DALLAS COUNTYDEPARTMENT OF HEALTH AND HUMAN SERVICESHOUSING DIVISION

~EQUAL HOUSING

OPPORTUNITY

ZACHARY S. THOMPSON

DIRECTOR

DALLAS COUNTY HOUSING AGENCY LANDLORD REQUEST FORM

DDD

Hold (Do not advertise at this time)Add Property to Vacancy listDelete Property from Vacancy List

Property: D Condo D DuplexName of Complex:Address:City: Zip Code:Monthly Rent: $ Deposit: $Date property will be ready for occupancy:Owner Name: -Owners Address:Contact Name: -Contact Ph. No.: (E-mail Address:

Have you attended a Dallas County Housing Choice Voucher Landlord Briefing Meeting?DYES D NO

If YES, the date attended:

D House D Apartment D Town Home D Mobile HomeYear Constructed:

No. of Bedrooms/Bathrooms: /

Leasing Name:City: St/Zip:

1 Fax Number: ( 1

taxes, fines, or fees to Dallas County? DYES DNO

Are utility services included? YES NO

Are the range and stove provided? YES NO

Is the refrigerator provided?

Is the unit wheelchair accessible?

YES NO

YES NO

YES NOAre pets allowed? YES NO Does property meet City Code Regulations?

Housing Agency, 2377 North Stemmons Freeway, Suite 700, Ib-16, Dallas, TX 75207-2710

. DCHA is one of many avenues available to advertise your property. Other available sources are TheDallasMorningNews, the Greensheet,etc.

Thehousinglist is onlyavailableto DCHA's Section 8 clients..

. Please inform our agency when your property has been leased. If you would like delete your propertyfrom our available housing list, check the delete box and note the property address.

Additionalpropertiesmay be listedon the attachedpage... For additional inquiries please contact Deanna Gilmore, Landlord Coordinator at 214-819-6090.

2377 North Stemmons Freeway, Suite 700, LB-16Dallas, Texas 75207-2710

Office (214) 819-1871FAX (214) 819-2828

REV (C) 4/2010

1. Name of Complex:Address:City: .Monthly Rent: $

ADDITIONAL UNITSCondo Duplex HouseApt. Town Home Mobile Home

No. of Bedrooms/Bathrooms: /Year Constructed:

Are utility services included?

Are the range and stove provided?

Are pets allowed?

Zip Code:Deposit: $

YES NO

YES NO

Is the refrigerator provided?

Is the unit wheelchair accessible?

YES NO

YES NO

YES NO

2. Name of Complex:Address:City: -Monthly Rent: $

YES NO Does property meet City Code Regulations?

Condo Duplex HouseApt. Town Home Mobile Home

No. of Bedrooms/Bathrooms: /Year Constructed:

Zip Code:Deposit: $

Are utility services included?

Are the range and stove provided?

Are pets allowed?

YES NO Is the refrigerator provided?

YES NO Is the unit wheelchair accessible?

YES NO Does property meet City Code Regulations?

YES NO

YES NO

YES NO

3. Name of Complex:Address:City: -Monthly Rent: $

Condo Duplex HouseApt. Town Home Mobile Home

No. of Bedrooms/Bathrooms: /Year Constructed:

Zip Code:Deposit: $

Are utility services included?

Are the range and stove provided?

Are pets allowed?

YES NO Is the refrigerator provided?

YES NO Is the unit wheelchair accessible?

YES NO Does property meet City Code Regulations?

YES NO

YES NO

YES NO

4. Name of Complex:Address:City: -Monthly Rent: $

Condo Duplex HouseApt. Town Home Mobile Home

No. of Bedrooms/Bathrooms: /Year Constructed:

Zip Code:Deposit: $

Are utility services included?

Are the range and stove provided?

Are pets allowed?

YES NO Is the refrigerator provided?

YES NO Is the unit wheelchair accessible?

YES NO Does property meet City Code Regulations?

YES NO

YES NO

YES NO

5. Name of Complex:Address:City: -Monthly Rent: $

Condo Duplex HouseApt. Town Home Mobile Home

No. of BedroomslBathrooms: /Year Constructed:

Zip Code:Deposit: $

Are utility services included?

Are the range and stove provided?

Are pets allowed?

YES NO Is the refrigerator provided?

YES NO Is the unit wheelchair accessible?

YES NO Does property meet City Code Regulations?

YES NO

YES NO

YES NO