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Box 4406, Taunton, MA 02780‐0420  \n􀁸 By fax: (617) 887‐8765  \n􀁸 In person at your local DTA office.  \nInstructions  \nYou can use this form to verify information about your housing situation:  \n􀁸 For TAFDC, we need to know if you live in private, public or subsidized housing and if you pay rent.  \n􀁸 For EAEDC, we need to know if you pay rent.  \n􀁸 For SNAP, you may get more benefits if you tell us your rent amount and whether you pay for utilities. You can get benefits if you do not give us this information, but the amount may be lower.  \n􀁸 For SNAP, TAFDC and EAEDC, we need verification that you live in Massachusetts.  \nTo use this form, give it to your landlord or property manager. See below for examples of verifications you can give us instead of this form. If you cannot get any of these verifications, talk to a DTA case manager. We may accept your written statement in some situations.  \nExamples of other verifications  \nTo verify that you live in Massachusetts:  \n􀁸 Recent rent receipt or lease  \n􀁸 Recent utility bill  \n􀁸 Voter registration card  \n􀁸 Recent wage stub or employment document showing your address  \n􀁸 Health insurance statement showing your address  \n􀁸 Driver’s license, state ID or school ID showing your address  \nTo verify your rent:  \n􀁸 Recent rent receipt or lease  \n􀁸 Recent cancelled check or money order for rent payment  \nTo verify your utilities:  \n􀁸 Recent bill for heating or cooling  \n􀁸 Recent bill for gas or oil (non‐heat), electricity, wood, coal, water, sewerage, or trash disposal  \n􀁸 Recent bill for phone  \n􀁸 Fuel assistance approval letter  \nIf you have questions or need help getting verifications  \n􀁸 If you are applying for or getting SNAP benefits, call DTA at 1‐877‐382‐2363.  \n􀁸 If you are applying for or getting cash assistance (TAFDC or EAEDC), call your case manager  \nLL/VER (Rev. 6/2016) Page 1 of 2 18‐083‐0616‐05  \nLandlord Verification Form For client and DTA:  \nGive this form to DTA  \n􀁸 By mail: DTA Document Processing Center, P.O. Box 4406, Taunton, MA 02780‐0420  \n􀁸 By fax: (617) 887‐8765  \n􀁸 In person at your local DTA office.  \nClient’s name Agency ID or last 4 of SSN  \nAddress  \nList people who are related to you or your children who live at the address:  \n____________________________________________________________________________________________________________  \nReturn completed form to the address above by:    \nFor Landlord or Property Manager  \nA. Rental Information  \n1. This tenant pays rent of: $   per  month  week  other    \n2. Is the tenant’s housing public or subsidized (e.g., Section 8 or MRVP)?  Yes  No  \n3. Is the tenant behind on the rent?  Yes  No  \nIf yes, how many months?   \nB. Utility Information  \n1. Are heat/air conditioning and all other utilities included in the rent?  Yes  No  \n2. If not, does the tenant pay for any of the following utilities separate from the rent?  \nHeat  Yes  No  \nAir conditioning  Yes  No  \nElectricity  Yes  No  \nFuel for cooking  Yes  No  \nC. Landlord or Property Manager Certification  \nI certify under penalty of perjury that my answers are correct and complete to the best of my knowledge. If not the landlord, I also certify that I have the legal authority to sign.  \nPrint name Date  \nSignature Telephone number  \nLL/VER (Rev. 6/2016) Page 2 of 2 18‐083‐0616‐05","cbCaibB8m4NaQ507","https://ap.wps.com/l/cbCaibB8m4NaQ507","pdf",152490,"English","# Instructions\n## Examples of other verifications\n## If you have questions or need help getting verifications\n# Landlord Verification Form\n## Client and DTA information\n## Rental Information\n## Utility Information\n## Certification","[{\"question\":\"该表格用于核实哪些住房信息？\",\"answer\":\"用于核实申请人的居住情况（例如是否为私有、公共或补贴住房、是否缴纳租金）以及与租金、公用事业相关的信息。\"},{\"question\":\"如果无法提供该表格，通常还能用哪些材料替代核实？\",\"answer\":\"可用近期租金收据或租约、近期公用事业账单、选民登记卡、显示地址的工资单或就业文件、健康保险声明、以及显示地址的驾照/州ID/学生证等替代。\"},{\"question\":\"房东或物业管理方需要完成哪些主要填写与认证？\",\"answer\":\"需填写租赁信息（租金支付情况、是否公共或补贴住房、是否拖欠租金）、公用事业信息（供暖/制冷是否计入租金及是否由租客另行支付各项费用），并完成在宣誓罚则下的认证签字、打印姓名、日期与联系方式。\"}]","Massachusetts Department of Transitional Assistance - Landlord Verification Form | PDF",1789503148]