Authority and to comply

with any applicable law, regulation, or guideline of

any governmental entity regulating utilities or fuels.

\[966.4 (f)(8)\]

Tenant also agrees to abide by any local ordinance or

House rules restricting or prohibiting the use of space

heaters in multi-dwelling units.

VII\. Terms and Conditions

The following terms and conditions of occupancy are made a

part of the Lease.

\(a\) Use and Occupancy of Dwelling: Tenant shall have

the right to exclusive use and occupancy of the

dwelling unit for Tenant and other household members

listed on the lease. With the prior written consent of

the Authority, members of the household may engage in

legal profitmaking activities in the dwelling unit

incidental to the residential use. \[966.4 (d) (1) &

(2)\]

This provision permits accommodation of Tenant\'s guests

or visitors for a period not exceeding fourteen (14)

days each year. Permission may be granted, upon

written request to the Manager, for an extension of

this provision. \[966.4 (d)(1)\]

\(b\) Ability to comply with Lease terms: If, during the

term of this Lease, Tenant, by reason of physical or

mental impairment, is no longer able to comply with the

material provisions of this lease and cannot make

arrangements for someone to aid him/her in complying

with the lease, and the Authority cannot make any

reasonable accommodation that would enable Tenant to

comply with the lease; THEN, the Authority will assist

Tenant, or designated member(s) of Tenant\'s family, to

find more suitable housing and move Tenant from the

dwelling unit. If there are no family members who can

or will take responsibility for moving Tenant, the

Authority will work with appropriate agencies to secure

suitable housing and will terminate the Lease in

accordance with Section XIV of this lease.

At the time of admission, all Tenants must identify the

family member(s) to be contacted if they become unable

to comply with lease terms.

\(c\) Redetermination of Rent, Dwelling Size, and

Eligibility. The rent amount as fixed in Part II of

the Lease Agreement is due each month until changed as

described below.

\(1\) The status of each family is to be re-examined

at least once a year. \[5.617 (a)(1)\]

\(2\) Tenant promises to supply the Authority, when

requested, with accurate information about: family

composition, age of family members, income and

source of income of all family members, assets, and

related information necessary to determine

eligibility, annual income, adjusted income, and

rent. \[5.617 (b)(2)\]

Failure to supply such information when requested

is a serious violation of the terms of the lease,

and the authority may terminate the lease.

All information must be verified. Tenant agrees to

comply with the Authority\'s requests for

verification by signing releases for third-party

sources, presenting documents for review, or

providing other suitable forms of verification.

\[966.4 (c)(2)\]

The Authority shall give Tenant reasonable notice

of what actions Tenant must take and of the date by

which any such action must be taken for compliance

under this section. This information will be used

by the Authority to decide whether the amount of

the rent should be changed, and whether the

dwelling size is still appropriate for Tenant\'s

needs.

This determination will be made in accordance with

the Admissions and Occupancy Policy, which is

publicly posted in the Project Office. A copy of

the policies can be furnished on request at the

expense of the person making the request.

\(3\) Rent will not change during the period between

regular re-examinations, UNLESS during such period:

\[5.617 (a)(2)\]

\(a\) A person with income joins the household.

\(b\) Tenant can verify a change in his/her

circumstances (such as decline in or loss of

income) that would justify a reduction in

rent. \[5.613\]

If a reduction is granted, Tenant must report

subsequent increases in income within 10 days of

the occurrence, until the next scheduled re-examination.

(Failure to report within the 10

days may result in a retroactive rent charge.)

\(c\) It is found that the Tenant has misrepresented

the facts upon which the rent is based so that

the rent Tenant is paying is less than the rent

that he/she should have been charged. The

Authority then may apply an increase in rent

retroactive to the first of the month following

the month in which the misrepresentation

occurred.

\(d\) Rent formulas or procedures are changed by

Federal law or regulation.

\(4\) All changes in family composition must be

reported to the Housing Manager within 10 days of

the occurrence. Failure to report within the 10

days may result in a retroactive rent charge.

\[966.4 (c) (2)\]

This Lease will NOT be revised to permit a change

of family composition resulting from a request to

allow adult children to move back into the unit.

An exception will be made if it is determined that

the move-in of a single adult child is essential

for the mental or physical health of Tenant.

\(d\) Rent Adjustments: Tenant will be notified in

writing of any rent adjustment due to the situations

described above. All notices will state the effective

date of the rent adjustment.

\(1\) In the case of a rent decrease, the adjustment

will become effective on the first day of the month

following the reported change in circumstances or

change in Federal law or regulations, provided

Tenant reported the change in a timely manner, as

specified above (when change is based on new

circumstances).

\(2\) In the case of a rent increase, when an

increase in income occurs after a prior rent

reduction and is reported within 10 days of the

occurrence, the increase will become effective the

first day of the 2nd month following the month in

which the change was reported.

\(3\) In the case of a rent increase due to a change

in Federal law or regulations, the increase will

become effective the first day of the second month

following the month in which the Authority notifies

the tenant of the law or regulatory change.

\(4\) In the case of a rent increase due to

misrepresentation, failure to report a change in

family composition, or failure to report an

increase in income (after a reduction in rent per

the fixed rent policy), the Authority shall apply

the increase in rent retroactive to the first of

the month following the month in which the

misrepresentation occurred.

\(e\) Transfers \[966.4 (c)(3)\]

\(1\) Tenant agrees that if the Authority determines

that the size or design of the dwelling unit is no

longer appropriate to Tenant\'s needs, the Authority

shall send Tenant written notice. Tenant further

agrees to accept a new lease for a different

dwelling unit of the appropriate size or design.

\(2\) The Authority may move a Tenant into another

unit if it is determined necessary to rehabilitate

or demolish Tenant\'s unit.

\(3\) If a Tenant makes a written request for

special unit features in support of a documented

disability, the Authority shall modify Tenant\'s

existing unit. If the cost and extent of the

modifications needed are tantamount to those

required for a fully accessible unit, the Authority

may transfer Tenant to another unit with the

features requested at the Authority\'s expense.

\(4\) A tenant without disabilities who is housed in

an accessible or adaptable unit must transfer to a

unit without such features should a Tenant with

disabilities need the unit (at the Authority\'s

expense). \[8.27 (b)\]

\(5\) In the case of involuntary transfers, Tenant

shall be required to move into the dwelling unit

made available by the Authority. Tenant shall be

given 15 days time in which to move following

delivery of a transfer notice. If Tenant refuses

to move, the Authority may terminate the Lease.

\[966.4 (c)(3)\]

\(6\) Involuntary transfers are subject to the

Grievance Procedure, and no such transfers may be

made until either the time to request a Grievance

has expired or the procedure has been completed.

\[966.4 (c)(4)\]

\(7\) The Authority will consider any Tenant

requests for transfers in accordance with the

transfer priorities established in the Admissions

and Occupancy Policies.

VIII\. Authority Obligations \[966.4 (e)\]

The Authority shall be obligated:

\(a\) To maintain the dwelling unit and the project in

decent, safe and sanitary condition; \[966.4 (e)(1)\]

\(b\) To comply with the requirements of applicable

building codes, housing codes, and HUD regulations

materially affecting health and safety; \[966.4 (e)(2)\]

\(c\) To make necessary repairs to the dwelling unit;

\[966.4 (e)(3)\]

\(d\) To keep project building, facilities, and common

areas, not otherwise assigned to Tenant for maintenance

and upkeep, in a clean and safe condition; \[966.4

(e)(4)\]

\(e\) To maintain in good and safe working order and

condition electrical, plumbing, sanitary, heating,

ventilating, and other facilities and appliances,

including elevators supplied or required to be supplied

by the Authority; \[966.4 (e)(5)\]

\(f\) To provide and maintain appropriate receptacles and

facilities (except container for the exclusive use of

an individual tenant family) for the deposit of

garbage, rubbish, and other waste removed from the

premise by Tenant as required by this Lease, and to

provide disposal service for garbage, rubbish and

other solid waste; \[966.4 (e)(6)\]

\(g\) To supply running water and reasonable amounts of

hot water and reasonable amount of heat at appropriate

times of the year according to local custom and usage;

EXCEPT where the building that includes the dwelling

unit is not required by law to be equipped for that

purpose, or where heat or hot water is generated by an

installation within the exclusive control of Tenant and

supplied by a direct utility connection; \[966.4 (e)(7)\]

\(h\) To notify Tenant of the specific grounds for any

proposed adverse action by the Authority. (Such

adverse action includes, but is not limited to, a

proposed lease termination, transfer of Tenant to

another unit, or imposition of charges for maintenance

and repair, or for excess consumption of utilities.)

When the Authority is required to afford Tenant the

opportunity for a hearing under the Authority\'s

grievance procedure for a grievance concerning a

proposed adverse action:

\(1\) The Notice of the proposed adverse action

shall inform Tenant of the right to request such

hearing. In the case of lease termination, a

notice of lease termination that complies with

966.4(l)(3) shall constitute adequate notice of

proposed adverse action.

\(2\) In the case of a proposed adverse action other

than a proposed lease termination, the Authority

shall not take the proposed action until time to

request such a hearing has expired and (if hearing

was timely requested) the grievance process has

been completed. \[966.4 (e)(8)\]

\(i\) Reasonable Accommodations for Residents with

Disabilities:

Housing providers must make reasonable accommodations

in, lease and other policy requirements when requested

by a qualified resident with disabilities. The concept

of reasonable accommodation involves helping a resident

meet essential lease requirements; it does not require

the lowering or waiving of essential requirements.

Accommodations are not reasonable if they require a

fundamental alteration in the nature of the program or

impose undue financial and administrative burdens on

the housing provider.

IX\. Tenant\'s Obligations

Tenant shall be obligated:

\(a\) Not to assign the Lease, nor sublease the dwelling

unit. \[ 966.4 (f)(1)\]

\(b\) (1) Not to give accommodation to boarders or

lodgers; \[966.4 f)(2)\]

\(2\) Not to give accommodation to long term guests

(in excess of 14 days) without the advance written

consent of the Authority.

\(c\) To use the dwelling unit solely as a private

dwelling for Tenant and Tenant\'s household as

identified in PART II of the Lease, and not to use or

permit its use for any other purpose. \[966.4 (f)(3) &

(d)(1 & 2)\] (See also Sec. I (b))

This provision does not exclude the care of foster

children or live-in care of a member of Tenant\'s

family, provided the accommodation of such persons

conforms to the Authority\'s Occupancy standards, and so

long as the Authority has granted prior written

approval for the foster child(ren), or live-in aide to

reside in the unit. \[966.4 (d)((3)(i)\]

\(d\) To abide by necessary and reasonable regulations

promulgated by the Authority for the benefit and well-being

of the housing project and Tenants. These

regulations shall be posted in a conspicuous manner in

the project office and incorporated by reference in

this Lease. Violation of such regulations constitutes

a violation of the Lease. \[966.4 (f)(4)\]

\(e\) To comply with the requirements of applicable state

and local building or housing codes, materially

affecting health and/or safety of Tenant and household.

\[ 966.4(f)(5)\]

\(f\) To keep the dwelling unit and other such areas as

may be assigned to Tenant for exclusive use in a clean

and safe condition. \[966.4(f)(6)\] This includes

keeping front and rear entrances and walkways for the

exclusive use of Tenant, free from hazards and trash

and keeping the yard free of debris and litter.

Exceptions to this requirement may be made for Tenants

who have no household members able to perform such

tasks because of age or disability. \[966.4 (g)\]

\(g\) To dispose of all garbage, rubbish, and other waste

from the dwelling unit in a sanitary and safe manner

only in containers approved or provided by the

Authority. \[ Sect. 966.4(f)(7)\] To refrain from, and

cause members of Tenant\'s household or guest to refrain

from, littering or leaving trash and debris in common

areas.

\(h\) To use only in reasonable manner all electrical,

sanitary, heating, ventilating, air-conditioning, and

other facilities and appurtenances including elevators.

\[966.4(f)(8)\]

\(i\) To refrain from, and to cause household and guests

to refrain from destroying, defacing, damaging, or

removing any part of dwelling unit or project. \[966.4

(f)(9)\]

\(j\) To pay reasonable charges (other than for wear and

tear) for the repair of damages to the dwelling unit,

project buildings, facilities, or common areas caused

by Tenant, household members or guests. \[&#55396;&#56350;.4(f)(10)\]

\(k\) To act, and cause household members or guests to act

in a manner that will:

\(1\) Not disturb other residents\' peaceful

enjoyment of their accommodations; and

\(2\) Be conducive to maintaining all Authority

projects in a decent, safe, and sanitary condition.

\[966.4 (f)(11)\]

\(l\) To assure that Tenant, any member of the household,

a guest, or another person under Tenant\'s control,

shall not engage in:

\(1\) Any criminal activity that threatens the

health, safety, or right to peaceful enjoyment

of the Authority\'s public housing premises by

other residents or employees of the Authority,

or;

\(2\) Any drug-related criminal activity on or off

the premises. Any criminal activity in violation

of the preceding sentence shall be cause for

termination of tenancy, and for eviction from the

unit. (For the purposes of this lease, the term

drug-related criminal activity means the illegal

possession, 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 Substances

Act.) \[966.4 (f)(12)\]

\(m\) To make no alterations or repairs or redecorations

to the interior of the dwelling unit or to the

equipment, nor to install additional equipment or major

appliances without written consent of the Authority.

To make no changes to locks or install new locks on

exterior doors without the Authority\'s written

approval. To use no nails, tacks, screws, brackets,

or fasteners on any part of the dwelling unit (a

reasonable number of picture hangers excepted) without

authorization by the Authority.

\(n\) To give prompt prior notice to the Authority, in

accordance with Section VIII hereof, of Tenant\'s

leaving dwelling unit unoccupied for any period

exceeding one calendar week.

\(o\) To act in a cooperative manner with neighbors and

the Authority\'s Staff. To refrain from and cause

members of Tenant\'s household or guests to refrain from

acting or speaking in an abusive or threatening manner

toward neighbors and the Authority\'s staff.

\(p\) Not to display, use, or possess or allow members of

Tenant\'s household or guests to display, use or possess

any firearms, (operable or inoperable) or other

offensive weapons as defined by the laws and courts of

the State of \_\_\_\_\_\_\_\_\_\_\_ anywhere in the unit or

elsewhere on the property of the Authority.

\(q\) To take reasonable precautions to prevent fires and

to refrain from storing or keeping flammable materials

upon the premises.

\(r\) To avoid obstructing sidewalks, areaways, galleries,

passages, elevators, or stairs, and to avoid using

these for purposes other than going in and out of the

dwelling unit.

\(s\) To refrain from erecting or hanging radio or

television antennas on or from any part of the dwelling

unit, except that roof antennas may be installed in

accordance with regulations set forth by the Authority

with the written approval of the Authority.

\(t\) To refrain from placing signs of any type in or

about the dwelling except those allowed under

applicable zoning ordinances and then only after having

received written permission of the Authority.

\(u\) To insure that no member of their household keeps,

maintains, harbors, or boards any dog, cat, livestock,

or pet of any nature in the dwelling unit or on the

grounds of any Authority development except in

accordance with the Authority\'s pet policy.

However, in any development, a person with a disability

may keep a companion or service animal that is needed

as a reasonable accommodation for his or her

disability. An animal needed as a reasonable

accommodation is not subject to the Authority\'s pet

policy (if there is one), although it is subject to

reasonable health and safety rules.

\(v\) To remove from Authority property any vehicles

without valid registration and inspection stickers. To

refrain from parking any vehicles in any right-of-way

or firelane designated and marked by the Authority. Any

inoperable or unlicensed vehicle as described above

will be removed from Authority property at Tenant\'s

expense. Automobile repairs are not permitted on

project site.

\(w\) To remove any personal property left on Authority

property when Tenant leaves, abandons or surrenders the

dwelling unit. Property left for more than 30 days

shall be considered abandoned and will be disposed of

by the Authority. Costs for storage and disposal shall

be assessed against the former Tenant.

\(x\) To use reasonable care to keep the dwelling unit in

such condition as to ensure proper health and

sanitation standards for Tenant, household members and

neighbors. TENANT SHALL NOTIFY THE AUTHORITY PROMPTLY

OF KNOWN NEED FOR REPAIRS TO THE DWELLING UNIT, and of

known unsafe or unsanitary conditions in the dwelling

unit or in common areas and grounds of the Project.

Tenant\'s failure to report the need for repairs in a

timely manner shall be considered to contribute to any

damage that occurs.

\(y\) (1) Not to commit any fraud in connection with any

Federal housing assistance program, and

\(2\) Not to receive assistance for occupancy of any

other unit assisted under any Federal housing

assistance program during the term of the lease.

\(z\) To pay promptly any utility bills for utilities

supplied to Tenant by a direct connection to the

utility company, and to avoid disconnection of utility

service for such utilities.

X. Defects Hazardous to Life, Health or Safety

In the event that the dwelling unit is damaged to the extent

that conditions are created which are hazardous to the life,

health, or safety of the occupants: \[966.4 (h)\]

Authority Responsibilities:

\(a\) The Authority shall be responsible for repair of the

unit within a reasonable period of time after receiving

notice from Tenant, provided, if the damage was caused

by Tenant, household members, or guests, the

reasonable cost of the repairs shall be charged to

Tenant. \[966.4 (h)(2)\]

\(b\) The Authority shall offer Tenant a replacement

dwelling unit, if available, if necessary repairs

cannot be made within a reasonable time. The Authority

is not required to offer Tenant a replacement unit if

the hazardous condition was caused by Tenant, household

members, or guests. \[966.4 (h)(3)\]

\(c\) Tenant shall accept any replacement unit offered by

the Authority.

\(d\) In the event repairs cannot be made by the

Authority, as described above, or alternative

accommodations are not provided, then rent shall abate

in proportion to the seriousness of the damage and loss

in value as a dwelling. No abatement of rent shall

occur if Tenant rejects alternative accommodations or

if the damage was caused by Tenant, household members,

or guests. \[966.4 (h)(4)\]

\(e\) If the Authority determines that the dwelling unit

is untenantable because of imminent danger to the life,

health, and safety of Tenant, and alternative

accommodations are refused by Tenant, this Lease shall

be terminated, and any rent paid will be refunded to

Tenant.

Tenant Responsibilities:

\(a\) Tenant shall immediately notify the Project Manager

of the damage and intent to abate rent, when the damage

is or becomes sufficiently severe that Tenant believes

he/she is justified in abating rent. \[966.4 (h)(1)\]

\(b\) Tenant agrees to continue to pay full rent, less the

abated portion agreed upon by the Authority, during the

time in which the defect remains uncorrected.

XI\. Inspections

\(a\) Move-in Inspection: The Authority and Tenant or

representative shall inspect the dwelling unit prior to

occupancy by Tenant. The Authority will give Tenant a

written statement of the condition of the dwelling

unit, both inside and outside, and note any equipment

provided with the unit. The statement shall be signed

by the Authority and Tenant and a copy of the statement

retained in Tenant\'s folder. \[966.4 (i)\] Any

deficiencies noted on the inspection report will be

corrected by the Authority, at no charge to Tenant.

\(b\) Other Inspections \-- The Authority will inspect the

unit at least annually to check needed maintenance,

tenant housekeeping, and other lease compliance

matters. Tenant will receive a written statement of

the charges, if any, for repairs or removal of non-approved

alterations to the unit.

\(c\) Move-out Inspection \-- The Authority will inspect

the unit at the time Tenant vacates and give Tenant

a written statement of the charges, if any, for

which Tenant is responsible. Tenant and/or

representative may join in such inspection, unless

Tenant vacates without notice to the Authority.

\[966.4 (i)\]

XII\. Entry of Premises During Tenancy

\(a\) Tenant Responsibilities\--

\(1\) Tenant agrees that the duly authorized agent,

employee, or contractor of the Authority will be

permitted to enter Tenant\'s dwelling during

reasonable hours (\_\_\_\_\_\_A.M. to \_\_\_\_\_\_ P.M.) for

the purpose of performing routine maintenance,

making improvements or repairs, inspecting the

unit, or showing the unit for releasing. \[966.4

(j)(1)\]

\(2\) When Tenant calls to request maintenance on

the unit, the Authority shall attempt to provide

such maintenance at a time convenient to Tenant.

If Tenant is absent from the dwelling unit when the

Authority comes to perform maintenance, Tenant\'s

request for maintenance shall constitute permission

to enter.

\(b\) Authority\'s Responsibilities\--

1\. Authority shall give Tenant at least 48 hours

written notice that the Authority intends to enter

the unit. Authority may enter only at reasonable

times. \[966.4 (j)(1)\]

2\. The Authority may enter Tenant\'s dwelling unit at

any time without advance notification when there is

reasonable cause to believe that an emergency

exists. \[966.4 (j)(2)\]

3\. If Tenant and all adult members of the household

are absent from the dwelling unit at the time of

entry, Authority shall leave in the dwelling unit a

written statement specifying the date, time and

purpose of entry prior to leaving the dwelling

unit. \[966.4 (j)(3)\]

XIII\. Notice Procedures

\(a\) Tenant Responsibility\-- Any notice to Authority must

be in writing, delivered to the Project Office or to

Authority\'s central office, or sent by prepaid first-class

mail, properly addressed. \[966.4 (k)(1)(ii)\]

\(b\) Authority Responsibility \-- Notice to Tenant must be

in writing, delivered to Tenant or to any adult member

of the household residing in the dwelling unit, or sent

by prepaid first-class mail addressed to Tenant. \[966.4

(k)(1)(i)\]

\(c\) Unopened, cancelled, first class mail returned by

the Post Office shall be sufficient evidence that

notice was given, whether signed or unsigned.

\(d\) If Tenant is visually impaired, all notices must be

in an accessible format. \[966.4 (k)(2)\]

XIV\. Termination of the Lease

In terminating the Lease, the following procedures shall be

followed by the Authority and Tenant:

\(a\) This Lease may be terminated only for serious or

repeated violations of material terms of the Lease,

such as failure to make payments due under the lease or

to fulfill Tenant obligations set forth in section IX

above, or for other good cause. \[966.4 (l)(2)\]

Such serious or repeated violation of terms shall

include but not be limited to:

\(1\) The failure to pay rent or other payments when

due; \[966.4 (l)(2)\]

\(2\) Repeated late payment, which shall be defined

as failure to pay the amount of rent or other

charges due by the \_\_\_\_\_ of the month. Four such

late payments within a 12 month period shall

constitute a repeated late payment; \[966.4 (l)(2)\]

\(3\) Failure to pay utility bills when Tenant is

responsible for paying such bills directly to the

supplier of utilities; \[966.4 (l)(2)\]

\(4\) Misrepresentation of family income, assets, or

composition; \[966.4 (c)(2)\]

\(5\) Failure to supply, in a timely fashion, any

certification, release, information, or

documentation on Family income or composition

needed to process annual reexaminations or interim

redeterminations. \[966.4 (c)(2)\]

\(6\) Serious or repeated damage to the dwelling

unit, creation of physical hazards in the unit,

common areas, grounds, or parking areas of any

project site; \[966.4 (l)(2)\]

\(7\) Criminal activity by Tenant, household member,

guest, or other person under Tenant\'s control,

including criminal activity that threatens the

health, safety or right to peaceful enjoyment of

the Authority\'s public housing premises by other

residents or employees, or any drug-related

criminal activity on or off the premises. \[966.4

(l)(2)\]

\(8\) Alcohol abuse that the Authority determines

interferes with the health, safety, or right

to peaceful enjoyment of the premises by other

residents.

\(9\) Weapons or illegal drugs seized in an

Authority unit by a law enforcement officer;

\[966.4 (l)(2)\]

\(10\) Any fire on Authority premises caused by the

tenant, household members or guests\' actions

or neglect. \[966.4 (l)(2)\]

\(b\) The Authority shall give written notice of the

proposed termination of the Lease of:

\(1\) 14 days in the case of failure to pay rent;

\(2\) A reasonable time, but not to exceed 30 days,

considering the seriousness of the situation when

the health or safety of other tenants or Authority staff is

threatened;

\(3\) 30 days in any other case. \[966.4 (l)(3)(i)(A), (B) & (C)\]

\(c\) The notice of termination:

\(1\) The notice of termination to Tenant shall

state specific reasons for the termination, shall

inform Tenant of his/her right to make such reply

as he/she may wish, and of Tenant\'s right to

examine Authority documents directly relevant to

the termination or eviction. \[966.4 (l)(3)(ii)\]

\(2\) When the Authority is required to offer Tenant

the opportunity for a grievance hearing, the notice

shall also inform Tenant of the right to request

such a hearing in accordance with the Authority\'s

grievance procedures. \[966.4 (l)(3)(ii)\]

\(3\) Any notice to vacate (or quit) which is

required by State or local law may be combined

with, or run concurrently, with the notice of lease

termination under this section. \[966.4 (l)(3)(iii)\]

The Notice to Vacate must be in writing, and

specify that if Tenant fails to quit the premises

within the applicable statutory period, appropriate

action will be brought against Tenant, and Tenant

may be required to pay the costs of court and

attorney\'s fees.

\(4\) When the Authority is required to offer Tenant

the opportunity for a grievance hearing under the

Authority\'s grievance procedure for a grievance

concerning the lease termination, the tenancy shall

not terminate (even if any Notice to Vacate under

State of local law has expired) until the period to

request a hearing has expired, or (if a hearing is

requested) the grievance process has been

completed. \[966.4 (l)(3)(iv)\]

\(5\) When the Authority is not required to offer

Tenant the opportunity for a hearing under the

grievance procedure and the Authority has decided

to exclude such grievance from Authority grievance

procedure, the notice of lease termination shall

\(a\) state that Tenant is not entitled to a

grievance hearing on the termination; (b) specify

the judicial eviction procedure to be used by the

Authority for eviction and state that HUD has

determined that this eviction procedure provides

the opportunity for a hearing in a court that

contains the basic elements of due process as

defined in HUD regulations; and (c) state whether

the eviction is for a criminal activity that

threatens health or safety of residents or staff or

for drug-related criminal activity. \[966.4 (l)(3)(v)\]

\(6\) The Authority may evict a Tenant from the unit

either by bringing a court action; or an as an

alternative, the Authority may evict by bringing an

administrative action if law of the jurisdiction

permits eviction by administrative action, after a

due process administrative hearing, and without a

court determination of the rights and liabilities

of the parties. In order to evict without bringing

a court action, the Authority must afford the

Tenant the opportunity for a pre-eviction hearing

in accordance with the PHA grievance procedure.

\[966.4 (l)(4)(i)(ii)\]. The hearing notice will

advise persons with disabilities of their rights to

request a reasonable accommodation.

\(d\) Tenant may terminate this Lease at any time by

giving 30 days written notice as described in Section

XIII, above.

\(e\) In deciding to evict for criminal activity, the

Authority shall have discretion to consider all of the

circumstances of the case, including the seriousness of

the offense, the extent of participation by or

awareness of family members, and the effects that the

eviction would have both on family members not involved

in the proscribed activity and on the family\'s

neighbors. In appropriate cases, the Authority may

permit continued occupancy by remaining family members

and may impose a condition that family members who

engaged in the proscribed activity will neither reside

in nor visit the unit. The Authority may require a

family member who has engaged in the illegal use of

drugs to present credible evidence of successful

completion of a treatment program as a condition to

being allowed to reside in the unit. \[966.4 (l)(5)\]

\(f\) When the Authority evicts a tenant from a dwelling

unit for criminal activity, the Authority shall notify

the local post office serving that dwelling unit that

such individual or family is no longer residing in the

unit so the post office will stop mail delivery for

such persons and they will have no reason to return to

the unit. \[966.4 (l)(5)(ii))\]

XV\. Waiver

No delay or failure by the Authority in exercising any right

under this lease agreement, and no partial or single exercise

of any such right shall constitute a waiver (post or

prospective) of that or any other right, unless otherwise

expressly provided herein.

XVI\. Housekeeping Standards

In an effort to improve the livability and conditions of the

apartments owned and managed by the Authority, uniform

standards for resident housekeeping have been developed for

all tenant families.

\(a\) Authority Responsibility: The standards that follow

will be applied fairly and uniformly to all Tenants.

The Authority will inspect each unit at least annually,

to determine compliance with the standards. Upon

completion of an inspection, the Authority will notify

Tenant in writing if he/she fails to comply with the

standards. The Authority will advise Tenant of the

specific correction(s) required to establish

compliance, and indicate that training is available.

Within a reasonable period of time, the Authority will

schedule a second inspection. Failure of a second

inspection will constitute a violation of the lease

terms.

Training will be available at no cost to any Tenant

requesting or needing assistance in complying with the

Housekeeping Standards.

\(b\) Tenant responsibility: Tenant is required to abide

by the standards set forth below. Failure to abide by

the Housekeeping Standards that results in the creation

or maintenance of a threat to health or safety is a

violation of the lease terms and can result in

eviction.

\(c\) Housekeeping Standards: Inside the Apartment

General\--

\(1\) Walls: should be clean, free of dirt, grease,

holes, cobwebs, and fingerprints.

\(2\) Floors: should be clean, clear, dry and free

of hazards.

\(3\) Ceilings: should be clean and free of cobwebs.

\(4\) Windows: should be clean and not nailed shut.

Shades or blinds should be intact.

\(5\) Woodwork: should be clean, free of dust,

gouges, or scratches.

\(6\) Doors: should be clean, free of grease and

fingerprints. Doorstops should be present.

Locks should work.

\(7\) Heating units: should be dusted and access

uncluttered.

\(8\) Trash: shall be disposed of properly and not

left in the unit.

\(9\) Entire unit should be free of rodent or insect

infestation.

Kitchen\--

\(1\) Stove: should be clean and free of food and

grease.

\(2\) Refrigerator: should be clean. Freezer door

should close properly and freezer have no more

than one inch of ice.

\(3\) Cabinets: should be clean and neat. Cabinet

surfaces and countertop should be free of grease

and spilled food. Cabinets should not be

overloaded. Storage under the sink should be

limited to small or lightweight items to permit

access for repairs. Heavy pots and pans should

not be stored under the sink.

\(4\) Exhaust Fan: should be free of grease and

dust.

\(5\) Sink: should be clean, free of grease and

garbage. Dirty dishes should be washed and put

away in a timely manner.

\(6\) Food storage areas: should be neat and clean

without spilled food.

\(7\) Trash/garbage: should be stored in a covered

container until removed to the disposal area.

Bathroom\--

\(1\) Toilet and tank: should be clean and odor

free.

\(2\) Tub and shower: should be clean and free of

excessive mildew and mold. Where applicable,

shower curtains should be in place, and of

adequate length.

\(3\) Lavatory: should be clean

\(4\) Exhaust fans: should be free of dust.

\(5\) Floor: should be clean and dry.

Storage Areas\--

\(1\) Linen closet: should be neat and clean.

\(2\) Other closets: should be neat and clean. No

highly flammable materials should be stored in

the unit.

\(3\) Other storage areas: should be clean, neat and

free of hazards.

\(d\) Housekeeping Standards: Outside the Apartment

The following standards apply to family and scattered

site development only; some standards apply only when

the area noted is for the exclusive use of Tenant:

\(1\) Yards: should be free of debris, trash, and

abandoned cars. Exterior walls should be free

of graffiti.

\(2\) Porches (front and rear): should be clean and

free of hazards. Any items stored on the porch

shall not impede access to the unit.

\(3\) Steps (front and rear): should be clean, and

free of hazards.

\(4\) Sidewalks: should be clean and free of

hazards.

\(5\) Storm doors: should be clean, with glass or

screens intact.

\(6\) Parking lot: should be free of abandoned

cars. There should be no car repairs in the

lots.

\(7\) Hallways: should be clean and free of hazards.

\(8\) Stairwells: should be clean and uncluttered.

\(9\) Laundry areas: should be clean and neat.

Remove lint from dryers after use.

\(10\) Utility room: should be free of debris, motor

vehicle parts, and flammable materials.

TENANT AGREES THAT ALL THE PROVISIONS OF THIS LEASE HAVE BEEN

READ AND ARE UNDERSTOOD AND FURTHER AGREES TO BE BOUND BY ITS

PROVISIONS AND CONDITIONS AS WRITTEN. ( SIGNATURE REQUIRED ON

PART II OF THE LEASE.)

(IN FINAL LEASE COPY \-- INSERT LEAD-BASED PAINT WARNING AS

REQUIRED BY HUD.)

PART II of the RESIDENTIAL LEASE AGREEMENT:

Housing Authority of \_\_\_\_\_\_\_\_\_\_

THIS AGREEMENT is executed between the Housing Authority of
\_\_\_\_\_\_\_\_\_\_\_\_\_

(herein called \"\_\_\_\_\_\"),

and
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(herein called the

\"Tenant\"), and becomes

effective as of this date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\[966.4 (a)\]

\(l\) Unit: That the PHA, relying upon the representations of Tenant as
to

Tenant\'s income, household composition

and housing need, leases to Tenant, (upon Terms and Conditions set forth

in Part I of this Lease agreement) the

dwelling unit LOCATED at \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(and hereinafter called the

\"premises\") to be occupied

exclusively as a private residence by Tenant and household. The Tenant
UNIT

NUMBER is:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. \[966.4 (a)\]

\(2\) Household Composition: The Tenant\'s household is composed of the

individuals listed below. (Other than the Head or Spouse) each

household member should be listed by age, oldest to youngest.

\[966.4 (a)(2)\] All members of the household over age 18 shall execute

the lease.

Name

Relationship

Age & Birthdate

Social Security \#

1\.

Head

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

2

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

3

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

4

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

5

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

6

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

7

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

8

\_\_\_ / /

\_ \_ \_- \_ \_- \_ \_ \_ \_

\(3\) Term: The term of this lease shall be one calendar month, renewed
as

stipulated in Part I of the Lease.

\(4\) Rent: Initial rent (prorated for partial month) shall be
\$\_\_\_\_\_.\_\_ and,

if applicable, the Tenant shall receive

the benefit of \$\_\_\_\_\_.\_\_ from the Authority for Utility

Reimbursement (for partial month) paid to the utility

supplier for the period beginning \_\_\_/\_\_\_/\_\_\_ and ending at

midnight on \_\_\_/\_\_\_/\_\_\_.

Thereafter, rent in the amount of \$\_\_\_\_\_.\_\_ per month

shall be payable in advance on the first day of each month,

and shall be delinquent after the \_\_\_\_ day of said month. A

utility reimbursement of \$\_\_\_\_\_.\_\_per month (if

applicable) shall be paid to the utility supplier by the

Authority for the Tenant. \[966.4 (b)(1)\]

\(5\) Utilities and Appliances: PHA-Supplied Utilities \[966.4 (b)(1)\]

If indicated by an (X) below, PHA provides the indicated utility

as part of the rent for the premises:

( ) Electricity ( ) Natural Gas ( ) Heating Fuel ( )
Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If indicated by an (X) below, the Authority shall provide the following

appliances for the premises:

( ) Cooking Range ( ) Refrigerator(6) Utilities Allowances: Tenant-Paid

Utilities \[913.102\]

If indicated by an (X) below, the Authority shall provide Tenant with a

Utility Allowance in the monthly amount

totaling \$\_\_\_\_\_\_ for the following utilities paid directly by the
Tenant to

the Utility supplier:

( ) Electricity ( ) Gas ( ) Heat ( ) Water ( ) Sewerage

\(7\) Charges for Excess Appliances (Not applicable to tenants who pay

utilities directly to utility supplier.)

Charges for excess appliances are due per the following: \[966.4
(b)(2)\]

Air Conditioners: An additional charge of \$\_\_\_\_\_\_\_\_\_ per month
will be

payable for each air conditioner in

the premises for each month of occupancy.

Other Appliances: If checked below, an additional charge of
\$\_\_\_\_\_\_\_ per

month for each month of

occupancy for each excess appliance on the premises.

( ) Freezer, type:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ( ) Extra
Refrigerator

( ) Second color TV ( ) Second Stereo

( ) Automatic washer ( ) Electric space heater

( ) Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ( ) Other:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(8\) Security Deposit: Tenant agrees to pay \$\_\_\_\_\_\_\_\_as a
security deposit.

See Part I of this lease for

information on treatment of the Security Deposit. \[966.4 (b)(5)\]

\(9\) Execution: By Tenant\'s signature below, Tenant and household
agree to

the terms and conditions of Part I

and II of this lease and all additional documents made a part of the

lease by reference.

By the signature(s) below I/we also acknowledge that the Provisions of
Part I

of this Lease Agreement have been

received and thoroughly explained to me/us.

TENANT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CO-TENANT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CO-TENANT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

MANAGER:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

WITNESS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DATE\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TENANT\'S CERTIFICATION

I, hereby certify that I, and other members of my

Household, have not committed any fraud in

connection with any federal housing assistance program, unless such
fraud was

fully disclosed to the Authority

before execution of the lease, or before the Authority\'s approval for
occupancy

of the unit by the Household member.

I further certify that all information or documentation submitted by
myself or

other Household members to the

Authority in connection with any federal housing assistance program
(before and

during the lease term) are true

and complete to the best of my knowledge and belief.

Tenant\'s Signature Date

ATTACHMENTS:

If indicated by an (X) below, the Authority has provided the tenant with
the

following attachments and information:

( ) Part I of this Lease ( ) Housekeeping Standards

( ) Standard Maintenance Charges (May be updated) ( ) Pet Policy

( ) Grievance Procedure (May be updated) ( ) Watch Out for Lead Paint
Poisoning

( ) Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STATEMENT ON RECEIPT OF INFORMATION

I/We have received a copy of the above information including \"The
Danger of

Lead Poisoning to Homeowners\"

and \"The Danger of Lead Poisoning to Renter.\" The above information
has been

thoroughly explained to me/us.

I/We understand the possibility the lead-based paint may exist in the
unit.

Tenant\'s Signature Date

OFFICE ADDRESS: HOURS

TELEPHONE NUMBER:

EMERGENCY MAINTENANCE TELEPHONE NUMBER

Monday through Friday after:\_\_\_\_\_p.m., and weekends and holidays.