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LIVING IN COMMUNITIES LINC APARTMENT REGISTRATION FORM 1. Program Information A Check One LINC I B Check One DHS Shelter Community Transfer 2. Tenant Information First Name Last Name Certification of Adults of Children CARES Case SSN Needs ADA Compliant Unit No Yes 3. Shelter Contact Information Note Shelter Name Shelter Code Phone 4. Building Information Borough Block Lot Zip Code Building Address of Units in Building AKA Building/Unit ADA Compliant No Yes Elevator No 5. Unit Information Unit Floor of Rooms Bedrooms Rent amount Is the unit rent controlled or rent stabilized 6. Landlord Information Landlord First/Last Name Tax ID Landlord Legal Name as Listed on Deed Owners s Landlord Address Apt State Email 7. Real Estate Broker if applicable License Name Broker Name License Business Name Business Address 8. Inspection Contact Information Check One Landlord Broker Other If other please complete contact information below Contact Name Phone 9. Tenant Information First Name Last Name Certification of Adults of Children CARES Case SSN Needs ADA Compliant Unit No Yes 3. Shelter Contact Information Note Shelter Name Shelter Code Phone 4. Building Information Borough Block Lot Zip Code Building Address of Units in Building AKA Building/Unit ADA Compliant No Yes Elevator No 5. Shelter Contact Information Note Shelter Name Shelter Code Phone 4. Building Information Borough Block Lot Zip Code Building Address of Units in Building AKA Building/Unit ADA Compliant No Yes Elevator No 5. Unit Information Unit Floor of Rooms Bedrooms Rent amount Is the unit rent controlled or rent stabilized 6. Unit Information Unit Floor of Rooms Bedrooms Rent amount Is the unit rent controlled or rent stabilized 6. Landlord Information Landlord First/Last Name Tax ID Landlord Legal Name as Listed on Deed Owners s Landlord Address Apt State Email 7. Landlord Information Landlord First/Last Name Tax ID Landlord Legal Name as Listed on Deed Owners s Landlord Address Apt State Email 7. Real Estate Broker if applicable License Name Broker Name License Business Name Business Address 8. Real Estate Broker if applicable License Name Broker Name License Business Name Business Address 8. Inspection Contact Information Check One Landlord Broker Other If other please complete contact information below Contact Name Phone 9. Tenant Information First Name Last Name Certification of Adults of Children CARES Case SSN Needs ADA Compliant Unit No Yes 3. Shelter Contact Information Note Shelter Name Shelter Code Phone 4. Building Information Borough Block Lot Zip Code Building Address of Units in Building AKA Building/Unit ADA Compliant No Yes Elevator No 5. Unit Information Unit Floor of Rooms Bedrooms Rent amount Is the unit rent controlled or rent stabilized 6. Shelter Contact Information Note Shelter Name Shelter Code Phone 4. Building Information Borough Block Lot Zip Code Building Address of Units in Building AKA Building/Unit ADA Compliant No Yes Elevator No 5. Unit Information Unit Floor of Rooms Bedrooms Rent amount Is the unit rent controlled or rent stabilized 6. Landlord Information Landlord First/Last Name Tax ID Landlord Legal Name as Listed on Deed Owners s Landlord Address Apt State Email 7. .

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