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The document requires landlords to document specific heating cost arrangements, confirming whether heating expenses are included in rent, paid as an additional fee to the landlord, or paid directly to a third-party fuel supplier. It captures essential data including heat source types, fuel supplier details, account numbers, and landlord contact information. By establishing clear payment responsibilities, this template ensures accurate disbursement of energy benefits. The form includes dedicated sections for landlord certification and applicant authorization, providing a structured mechanism to validate rental and utility agreements for program eligibility purposes. 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The above listed applicant has requested a payment for energy assistance to be made payable directly to them. They have stated that their heating costs are included as part of their rent. Please indicate the payment arrangement with this tenant for heating-related costs.  \n  1. Tenants heating costs are included in their rent payment to landlord. Amount of rent is $   \n  2. Tenant pays heating cost in addition to rent to landlord.  \n  3. Tenant is responsible for heating cost paid to fuel supplier.  \nB. Please indicate the primary (P) and/or secondary (S) heat source at the address listed above and the account number or supplier.  \n  ELECTRIC HEAT    \nNATURAL GAS  \n_____ ___________________  \nOIL – SUPPLIER  \n_____ ___________________  \nC.  \nSignature of Landlord / Agent  \nLandlord Address  \n_____  \n_____  \nPROPANE/  \nLIQUID GAS – SUPPLIER  \n______________  \nWOOD – SUPPLIER  \n______________  \nDate of Landlord Signature  \nLandlord Telephone  \nAPPLICANT: COMPLETE THIS PART  \nI PAY MY HEATING EXPENSES TO    \n(Name of Landlord or Fuel Supplier)  \nSignature of Applicant Date","cbCaisMMuFEKfmEN","https://ap.wps.com/l/cbCaisMMuFEKfmEN","pdf",100567,"English","# Landlord Information Requirements\n## Heating Cost Arrangement Details\n## Primary and Secondary Heat Source Identification\n## Landlord Certification and Contact Information\n## Applicant Authorization and Payment Declaration","[{\"question\":\"What is the purpose of this Landlord Letter?\",\"answer\":\"This letter is used to verify an applicant's heating cost arrangements with their landlord to facilitate the distribution of energy assistance payments.\"},{\"question\":\"What information must the landlord provide regarding heating costs?\",\"answer\":\"The landlord must indicate whether heating costs are included in the rent, paid in addition to the rent, or paid directly by the tenant to a separate fuel supplier.\"},{\"question\":\"What details are required in the heat source section?\",\"answer\":\"The landlord must specify the primary and/or secondary heat source (such as electric, natural gas, oil, propane, or wood) and provide the corresponding account number or supplier name.\"}]","Landlord Letter - Energy Assistance Verification Form | PDF",1789628500]