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Get NYC HRA W-147Q LLF 2012

Form W-147Q LLF Rev. 5/3/12 Primary Tenant s Statement Regarding Occupancy of Secondary Tenant Secondary Tenant s Name Case Number if any Address Apt. Number Borough Zip Code I do hereby declare that I am the primary tenant of apartment located at. I do also declare that also lives on these premises. name of secondary tenant I charge per month rent for providing shelter heat/utilities. Attached is a copy of my lease or other documentation demonstrating that I am a legal tenant of this apartment. Rent payment method check the applicable boxes c d e f g Rent is paid directly to the landlord. I share meals with the secondary tenant named above g Yes g No I swear under penalty of perjury that the information I have given on this form is correct and complete to the best of my knowledge. Number Borough Zip Code I do hereby declare that I am the primary tenant of apartment located at. I do also declare that also lives on these premises. name of secondary tenant I charge per month rent for providing shelter heat/utilities. Attached is a copy of my lease or other documentation demonstrating that I am a legal tenant of this apartment. name of secondary tenant I charge per month rent for providing shelter heat/utilities. Attached is a copy of my lease or other documentation demonstrating that I am a legal tenant of this apartment. Rent payment method check the applicable boxes c d e f g Rent is paid directly to the landlord. I share meals with the secondary tenant named above g Yes g No I swear under penalty of perjury that the information I have given on this form is correct and complete to the best of my knowledge. Number Borough Zip Code I do hereby declare that I am the primary tenant of apartment located at. I do also declare that also lives on these premises. name of secondary tenant I charge per month rent for providing shelter heat/utilities. Attached is a copy of my lease or other documentation demonstrating that I am a legal tenant of this apartment. Rent payment method check the applicable boxes c d e f g Rent is paid directly to the landlord. I share meals with the secondary tenant named above g Yes g No I swear under penalty of perjury that the information I have given on this form is correct and complete to the best of my knowledge. .

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