Bridgeport, CT · Fairfield County
Renters’ Rebate Landlord Rent Verification Form
This form lets a Bridgeport landlord verify a tenant’s monthly rent payments during 2025 for the City of Bridgeport Department of Health & Social Services.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The landlord lists the tenant, rental property address, and rent amounts paid for each month of 2025, then signs the form before a notary. The form is for landlords to complete as rent verification for the renters’ rebate process; the PDF identifies the City of Bridgeport Department of Health & Social Services and says it is to be completed by the landlord.
Who needs it
A landlord whose tenant needs verification of rent paid at a Bridgeport property during 2025 should complete and sign this form.
Why it needs a notary
The form has a subscribed-and-sworn jurat; the landlord signs before the notary, who completes the date, signature, and commission-expiration fields.
How to get this notarized
- 1
Download the Form
Get the Renters’ Rebate Landlord Rent Verification Form from the City of Bridgeport.
- 2
Fill In the Rent Details
Enter the tenant and rental property information and the amounts paid for each month of 2025.
- 3
Book an Online Notary
Arrange an online notarization with a commissioned online notary.
- 4
Sign on Video
As the landlord, sign the form during the video session so the notary can complete the jurat.
- 5
Submit to the City
Send the completed form as directed by the City of Bridgeport Department of Health & Social Services.
Preview the form
The blank PDF straight from Bridgeport. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete and submit this rent verification form?
- The landlord enters the tenant and property details, reports rent amounts by month for 2025, and signs before a notary. Submit the completed form as directed by the City of Bridgeport Department of Health & Social Services.
- Do I need to sign this form before a notary?
- Yes. The form includes a subscribed-and-sworn jurat, so the landlord signs before the notary, who completes the notarial section.
- Can I use a commissioned online notary for this form?
- Connecticut authorizes remote online notarization by its own notaries under Public Act 23-28, effective October 1, 2023. If unsure whether the City will accept an online-notarized form, confirm with the town clerk if unsure.