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Contract with an owner, the Authority will pay to the owner on behalf of the Family an amount equal to the difference between the monthly rental amount owed by the Family to the owner and the total monthly rent which the owner is entitled to receive under the lease.

4. Authority Approval of Lease. The Authority will notify the owner and the Family whether or not the proposed lease is approvable within

working days from receipt of a Request for Lease Approval. The Authority, upon issuing this Certificate, anticipates that if a lease meeting the requirements of this program is submitted for approval, the Authority will have funds available for a Housing Assistance Payments Contract with the owner; however, the Authority is under no obligation to the Family, to any owner or to any other person to approve any submitted lease, nor does the Authority incur any liability by reason of issuing this Certificate. Approval of any lease will be at the Authority's sole discretion and subject to availability of funds.

5. Conditions. The Family agrees to perform all its obligations under the Housing Assistance Payments Program, including the obligations to (a) provide such income information and records as may be required in the administration of the program, (b) permit inspections of its dwelling unit at reasonable times after reasonable advance notice, and (c) give at least 30 days notice to the Authority of the Family's intention to vacate the unit.

6. Equal Housing Opportunity. If the Family has reason to believe that, in its search for suitable housing, it has been discriminated against on the basis of race, color, creed, sex, religion, or national origin, it may file a complaint with the HUD Regional Office. Fair Housing Complaint Forms (form HUD 903) are available from this Authority.

7. Expiration Date. A request for Lease Approval may be submitted to this Authority no later than

(60 days from the date of this Certificate). If a Request is not submitted by such date, this Certificate shall expire unless extended by the Authority in writing.

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approve the attached lease for the dwelling unit located at

(street address and apartment

number, if any) for a period of months, beginning

19--- The unit, consisting of bedrooms, is to be leased at $-per month. This rent includes maintenance and other services as provided in the lease and the following utilities and appliances: (Check where applicable) heat ---- electricity ---- gas

water sewer refrigerator range other (specify)

2. Certification. The Owner, by executing this Request, certifies that:

a. The most recent rent charged for the above dwelling unit was $---- per month. The reasons for the difference, if any, between this amount and the proposed rent are:

b. The specified dwelling unit is currently: 0 Vacant and has been since before the

date of this Request. Occupied by the undersigned Family. Occupied by other than the undersigned

Family but the unit will be vacated prior to occupancy by the Family as a result of (1) voluntary decision of occupant, or (2) action by Owner for cause, or (3) other reasons clearly unrelated to the proposed leasing to the

Family. c. This unit is made available, managed, and operated regardless of race, color, religion, creed, sex, or national origin.

3. Security and Utility Deposits. The Family o will will not require Authority assistance to pay security and/or utility deposits. The amount of Owner's required security deposit (not to exceed one month's rent) is $--------. The amounts of the required utility deposits are: Deposit to

(Insert name of utility company) Deposit to

$. (Insert name of utility company) 4. Authority Determination. The Owner and the Family understand that the Authority will notify them as to whether or not the proposed lease is approvable within the time period specified in paragraph 4 of the Certificate of Family Participation.

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By:

By:

(Signature and Title)

(Signature)

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(Owner) for the dwelling unit located at

Returned here(street address and apart

ment number, if any) with are (a) the proposed lease completed by the Authority with respect to the portion of the monthly lease rental which the Family shall be obligated to pay to the Owner, and (b) two copies of a Housing Assistance Payments Contract completed by this Authority except for execution. The lease shall be executed by the Family and the Owner and a copy returned to the Authority. The Owner shall sign both copies of the Contract and return them to the Authority. "The Authority will execute the Contract by the first day of occupancy specified in the lease and will immediately return an executed copy to the Owner.

Attached is a Security Deposit Agreement, signed by this Authority, which shall be signed by the Owner and the Family and a signed copy returned to this Authority. o Yes

0 No 0 2. Disapproval. The proposed lease and/ or the dwelling unit are/ is disapproved for the following reasons: 0 3. Resubmission. If the conditions in item 2 above are remedied, and a Request for Lease Approval is resubmitted by the Owner and the Family to the Authority by (date), the lease will be approved by the Authority if it determines that the conditions have been remedied to its satisfaction, (The Certificate of Family Participation issued to the Family shall not expire before said date.)

"b. The Lessor shall provide the following services (including security) and maintenance:

(Here specify all services to be provided by the Lessor, which shall include all services customarily supplied to tenants of this type of housing in the locality. In preparing this "list, the provisions contained in form HUD52505A, Guide for Lease Provisions for Maintenance and Security Services, shall be included except to the extent modifications are approved by the LHA.]

"c. The Lessor shall not evict the Lessee unless the Lessor complies with the requirements of local law, if any, and of this provision. The Lessor shall give the Lessee a written notice of the proposed eviction, stating the grounds and advising the Lessee that he has 10 days (or such greater number, if any, that may be required by local law) within which to respond to the Lessor. Because the Lessor must obtain the LHA's authorization for an eviction, a copy of the notice shall be furnished simultaneously to the LHA, and the notice shall also state that the Lessee -may, within the same time period, present his objections to the LHA in writing or in person. The LHA shall forthwith examine the grounds for eviction and shall authorize the eviction unless it finds the grounds to be insufficient under the Lease. The LHA shall notify the Lessor and the Lessee of its determination within 20 days of the date of receipt of the notice by the Lessee whether or not the Lessee has presented objections to the LHA.

d. The Lessor shall not discriminate against the Lessee in the provision of services, or in any other manner, on the grounds of race, color, creed, religion, sex, or national origin.

"e. This Lease has been signed by the parties on the condition that the LHA will promptly execute a Housing Assistance Payments Contract with the Lessor. Accordingly, this Lease shall not become effective unless the LHA has executed such Contract by the first day of occupancy specified in the Lease. Lessor

Lessee
Date
By

Date

(Date)

(Name of Local Housing

Authority)
By:

(Signature and Title) APPENDIX VI-LEASE PROVISIONS REQUIRED

FOR PARTICIPATION IN THE HOUSING ASSISTANCE PAYMENTS PROGRAM

"ADDENDUM TO LEASE

GUIDE FOR LEASE PROVISIONS FOR MAINTENANCE

AND SECURITY SERVICES

(Section 23 Housing Assistance Payments

Program) "The following additional Lease provisions are incorporated in full in the Lease between

(Lessor) and (Lessee) for the following dwelling unit:

In case of any conflict between these and any other provisions of the Lease, these provisions shall prevail. "a. Of the total rent ($_

per month), $-------- shall be payable by the Housing Authority (LHA) as housing assistance payments on behalf of the Lessee and $

shall be payable by the Lessee. "These amounts shall be subject to change by reason of changes in the family income or composition, as determined by the LHA, effective as of the date stated in a notification of such change by the LHA to the Lessee and Lessor.

The following provisions shall be included by an owner among lease provisions regarding maintenance and security services for units to be leased to families participating in a Section 23 Housing Assistance Payments Program. Subject to the approval of the LHA, items which are not customarily provided for this type of housing in the locality may be excluded.

The Lessor shall provide the following services (including security) and maintenance:

a. Custodial services (including, but not limited to, cleaning of hallways, garbage storage areas, and all common areas, and provision of an adequate supply of trash and

garbage storage equipment, and/or adequate 1.2. Housing assistance payments. a. The trash and garbage disposal);

LHA has determined that the Family can b. Grounds maintenance (including, but afford to pay $-------- per month toward not limited to, exterior custodial services and the rent chargeable by the Owner. The LHA maintenance of lawns and outdoor plantings, will pay on behalf of the Family a housing including lawn cutting and reseeding);

assistance payment in the amount of $. c. Prompt response to Lessee service calls

which represents the difference between the (including, but not limited to, calls with re- rent chargeable by the owner and that porspect to refrigerators, ranges, plumbing, tion of said rent payable by the Family. The heating, electrical and hot water fixtures and amount of housing assistance payment and systems, and broken, stuck, or damaged the amount of rent payable by the Family doors, screens or windows);

shall be subject to change by reason of d. Repainting and redecorating dwelling changes in the Family income or composition, space and non-dwelling space surfaces on the as determined by the LHA, effective as of following basis: (to be specified in the the date stated in a notification of such lease];

change by the LHA to the Family and Owner. e. Prompt replacement of light bulbs and However, any increase in the amount payother lighting equipment in common (in- able by the Family shall be offset by a corcluding outdoor) areas;

responding decrease in the amount of housf. Exterminating services on a regularly ing assistance payment; and any decrease scheduled basis, as follows: (to be specified in the amount payable by the Family shall in lease];

be offset by a corresponding increase in the g. Where applicable, removal of snow and amount of housing assistance payment, but ice from walkways, exterior stairs, and park- not in excess of the amount available with ing areas on a timely basis;

respect to this assisted unit out of the aggreh. Repair of walkways and parking lot gate amount pledged in the Annual Consurfaces;

tributions Contract (ACC) for all dwelling i. Where applicable, repair of garbage dis

units under the ACC (see Section 2.3(b)). posals, dishwashers, air conditioners, and

b. Housing assistance payments shall be laundry equipment;

made by the LHA to the Owner, under the j. Where applicable, regular maintenance

terms and conditions of this Contract, only and prompt repair of elevators, incinerators, for the period during which the assisted unit compactors, and laundry equipment and

is leased by the Family under the lease for facilities;

the dwelling unit approved by the LHA k. Security services and equipment (to be

("Lease”). Should the Family vacate its unit specified in the lease).

in violation of the provisions of its Lease, NOTE: Appendices VII and VIII, which re

the Owner may continue to receive housing late to internal HUD processing procedures, assistance payments in accordance with the are not included herein, but do appear in the

terms of the Contract, not beyond the term HUD Existing Housing Handbook.

of the Lease, but only if the Owner (1) imAPPENDIX IX-HOUSING ASSISTANCE PAYMENTS

mediately upon leasing of the vacancy, has CONTRACT

taken all feasible action to fill it, including,

but not limited to, contacting families on This Housing Assistance Payments Con

his waiting list, requesting the LHA to refer tract ("Contract") is made and entered into eligible families, and advertising the availaon this day of

19----,

bility of the unit; (2) has promptly (within by and between

30 days of the date the Family vacated the the person or entity having the legal right unit) notified the LHA of the vacancy; and to lease the unit (hereinafter called the (3) has not rejected, except for good cause "Owner"), and

acceptable to the LHA, any substitute family (LHA"), a public body, corporate and poli- provided by the LHA. tic, organized and existing under and by c. Neither the LHA nor the United States virtue of the laws of the State of

of America, (hereinafter referred to as the "Government”) has assumed any obligation

whatsoever for the amount of rent payable The Owner and the LHA agree as follows: by the Family or the satisfaction of any PART I

claim by the Owner against the Family. The

financial obligation of the LHA is limited 1.1. Purpose of contract. a. The LHA hereby to making housing assistance payments on agrees to make housing assistance payments behalf of the Family in accordance with this on behalf of name of family) ("Family") Contract. for the following described dwelling unit d. (1) The Owner shall submit a monthly

(“assisted unit”), to enable the request to the LHA for the housing assistFamily to lease decent, safe, and sanitary ance payment. Upon the determination of housing pursuant to Section 23 of the United the LHA that the amount of the request is States Housing Act of 1937.

correct and that the Owner is in compliance b. The assisted unit is to be leased by the with the provisions of this contract, the Owner to the Family for use and occupancy LHA shall pay to the Owner the amount by the Family solely as a private dwelling. requested.

Owner and the Family of its determination within 20 days of the date of receipt of the notice by the Family, whether or not the Family has presented objections to the LHA.

1.6. Owner-family lease. The Lease between the Owner (Lessor) and the Family (Lessee) shall contain the following provisions:

ADDENDUM TO LEASE

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(2) If the Owner receives any excessive payment, the LHA, in addition to any other rights to recovery, may deduct the amount from any subsequent payment or payments.

(3) The Owner's monthly requests for housing assistance payments shall be made subject to penalty under 18 U.S.C. 1001, which provides, among other things, that whoever knowingly and willfully makes or uses a document or writing containing any false, fictitious, or fraudulent statement or entry, in any matter within the jurisdiction of any department or agency of the United States shall be fined not more than $10,000 or imprisoned for not more than five years or both.

1.3. Maintenance, operation and inspection. a. The term “Premises”, as used in this Contract, means the dwelling unit leased by the Family and areas, facilities and grounds which are for its benefit or use.

b. The Owner agrees (1) to maintain and operate the Premises so as to provide decent, safe, and sanitary housing, and (2) to provide all maintenance and services as contained in the Lease. If, at any time during the term of this contract, the Owner fails to comply with the obligation in (1), housing assistance payments on behalf of the Family shall be wholly abated and if the Owner fails to comply with the obligation in (2), housing assistance payments on behalf of the Family shall be abated in whole or in part. Any abatement under this paragraph b shall be effective upon written notification to the Owner, and shall continue until such time as the obligation is complied with. The LHA shall promptly notify the Family of any such abatement.

c. The LHA will inspect, or cause to be inspected, at least annually, the Premises to determine that they are in decent, safe, and sanitary condition.

1.4. Term of contract. The term of this Contract shall be

The Contract shall terminate upon expiration or termination of the Lease and shall be subject to termination in accordance with the provisions of Section 2.5 of this contract.

1.5. Eviction. The Owner shall not evict the Family unless the Owner complies with the requirements of local law, if any, and of this Section, The Owner shall give the Family a written notice of the proposed eviction, stating the grounds and advising the Family that it has 10 days (or such greater number, if any, that may be required by local law) within which to respond to the Owner. The Owner must obtain the LHA's authorization for an eviction; accordingly, a copy of the notice shall be furnished simultaneously to the LHA, and the notice shall also state that the Family may, within the same time period, present its objections to the LHA in writing or in person. The LHA shall forthwith examine the grounds for eviction and shall authorize the eviction unless it finds the grounds to be insufficient under the Lease. The LHA shall notify the

"The following additional Lease provisions are incorporated in full in the Lease between

(Lessor)

and (Lessee) for the following dwelling unit:

In case of any conflict between these and any other provisions of the Lease, these provisions shall prevail.

"a. Of the total rent ($-------- per month), $-------- shall be payable by the Housing Authority (LHA) as housing assistance payments on behalf of the Lessee and

shall be payable by the Lessee. These amounts shall be subject to change by reason of changes in the family income or composition, as determined by the LHA, effective as of the date stated in a notification of such change by the LHA to the Lessee and Lessor.

“b. The Lessor shall provide the following services (including security) and maintenance:

(Here specify all services to be provided by the Lessor, which shall include all services customarily supplied to tenants of this type of housing in the locality. In preparing this list, provisions contained in form HUD 52505A, Guide for Lease Provisions for Maintenance and Security Services, shall be included except to the extent modifications are approved by the LHA.]

"c. The Lessor shall not evict the Lessee unless the Lessor complies with the requirements of local law, if any, and of this provision. The Lessor shall give the Lessee a written notice of the proposed eviction, stating the grounds and advising the Lessee that he has 10 days (or such greater number, if any, that may be required by local law) within which to respond to the Lessor. Because the Lessor must obtain the LHA's authorization for an eviction, a copy of the notice shall be furnished simultaneously to the LHA, and the notice shall also state that the Lessee may, within the same time period, present his objections to the LHA in writing or in person. The LHA shall forthwith examine the grounds for eviction and shall authorize the eviction unless it finds the grounds to be insufficient under the Lease. The LHA shall notify the Lessor and the Lessee of its determination within 20 days of the date of receipt of the notice by the Lessee whether or not the Lessee has presented objections to the LHA.

“d. The Lessor shall not discriminate against the Lessee in the provision of services, or in any other manner, on the grounds of race, color, creed, religion, sex, or national origin.

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"e. This Lease has been signed by the SECTION 23 HOUSING ASSISTANCE PAYMENTS parties on the condition that the LHA will

PROGRAM EXISTING HOUSING promptly execute a Housing Assistance Pay

HOUSING ASSISTANCE PAYMENTS CONTRACT ments Contract with the Lessor. Accordingly,

PART II this Lease shall not become effective unless the LHA has executed such Contract by the 2.1 Nondiscrimination in housing. first day of occupancy specified in the Lease. Neither the Owner nor the LHA shall, in the "Lessor Lesseo

selection or approval of Families, in the proBy Date

vision of services, or in any other manner, Date

discriminate against any person on the 1.7. Relocation certification. a. The Owner grounds of race, color, creed, religion, sex, or hereby certifies that the dwelling unit was national origin. No person shall be autovacant on the date that he executed the matically excluded from participation in or Request for Lease Approval with the Family. be denied the benefits of the Housing AssistIf the unit was not vacant on that date, ance Payments Program because of memberthe Owner hereby certifies that it was or ship in a class such as unmarried mothers, will be vacated (check applicable box): recipients of public assistance, etc.

as a result of voluntary decision of oc- b. The Owner shall comply with all recupant,

quirements imposed by Title VIII of the Civil as a result of action by Owner for cause, Rights Act of 1968, Public Law 90-284, 82

Stat. 73 and any rules and regulations purfor reasons clearly unrelated to leasing suant thereto.

of the unit by the Family under the c. The Owner shall comply with all reHousing Assistance Payments Program, quirements imposed by Title VI of the Civil and the Owner further certifies that the Rights Act of 1964, Public Law 88–352, 78 specific circumstances were as follows: Stat. 241; the regulations of the Department

of Housing and Urban Development issued This certification is made subject to pen- thereunder, 24 CFR, Subtitle A, Part 1, Secalty under 18 U.S.C. 1001, which provides, tion 1.1, et seq.; the requirements of said among other things, that whoever knowingly Department pursuant to said regulations; or willfully makes or uses a document or and Executive Order 11063 to the end that, writing containing any false, fictitious, or in accordance with that Act, the regulations fraudulent statement or entry, in any matter and requirements of said Department therewithin the jurisdiction of any department under, and said Executive Order, no person in or agency of the United States, shall be fined the United States shall, on the ground of not more than $10,000 or imprisoned for not race, color, creed, religion or national origin, more than five years, or both.

be excluded from participation in, or be b. The Government has determined that denied the benefits of, the Housing Assistsatisfactory commitments have been made ance Payments Program, or be otherwise subfor the funding of relocation costs pursuant jected to discrimination. This provision is to the Uniform Relocation Assistance Real included pursuant to the regulations of the Property Acquisition Policies Act of 1970, as Department of Housing and Urban Developfollows:

ment, 24 CFR, Subtitle A, Part 1, Section 1.1, c. If paragraph b is inapplicable, the et seq.; issued under Title "I of the said Civil Owner agrees to hold harmless and to indem- Rights Act of 1964, and the requirements of nify the LHA for any cost incurred under said Department pursuant to said regulasaid Act in connection with vacation of said tions; and the obligation of the Owner to units, and the Owner further agrees that comply therewith inures to benefit of the the LHA shall have the right to be reim- Government, the said Department, and the bursed for any such costs by withholding LHA any of which shall be entitled to invoke from housing assistance payments payable

any remedies available by law to redress any to the Owner.

breach thereof or to compel compliance 1.8. Entire Agreement. This Contract, in

therewith by the Owner. cluding Part II hereof, contains the entire

2.2. Cooperation in equal opportunity comagreement between the parties hereto, and

pliance reviews. The LHA and the Owner neither party is bound by any representa

shall cooperate with the Government in the

conducting of compliance reviews and comtions or agreements of any kind except as

plaint investigations pursuant to all apcontained herein. No changes in this con- plicable civil rights statutes, Executive Ortract shall be made except in writing signed ders, and rules and regulations pursuant by both the Owner and the LHA.

thereto. 1.9. Legal interest. The Owner warrants 2.3. Annual Contributions Contract that he has the legal right to execute this

a. The LHA has entered into an Annual Contract and to lease the dwelling unit

Contributions Contract dated covered by this Contract.

with the Government, with respect to Project Local Housing Authority

No.

("ACC"), under which the Gov

ernment will provide financial assistance to By:

the LHA pursuant to Section 23 of the United Owner:

States Housing Act of 1937, for the purpose of By:

making housing assistance payments, which

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